AGA technical review on short bowel syndrome and intestinal transplantation

Nutrient intake from habitual oral diet in patients with severe short bowel syndrome living in the southeastern United States

“…We found that a surprisingly low percentage of our patients were taking oral micronutrient supplements, even on non-PN infusion days. Furthermore, conventional PN may provide inadequate amounts of certain nutrients for the needs of some individuals, such as essential fatty acids (39), vitamin E (40), vitamin D or calcium (2,41). Patients with SBS require high doses of oral calcium, not only for total body function and bone metabolism but also to prevent oxalate absorption and oxalate renal stone formation, and as others and we have observed there is also active secretion of calcium in stools (14,37).…”

“…However, gastrointestinal symptoms, including exacerbation of diarrhea, anal burning associated with diarrhea, bacterial overgrowth and/or intermittent partial small bowel obstruction make it difficult for many patients to consume the enormous amount of calories necessary to maintain body weight without PN. In addition, there is large individual variation in tolerance to oral lactose, hypotonic fluids and individual food groups and specific food items (2,8,38). Because of the great variability in nutrient absorptive function in SBS patients, dietary counseling must be approached individually and with close follow up of intestinal function changes, diet tolerance and response to optimization of antidiarrhea medications.…”

“…In patients with jejuno-or ileostomies high carbohydrate intake, especially simple sugars, worsen stomal effluents, whereas high-fat diets may increase ostomy fat loss but improve total energy absorption (21,25). Sipping of near-isotonic oral re-hydration fluids with a high content of sodium is essential in patients with jejunostomies, whereas patients with colon and ileostomies may tolerate hypotonic solutions as and additional sodium chloride added to food (2,8).…”

“…Dietary modifications typically involve smaller, more frequent feedings, use of oral rehydration solutions and soluble fiber, avoidance of simple sugars, oxalate, and, in some cases, lactose and modification of fat intake and consumption of specific foods based on individual tolerance (2,(6)(7)(8). Based on clinical observations and limited experimental evidence, the type and pattern or oral food/fluid intake can dramatically affect the overall nutritional status and stool output volume of SBS subjects (7)(8).…”

Clinical case and short review of extreme short bowel syndrome: an update 21 years after

“…Patients without functional colon whose remnant small intestinal length is <100 cm, and patients with a functional colon and <60 cm of small intestine remaining will usually be dependent on parenteral nutrition and/or intravenous fluid; ii) jejunal, as opposed to ileal, resections; in fact, the ileum adapts structurally and functionally, whereas the jejunum can adapt only functionally; iii) ileocecal valve sparing; in fact, the valve is an important regulator of intestinal transit speed and a physical barrier to anterograde flow of chyme from the large to small intestine. [8][9][10][11] Our patient did not have any of the above conditions accepted as being favorable to survival: in fact, the infant's residual small intestine was <25 cm (only [page 48] [Italian Journal of Medicine 2016; 10:543] Case Report 11 cm), no segment of the ileum remained, surgery included resection of part of the colon, and, finally, the ileocecal valve was not spared. Therefore the reported case is certainly of great interest in view of the patient's capacity to survive for many years after massive resection of the small intestine, despite several associated negative prognostic factors.…”