Management of nutritional problems in short bowel syndrome

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.

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