Nutrition and Fluid Optimization for Patients With Short Bowel Syndrome

East Carolina University, Greenville, North Carolina.
Journal of Parenteral and Enteral Nutrition (Impact Factor: 3.15). 12/2012; 37(2). DOI: 10.1177/0148607112469818
Source: PubMed


Short bowel syndrome (SBS) is characterized by nutrient malabsorption and occurs following surgical resection, congenital defect, or disease of the bowel. The severity of SBS depends on the length and anatomy of the bowel resected and the health of the remaining tissue. During the 2 years following resection, the remnant bowel undergoes an adaptation process that increases its absorptive capacity. Oral diet and enteral nutrition (EN) enhance intestinal adaptation; although patients require parenteral nutrition (PN) and/or intravenous (IV) fluids in the immediate postresection period, diet and EN should be reintroduced as soon as possible. The SBS diet should include complex carbohydrates; simple sugars should be avoided. Optimal fat intake varies based on patient anatomy; patients with end-jejunostomies can tolerate a higher proportion of calories from dietary fat than patients with a remnant colon. Patients with SBS are prone to deficiencies in vitamins, minerals, and essential fatty acids; serum levels should be periodically monitored and supplements provided as needed. Prebiotic or probiotic therapy may be beneficial for patients with SBS, although further research is needed to determine optimal protocols. Patients with SBS, particularly those without a colon, are at high risk of dehydration; oral rehydration solutions sipped throughout the day can help maintain hydration. One of the primary goals of SBS therapy is to reduce or eliminate dependence on PN/IV; optimization of EN and hydration substantially increases the probability of successful PN/IV weaning.

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Available from: Laura E Matarese, Nov 10, 2014
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    • "Les fibres hydrosolubles (pectines, gommes, mucilages ) retiennent de l'eau, exercent un fort pouvoir gélifiant, augmentent la viscosité du chyme, contribuent à ralentir le transit et majorent le temps de contact des nutriments avec la surface d'absorption. Dans le cas d'une entérostomie temporaire , l'apport de fibres alimentaires est plutôt bénéfique que délétère [2] ; • l'item c est faux : les laitages sont sources de calcium, de protéines et d'énergie. Le lait en grande quantité est généralement déconseillé, du fait d'une accélération de la vidange gastrique qui entraine une saturation plus rapide de l'activité lactasique résiduelle, et du fait de la réduction des capacités d'absorption du lactose. "
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    ABSTRACT: During intra-abdominal surgery and whatever the reason of this operation, it might be necessary to make a temporary double enterostomy. Small bowel is divided in a duodeno-stomial part, which can be used for oral or enteral nutrition, and an excluded efferent part. The dehydration and undernutrition risks result from the stomy outflow. In the described clinical case, intestinal losses compensation requires the combination of dietetic measures, and enteral and parenteral nutrition. Enteroclysis and chyme reinfusion through the excluded intestinal part are also helpful.
    Full-text · Article · Sep 2014 · Nutrition Clinique et Métabolisme
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    • "Although patients require parenteral nutrition (PN) and/or intravenous (IV) fluids in the immediate post-resection period, oral diet and enteral nutrition (EN) should be introduced as soon as possible to enhance intestinal adaptation [4]. Optimizing hydration and enteral nutrition (EN) through individualized dietary and pharmaceutical management of SBS can reduce or eliminate the need for PN/IV and improve the nutritional status of this patient population [4]. "
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    ABSTRACT: Short Bowel Syndrome (SBS) is a condition that causes malabsorption and nutrient deficiency because a large section of the small intestine is missing or has been surgically removed. SBS may develop congenitally or from gastroenterectomy, which often change the motility, digestive, and/or absorptive functions of the small bowel. The surgical procedure for SBS and the condition itself have high mortality rates and often lead to a range of complications associated with long-term parenteral nutrition (PN). Therefore, careful management and appropriate nutrition intervention are needed to prevent complications and to help maintain the physiologic integrity of the remaining intestinal functions. Initial postoperative care should provide adequate hydration, electrolyte support and total parenteral nutrition (TPN) to prevent fatal dehydration. Simultaneously, enteral nutrition should be gradually introduced, with the final goal of using only enteral nutrition support and/or oral intake and eliminating TPN from the diet. A patient should be considered for discharge when macro and micronutrients can be adequately supplied through enteral nutrition support or oral diet. Currently, there is more research on pediatric patients with SBS than on adult patient population. A 35-year-old man with no notable medical history was hospitalized and underwent a surgery for acute appendicitis at a local hospital. He was re-operated on the 8th day after the initial surgery due to complications and was under observation when he suddenly complained of severe abdominal pain and high fever. He was immediately transferred to a tertiary hospital where the medical team discovered free air in the abdomen. He was subsequently diagnosed with panperitonitis and underwent an emergency reoperation to explore the abdomen. Although the patient was expected to be at a high risk of malnutrition due to short bowel syndrome resulting from multiple surgeries, through intensive care under close cooperation between the medical and nutrition support team, his nutritional status improved significantly through continuous central and peripheral parenteral nutrition, enteral nutrition, and oral intake. The purpose of this paper is to report the process of the patient's recovery.
    Full-text · Article · Jul 2013
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    ABSTRACT: Short bowel syndrome (SBS) occurs as a result of intestinal resection, and in many patients is associated with complications, such as diarrhea, dehydration, weight loss, and nutrition deficiencies. Many individuals with SBS develop intestinal failure and require parenteral nutrition (PN) and/or intravenous (IV) fluids (PN/IV). Although PN is essential for survival, some patients with SBS who require long-term PN experience significant complications that contribute to morbidity and mortality. Consequently, therapies that decrease reliance on PN are of considerable importance. Intestinal adaptation, which results in morphologic and functional changes that increase performance of the remnant bowel, occurs spontaneously after intestinal resection. These effects can be enhanced with nutrition and pharmaceutical approaches. For example, oral or tube-fed nutrients stimulate growth and adaptation of intestinal tissues. In addition, prebiotics support growth of beneficial intestinal microbiota that produce short-chain fatty acids, which have been shown in preclinical studies to enhance intestinal structure and function. Finally, glucagon-like peptide 2 (GLP-2) is an endogenous peptide that promotes intestinal rehabilitation and improves intestinal absorption. Teduglutide, a recombinant human GLP-2 analog, has recently been approved in the United States for the treatment of adults with SBS who are dependent on PN. In pharmacodynamic and clinical studies, teduglutide has been shown to promote changes in intestinal structure, such as increases in villus height and crypt depth, and to improve intestinal absorption, as indicated by reduced PN/IV dependence. This article presents a brief overview of SBS, including effects on survival and quality of life and current treatment options.
    Full-text · Article · Nov 2013 · Journal of Parenteral and Enteral Nutrition
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