Do patients with short-bowel syndrome need a lactose-free diet?

Marteau, Philippe; Messing, Bernard; Arrigoni, Eviano; Briet, F.; Flourié, Bernard; Morin, Marie‐Christine; Rambaud, Jean–Claude

doi:10.1016/s0899-9007(97)90872-8

Cited by 75 publications

(27 citation statements)

References 17 publications

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“…The notion of a "functional workload" was reinforced when it was shown that disaccharides are more trophic than monosaccharides, which, through their greater osmolality, contribute to diarrhea (Weser et al 1986). In a study of adult patients with SBS, a formula providing 20 g/day of lactose was well tolerated (Marteau et al 1997). The addition of a small amount of lactose has been recommended for infants because it promotes the production of SCFAs .…”

Section: Chos and Scfasmentioning

confidence: 99%

Short bowel syndrome in infants: the critical role of luminal nutrients in a management program

Roy

Groleau

Bouthillier

et al. 2014

Appl. Physiol. Nutr. Metab.

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Short bowel syndrome develops when the remnant mass of functioning enterocytes following massive resections cannot support growth or maintain fluid-electrolyte balance and requires parenteral nutrition. Resection itself stimulates the intestine's inherent ability to adapt morphologically and functionally. The capacity to change is very much related to the high turnover rate of enterocytes and is mediated by several signals; these signals are mediated in large part by enteral nutrition. Early initiation of enteral feeding, close clinical monitoring, and ongoing assessment of intestinal adaptation are key to the prevention of irreversible intestinal failure. The length of the functional small bowel remnant is the most important variable affecting outcome. The major objective of intestinal rehabilitation programs is to achieve early oral nutritional autonomy while maintaining normal growth and nutrition status and minimizing total parenteral nutrition related comorbidities such as chronic progressive liver disease. Remarkable progress has been made in terms of survivability and quality of life, especially in the context of coordinated multidisciplinary programs, but much work remains to be done.

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Section: Chos and Scfasmentioning

confidence: 99%

Short bowel syndrome in infants: the critical role of luminal nutrients in a management program

Roy

Groleau

Bouthillier

et al. 2014

Appl. Physiol. Nutr. Metab.

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“…In the absence of signifi cant jejunal resection or documented lactase defi ciency, lactose -containing foods should not be limited, as they are an important source of dietary calcium [23,24] .…”

Section: Medical Managementmentioning

confidence: 99%

Short Bowel Syndrome

Gastroenterology

and

2010

Practical Gastroenterology and Hepatology: Small and Large Intestine and Pancreas

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Short bowel syndrome (SBS) is defi ned as malabsorption due to insuffi cient intestinal surface area, with an inability to sustain an adequate nutritional, electrolyte, or hydration status in the absence of specialized nutritional support. In adults, it is typically the consequence of extensive bowel resection, with loss of absorptive surface area. Over time, the intestine can adapt in order to ensure more effi cient absorption. Overall, the most important aspects of the management of patients with SBS are to provide adequate nutrition, and to provide suffi cient fl uid and electrolytes to prevent dehydration. Anastomosis of the residual small bowel to the colon is the most important surgical procedure, enhancing the ability of the colon to become an energy -absorptive organ, and allowing for decreased dependence on total parenteral nutrition (TPN). The prognosis for patients with SBS depends on the patient ' s age, the type and extent of bowel resection, along with the underlying disease and health of residual intestine.function is better described in terms of energy absorption and loss, rather than the length of residual intestine, and some patients with SBS will not have suffi cient loss of functional capacity so as to develop intestinal failure [1] . The patients at highest risk generally have a duodenostomy or a jejunoileal anastamosis with less than 35 cm of residual intestine, a jejunocolic or ileocolic anastamosis with less than 60 cm of residual intestine, or an end jejunostomy with less than 115 cm of residual intestine [2] .The incidence of SBS is diffi cult to assess given the lack of a national registry and prospective studies. However, based on multinational European data, the incidence and prevalence of severe SBS, necessitating long -term total parenteral nutrition (TPN), is estimated to be between 2 and 4 cases per 1 million persons per year [1] . These numbers, however, do not refl ect patients who do not require TPN, and approximately 50 -70% can successfully be weaned off TPN [3] . PathophysiologyThe major consequence of extensive bowel resection is loss of absorptive surface area, which results in malabsorption of nutrients, electrolytes, and water [4] . The degree of malabsorption is determined by the length and 262 Case A 57 -year -old man with atrial fi brillation develops severe abdominal pain. He is diagnosed with an acute abdomen. He undergoes an emergent exploratory laparotomy, where an embolism is found in the superior mesenteric artery, and 200 cm of gangrenous small bowel is resected, and an ileostomy is created. Two days later, the patient undergoes a second -look surgery, and a jejunocolic anastamosis is created. TPN is initiated postoperatively, and, once bowel function returns, enteral nutrition is initiated with a goal of gradually decreasing the requirement for TPN. Defi nition and EpidemiologyIntestinal failure is defi ned as an inability to sustain an adequate nutritional, electrolyte, or hydration status, in the absence of specialized nutritional support, and is often seen ...

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“…However, lactose may be restricted from diet in the immediate postoperative period, although the intestine recovers from shock; later on, 20 mg/d of lactose may be added in the diet with no more than 4 g/d as milk. 92 The diet should provide a high-energy intake from both carbohydrates and fat. 13 However, there are certain problems related to diet.…”

Section: Adaptation Phasementioning

confidence: 99%

Short Bowel Syndrome: Current Medical and Surgical Trends

Misiakos

Macheras

Kapetanakis

et al. 2007

Journal of Clinical Gastroenterology

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Short bowel syndrome is a chronic malabsorptive state usually resulting from extensive small bowel resections. A combination of diarrhea, nutrient malabsorption, dysmotility, and bowel dilatation may constitute the clinical symptomatology of this syndrome. The remaining bowel undergoes a process called adaptation, which may replace lost intestinal function. Chronic complications include nutrient, electrolyte, and vitamin deficiencies. Therapy depends largely on the administration of various factors stimulating intestinal adaptation of the remaining bowel. If the patient despite medical therapy fails to return to oral diet alone, then long-term parenteral nutrition is required. However, long-term parenteral nutrition may gradually induce cholestatic liver disease. Surgical methods may be required for treatment including intestinal transplantation, as a last resort for the treatment of end-stage intestinal failure. The goal of this review is to analyze the clinical spectrum and pathophysiologic aspects of the syndrome, the process of intestinal adaptation, and to outline the medical and surgical methods currently used to treat this complicated group of patients.

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Do patients with short-bowel syndrome need a lactose-free diet?

Cited by 75 publications

References 17 publications

Short bowel syndrome in infants: the critical role of luminal nutrients in a management program

Short bowel syndrome in infants: the critical role of luminal nutrients in a management program

Short Bowel Syndrome

Short Bowel Syndrome: Current Medical and Surgical Trends

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