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intestinal rehabilitation

Gastroenterology

Managing Short Bowel Syndrome & Intestinal Failure

Sirine Belaid, M.D., created a new curriculum to teach residents how to manage the complexities of SBS and IF in pediatric patients.

By Conan Gasque

When Sirine Belaid, M.D., was a fellow at University of Pittsburgh Medical Center, she noticed a problem with the management of patients with short bowel syndrome (SBS) and intestinal failure (IF)—residents had little confidence in caring for patients with these conditions. This was understandable—these patients have highly complex needs, and residents, being new in the profession, are still learning. Plus, they didn’t have the proper training. “I didn’t blame them because at that point in time there was no curriculum in place basically to help in the care of these patients,” said Belaid, who’s now an attending gastroenterologist at Children’s of Alabama and an assistant professor at the University of Alabama at Birmingham (UAB). She decided to address the problem by creating a curriculum herself.

“I wanted them to ease their insecurities and their fear and make them confident and comfortable in taking care of these kids,” she said.

Belaid created and implemented the curriculum during her fellowship in Pittsburgh before joining Children’s and UAB in August 2025. Since arriving, she has begun to implement the program for fellows in Birmingham and aims to do the same for residents. Her study on its effectiveness was published in early 2026.

When she started the project, Belaid aimed to create a curriculum that addressed complexities associated with SBS and IF. Patients with these conditions, she said, present with three key challenges: unique anatomy, required devices, and potential complications.

IF is often caused by SBS, which can occur in children in two ways—either they’re born with it or they develop it following surgical complications. The condition leaves them with a shortened small intestine or other anatomical changes that affect their ability to absorb nutrients. As a result, they’re dependent on parenteral nutrition through a central line that provides lipids, carbohydrates, and all the other nutrients they need to grow and, in some cases, survive. Patients often have gastrostomy tubes, jejunostomy tubes or stomas. These enteral tubes, central lines and the patients’ anatomical differences can predispose them to complications, such as ostomy prolapse or necrosis, gastrojejunostomy tube dislodgement, line dislodgment, or line infection.

For untrained residents and other providers, these complexities can be daunting. In some cases, their lack of understanding can lead to misdiagnosis. “I’ve had so many kids who see primary care providers with fever, and they have their central line, and [the providers] just say, ‘Well, it could just be a virus. Just go home,’” Belaid said. But if the child is actually suffering from a central line infection, that’s a mistake that could prove fatal, she added.

Historically, patients with IF rarely survived into adulthood, and many did not survive childhood. But thanks to the emergence of better treatment options in recent years, more patients with SBS and IF are surviving and thriving. “We are seeing more and more of these kids—they are becoming a growing population,” Belaid said. “And so we need to have our residents ready to manage the kids, especially when they come in the [emergency department].”

For Belaid, this underscored the urgency for developing a curriculum. And the job was the perfect marriage of her two passions: intestinal rehabilitation and education. So when she discovered the problem during her fellowship, she began doing research to see how she could address it.

Belaid started by asking the residents to fill out a needs assessment survey to determine in which areas they needed the most help. It revealed their confidence level in certain tasks along with their preferred education materials. Using this data, Belaid created a five-month curriculum divided into three parts:

  • In-person lecture – This lasted 45-50 minutes and summarized the most common topics related to intestinal rehabilitation while allowing for interactive discussions.
  • Total parenteral nutrition (TPN) workshops – Each week, Belaid presented two cases designed to help residents understand various parts of the TPN process, with the residents performing these tasks more independently as they progressed through the curriculum.
  • Quick-reference survival guide – Belaid created a guide residents could keep in their pockets or save digitally that summarizes key points and how to handle emergencies.

After residents completed the curriculum, Belaid asked them to fill out another survey to determine their progress. It showed that the curriculum significantly improved resident confidence across nearly every assessed skill, and it increased appreciation for the educational value of caring for patients with SBS and IF. Residents also gave excellent feedback on the curriculum.

Now, Belaid is working to replicate the process at Children’s and UAB. In the meantime, she’s sharing her successful strategies with other gastroenterologists across the country. She has presented her research at the North American Society for Pediatric Gastroenterology, Hepatology & Nutrition (NASPGHAN) Annual Meeting, the American Society for Parenteral and Enteral Nutrition (ASPEN) conference, and other events. “I’m really hoping to disseminate this curriculum nationally,” she said. “That’s my goal.” She believes her approach can be effective for other specialties, as well.

In the process, she hopes her work will encourage more residents to pursue a career in intestinal rehabilitation, just as she was inspired to do during her own residency when she was first exposed to the complex needs of patients with IF. She says she discovered the profound satisfaction of helping children wean off parenteral nutrition and eventually have their central lines removed, allowing them to swim, run, and enjoy the everyday experiences of childhood. “Everything began during my residency at the University of Iowa Health Care, where my mentor, Dr. Riad Rahhal, first sparked my interest in intestinal rehabilitation. His guidance and mentorship shaped my passion for the field and ultimately influenced my career path, for which I am deeply grateful,” she said. “I just fell in love with it and with the patients and their parents. And seeing the joy on their face when their kid is finally without a line, without anything—it’s pure joy.”

August 6, 2026 by
Gastroenterology

Expanding to Improve Patient Care

To improve patient care, the Children’s Division of Gastroenterology, Hepatology and Nutrition has added six new faculty members.

When Sandeep Gupta, M.D., arrived at Children’s of Alabama and the University of Alabama at Birmingham (UAB) as chief of the Division of Pediatric Gastroenterology, Hepatology and Nutrition in 2023, he immediately recognized the need for expansion. So, not long after his arrival, he embarked on the mission to grow his team. Within the last year-and-a-half, he has welcomed six new faculty, and they’re already making a difference in the way the division serves its patients.

For Gupta, that was the objective—providing better patient care. It’s a large undertaking considering Children’s massive catchment area—the entire state of Alabama along with surrounding states. “Every disease state we have is in the hundreds,” he said. “And the doctors we had in those areas were just one or two.”

Intestinal rehabilitation, or ‘short gut,’ is a good example. It’s a complex issue affecting more than 160 of the team’s patients. But previously, only one doctor was available to serve them. With inflammatory bowel disease (IBD), the team had two doctors for more than 400 patients. The math was similar for patients with liver issues. “There was such a need to bring [new hires] in to just serve what we have,” Gupta said. “We were simply to trying keep our heads above water.”

To address these issues, Gupta began the process of expanding the division in September 2024, making all of the new hires over the course of the next year. In the case of IBD, the expansion was transformative. That group now has two new clinicians, Rahmath Althaf, D.O., and Maggie Vickers, M.D., and a basic scientist, Babajide Ojo, Ph.D. “Now, what we have is basically a team that goes from bench to bedside,” Gupta said. “We are starting studies where we are collecting samples from patients in the clinic, and then [Ojo] is processing these in the lab to do the studies. And with the discoveries he will make, we can then bring the knowledge back to the bedside.”

It’s an “ecosystem” that Gupta believes has not existed in gastroenterology at Children’s. The team has study coordinators and is part of national consortia. “So basically, we are creating a self-dependent and interdependent team of itself that can grow on its own,” he said.

Gupta aspires to create the same setup for intestinal rehabilitation. In the meantime, care is already improving. With Sirine Belaid, M.D., joining the team, the division now has two doctors to treat these patients, allowing them to see inpatients twice each week instead of once. “So now we are able to better serve the people more intentionally, more mindfully,” Gupta said.

Gupta also added liver doctors in David Willcutts, M.D., and Stephanie Saaybi, M.D., who “will helps us grow the liver team further,” he said.

Perhaps the most salient sign of the team’s success so far is this: patients who once had no choice but to go hundreds of miles away for treatment are now able to stay in Alabama for their care. “They are now being sent back to us by the doctors, who are saying, ‘Hey, UAB has a great program—go back there, you don’t need to come see us anymore,’” Gupta said. “So that has been very fulfilling that people are recognizing we are ace-ing our game here.”

With changes of this magnitude, Gupta believes the division can start to move from excellence to eminence, which was another of his goals when he first arrived.

New hires since September 2024

Rahmath Althaf, D.O., an assistant professor, earned her medical degree from the Touro College of Osteopathic Medicine. She completed her residency in general pediatrics at the Medical College of Georgia and her pediatric gastroenterology fellowship at UAB. Her research and clinical interests include IBD and intestinal ultrasound.

Sirine Belaid, M.D., an assistant professor, earned her medical degree from the University of Pittsburgh. She completed her residency in general pediatrics at the University of Iowa Stead Family’s Children’s Hospital and her pediatric gastroenterology fellowship at the University of Pittsburgh Medical Center.

Babajide Ojo, Ph.D., an assistant professor, earned his doctoral degree in nutritional sciences from Oklahoma State University. He completed his postdoctoral research at Stanford University School of Medicine. He received the NIH MOSAIC K99/R00 award in 2023. His research interests include using patient-derived intestinal organoids and murine models to determine how the environment (dietary components, therapies) shapes epithelial metabolism and differentiation in intestinal health and inflammatory bowel diseases.

Stephanie Saaybi, M.D., an assistant professor, earned her medical degree from the American University of Beirut in Lebanon. She completed her residency in general pediatrics at MedStar Georgetown University and her pediatric gastroenterology fellowship at UAB. She completed an additional fellowship in pediatric advanced hepatology and liver transplant at Northwestern University.

Maggie Vickers, M.D., an assistant professor, earned her medical degree from UAB. She completed her residency in general pediatrics and her pediatric gastroenterology fellowship at the Le Bonheur Children’s Hospital, St Jude Children’s Research Hospital and Regional One Health. Her clinical interests include general gastroenterology, nutrition and inflammatory bowel disease.

David Willcutts, M.D., an assistant professor, earned his medical degree from the University of Texas Southwestern Medical Center, where he also completed his residency in pediatrics and his pediatric gastroenterology fellowship. He completed an additional fellowship in pediatric advanced hepatology and liver transplant at the University of Colorado.

February 17, 2026 by