Effects of Cimetidine on Jejunostomy Effluents in Patients with Severe Short-Bowel Syndrome

Abstract

The effect of the H2-receptor blocking agent cimetidine on jejunal effluent was examined in eight short-bowel patients with high-output jejunostomies. Stool mass and faecal excretion of sodium and potassium were significantly reduced by intravenous injection of 400 mg cimetidine four times a day. The amount of calcium, magnesium, phosphate, zinc, and fat in jejunostomy effluent did not change significantly. Cimetidine may be considered an antidiarrhoeal drug in extensively small-bowel-resected patients with a jejunostomy and may reduce the need for parenteral saline supply in these patients.

Management of patients with a short bowel

“…The effect of these drugs is as good as octreotide (50 ìg subcutaneously twice daily) in terms of the reduction in stomal volume [38,104] . They do not change the absorption of energy, carbohydrate, lipid, nitrogen and divalent cations [102][103][104][105] and do not reduce jejunostomy output enough to prevent the need for parenteral fluid and electrolyte replacement.…”

“…There is one report of a patient with a jejunostomy for Crohn's disease having gastric irradiation to successfully reduce their stomal output [101] . H 2 antagonists/proton pump inhibitors Cimetidine (400 mg orally or intravenously four times a day) [102,103] , ranitidine (300 mg orally twice daily) [38] and omeprazole (40 mg orally once a day or intravenously twice a day) [104,105] reduce jejunostomy output particularly in net secretors and generally in those with an output exceeding 2 litres daily. Omeprazole is readily absorbed in the duodenum and upper small bowel, but if less than 50 cm jejunum remains it may need to be given intravenously.…”

Clinical problems of a short bowel and their treatment

“…8) in net 'secretors' when absorbed, but had little effect upon the output in net 'absorbers' (Nightingale et al 1!>913). The H2 antagonists cimetidine and ranitidine have a similar effect (Jacobsen et al 1986). …”

Basic Science for the Clinical Gastroenterologist: A Review of the Recent Literature on the Small Bowel (Part 1)

“…Perhaps ;i liberal attitude 1s appropriate toward the fat and fibre content of the Jiet in such individuals. Patients with a high output JCJunostomy may ;ilso benefit from cimeudtne (47). The massive loss of intestine appears to be a contributing factor to the development of hepatic chole~tasis and fibro 1s which occurs in some patients mnintained on prolonged parenteral nutrition ( 48) The role of diet1t1am, in enteral feeding has been acknowledged ( 49).…”