Management of nutritional problems in patients with short bowel syndrome
- Therapy in the acute postsurgical phase is aimed at intravenous fluid and electrolyte restoration. Parenteral nutrition may be required while the remaining gut function is assessed and adaptation takes place.
- Attempts at oral feeding should include frequent, small meals with initial limitations in fluid and fat consumption. Osmolar sugars (e.g., sorbitol), lactose, and high-oxalate foods are best avoided.
- In patients with small bowel–colon continuity, increased use of complex carbohydrates may allow the salvage of a few hundred calories from colonic production and absorption of short-chain fatty acids (SCFAs).
- Antimotility drugs and gastric acid suppression should be used if stool output remains high.
- Oral rehydration with glucose- and sodium-containing fluids (e.g., sports drinks) may help prevent dehydration. Pancreatic enzymes, bile acid–binding resins (if bile acids are irritating the colon), and octreotide injections may play a role in selected cases.
- If oral diets fail, the use of elemental feedings may enhance absorption and nutritional state. Studies of gut rehabilitation with growth hormone and glutamine, as well as intestinal or combined intestinal-liver transplantation, are available at selected centers.
