GASTROENTEROLOGY ARTICLE OF THE WEEK
November 13, 2003
AGA. American Gastroenterological Association medical position statement: Short Bowel Syndrome and Intestinal Transplantation. Gastroenterology 2003;124:1105-1110.
1. Interventions to minimize fluid losses through the ostomy include:
a. PPI’s
b. Magnesium supplements
c. Anti-motility agents
d. Cholestyramine in patients with <100cm of ileum and no colon
e. Codeine
f. Octreotide, which may also promote early intestinal adaptation
g. Bile acid supplements to decrease steatorrhea
2. Dietary interventions in SBS
a. Oxalate must be restricted if a total colectomy has been performed
b. Soluble fiber can provide additional energy in patients with intact colon
c. Oral calcium supplements may reduce risk of renal stones in patients with an intact colon
d. Oral diet should consist of low carbohydrate, high fat to slow motility
True or False
3. The definition of short bowel syndrome (SBS) is <200 cm of functional small intestine
4. Maximal adaptation of the remaining small bowel may take up to 2 years after the operation.
5. Glucose in the oral rehydrating solution is important to promote sodium absorption in the jejunum, but the presence of glucose is not important for sodium absorption in the ileum.
6. Cytomegalovirus infection and post-transplant lymphoproliferative disorders are major complications of small bowel transplantation.
7. Glutamine-enriched enteral formulas improve intestinal absorption.
8. Patients with short bowel syndrome should be fed with peptide-based diets to enhance absorption.
9. A patient with resection of 150cm of ileum, colon in place, who has diarrhea, should be placed on cholestyramine for the control of diarrhea.
10. Rejection is the most common cause of graft loss in transplant recipients; detection usually requires endoscopy with biopsies.
11. Intestinal transplantation is indicated in a person who is dependent on TPN even if tolerating TPN without complications.
12. Possible interventions to treat TPN-associated liver disease, even if not proven, include
a. metronidazole
b. intravenous choline supplementation
c. ursodeoxycholic acid
d. carnitine supplementation
e. limit total IV lipids to <1-2 g/kg/d
