Short Bowel Syndrome: Clinical Guidelines for Nutrition Management

Abstract

Intestinal failure is a condition in which inadequate digestion or absorption of fluid, electrolytes, and nutrients leads to dehydration or malnutrition. The most common cause of intestinal failure is short bowel syndrome (SBS) defined as <200 cm of functional small intestine. SBS may result from congenital abnormalities or from surgical resection. For the past 3 decades, patients with severe SBS were managed with home parenteral nutrition (HPN). With the emergence of new therapies, the clinician now has multiple options to treat these patients. These include intestinal rehabilitation regimens whereby patients are treated with specialized oral diets, soluble fiber, oral rehydration solutions (ORS), and trophic factors to enhance absorption. There are also a variety of surgical techniques available to preserve intestinal length. Small bowel and multivisceral transplantation has evolved during the last decade to be a valid therapeutic option for those patients who cannot be rehabilitated or who fail HPN. These are interrelated services designed to offer the patient the best therapeutic options to meet their individual needs. This article reviews the principles associated with the nutrition management of this very complex and diverse group of patients.

Oral rehydration solution normalizes plasma renin and aldosterone levels in patients with ulcerative colitis after proctocolectomy

“…ENaC mediates Na+ entry through the apical membrane, whereas SGLT-1 facilitates co-transport across the luminal membrane. Glucose in the enterocyte is transported into the blood by glucose transporter type 2 (GLUT2) through the basolateral membrane [17][18][19][20] . These mechanisms are believed to contribute to the improvement of post-colectomy diarrhea.…”

Short Bowel Syndrome: clinical management

“…Il recupero delle funzioni intestinali da parte dell'intestino residuo può essere facilitato dalle modificazioni della dieta, dalla somministrazione di farmaci, nutrienti e ormoni con effetto specifico, dagli interventi chirurgici mirati ad aumentare la superficie di assorbimento e/o il tempo di contatto nutrienti-mucosa intestinale e infine dal ricorso al trapianto di intestino. La dieta deve rispettare alcune regole di base, le quali vanno adattate alle esigenze del singolo paziente attraverso una stretta attività di counseling da parte di una dietista esperta (Tabella II) [12,17]. La loperamide, gli inibitori della pompa protonica, l' octreotide, la colestiramina e gli antibiotici sono utilizzati per ridurre le perdite e rallentare il transito intestinale [12,17].…”

“…La dieta deve rispettare alcune regole di base, le quali vanno adattate alle esigenze del singolo paziente attraverso una stretta attività di counseling da parte di una dietista esperta (Tabella II) [12,17]. La loperamide, gli inibitori della pompa protonica, l' octreotide, la colestiramina e gli antibiotici sono utilizzati per ridurre le perdite e rallentare il transito intestinale [12,17]. La glutammina, aminoacido specifico per gli enterociti, le fibre solubili dalle quali dopo fermentazione intestinale originano gli acidi grassi a catena breve, specifici per i colociti, l' ormone della crescita e il glucagonlike peptide 2 (non ancora in commercio) possono favorire l'adattamento.…”

Effects of a supplementary diet with specially processed cereals in patients with short bowel syndrome

“…An attractive physiological approach would be a supplementary diet targeting increased viscosity of the intestinal content. Generally, this may affect the transit time, and thus promote the nutrient uptake [17][18][19][20]. In this respect, antisecretory factor (AF), a 41 kDa protein found in many human tissues, is of special interest [21].…”