GASTROENTEROLOGY ARTICLE OF THE WEEK
May 18, 2006
Buchman AL. Short Bowel Syndrome. Clin Gastroenterol Hepatol 2006;3:1066-70
1. Enteral feedings after small bowel resection
a. Daily caloric intake should be 1.5 to 3 times higher than the calculated need
b. Oral rehydration solutions should be used to replace fluid losses
c. Low oxalate diet should be prescribed to prevent oxalate gallstones
d. Low oxalate diet is most important in patients who have an ileostomy
e. The use of digestable fiber will increase calorie salvage by the colon
2. Management of diarrhea in SBS
a. Loperamide doses as high as 16mg/day may be needed
b. Codeine 30 to 60mg 2-4 times a day should be added if stool output is >3 liters.
c. Octreotide should be used for patients with diarrhea and ileostomy
d. Cholestyramine should be used in patients with total colectomy
True or False
3. Gastric hypersecretion occurs during the first 6 months after small bowel resection and should be managed with high dose PPI.
4. Intestinal failure rarely develops if >200cm of small bowel remain after resection.
5. Over 80% of patients who are TPN dependent after small bowel resection will remain TPN dependent indefinitely.
6. Peptide-based enteral formulas are clearly superior for patients with SBS
7. Continuity with the colon should not be attempted if there is <20% of the colon and < 60cm of small bowel left after resection
8. Glutamine supplementation improves intestinal adaptation in humans after small bowel resection.
9. Patients who are TPN dependent during the first 6 months after surgery should be considered for small bowel transplant
10. Patients who develop short bowel syndrome as a result of mesenteric ischemia are more likely to develop catheter-related thrombosis.
11. Oral calcium supplement should be used routinely in patients with SBS
12. Once enteral feeding resume, the goal is to give 1.5 to 3 times the calculated caloric needs.
13. Zinc deficiency is common in patients with SBS who are not TPN dependent.