Short bowel syndrome medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
*Management of short bowel syndrome is complicated and requires close collaboration of all medical team members including the physician, nutritionist, and nurse with the patient and their families. | *Management of short bowel syndrome is complicated and requires close collaboration of all medical team members including the physician, nutritionist, and nurse with the patient and their families.<ref name="pmid16770167">{{cite journal |vauthors=Matarese LE, Steiger E |title=Dietary and medical management of short bowel syndrome in adult patients |journal=J. Clin. Gastroenterol. |volume=40 Suppl 2 |issue= |pages=S85–93 |year=2006 |pmid=16770167 |doi=10.1097/01.mcg.0000212678.14172.7a |url=}}</ref><ref name="pmid24247092">{{cite journal |vauthors=Kelly DG, Tappenden KA, Winkler MF |title=Short bowel syndrome: highlights of patient management, quality of life, and survival |journal=JPEN J Parenter Enteral Nutr |volume=38 |issue=4 |pages=427–37 |year=2014 |pmid=24247092 |doi=10.1177/0148607113512678 |url=}}</ref> | ||
*Management of short bowel syndrome consists of medical therapy and surgical interventions.<ref name="pmid25052938">{{cite journal |vauthors=Bechtold ML, McClave SA, Palmer LB, Nguyen DL, Urben LM, Martindale RG, Hurt RT |title=The pharmacologic treatment of short bowel syndrome: new tricks and novel agents |journal=Curr Gastroenterol Rep |volume=16 |issue=7 |pages=392 |year=2014 |pmid=25052938 |doi=10.1007/s11894-014-0392-2 |url=}}</ref><ref name="RodriguesSeetharam2011">{{cite journal|last1=Rodrigues|first1=Gabriel|last2=Seetharam|first2=Prasad|title=Short bowel syndrome: A review of management options|journal=Saudi Journal of Gastroenterology|volume=17|issue=4|year=2011|pages=229|issn=1319-3767|doi=10.4103/1319-3767.82573}}</ref> | *Management of short bowel syndrome consists of medical therapy and surgical interventions.<ref name="pmid25052938">{{cite journal |vauthors=Bechtold ML, McClave SA, Palmer LB, Nguyen DL, Urben LM, Martindale RG, Hurt RT |title=The pharmacologic treatment of short bowel syndrome: new tricks and novel agents |journal=Curr Gastroenterol Rep |volume=16 |issue=7 |pages=392 |year=2014 |pmid=25052938 |doi=10.1007/s11894-014-0392-2 |url=}}</ref><ref name="RodriguesSeetharam2011">{{cite journal|last1=Rodrigues|first1=Gabriel|last2=Seetharam|first2=Prasad|title=Short bowel syndrome: A review of management options|journal=Saudi Journal of Gastroenterology|volume=17|issue=4|year=2011|pages=229|issn=1319-3767|doi=10.4103/1319-3767.82573}}</ref><ref name="RodriguesSeetharam2011">{{cite journal|last1=Rodrigues|first1=Gabriel|last2=Seetharam|first2=Prasad|title=Short bowel syndrome: A review of management options|journal=Saudi Journal of Gastroenterology|volume=17|issue=4|year=2011|pages=229|issn=1319-3767|doi=10.4103/1319-3767.82573}}</ref><ref name="Wall2013">{{cite journal|last1=Wall|first1=Elizabeth A.|title=An Overview of Short Bowel Syndrome Management: Adherence, Adaptation, and Practical Recommendations|journal=Journal of the Academy of Nutrition and Dietetics|volume=113|issue=9|year=2013|pages=1200–1208|issn=22122672|doi=10.1016/j.jand.2013.05.001}}</ref><ref name="ThompsonWeseman2011">{{cite journal|last1=Thompson|first1=Jon S.|last2=Weseman|first2=Rebecca|last3=Rochling|first3=Fedja A.|last4=Mercer|first4=David F.|title=Current Management of the Short Bowel Syndrome|journal=Surgical Clinics of North America|volume=91|issue=3|year=2011|pages=493–510|issn=00396109|doi=10.1016/j.suc.2011.02.006}}</ref><ref name="EçaBarbosa2016">{{cite journal|last1=Eça|first1=Rosário|last2=Barbosa|first2=Elisabete|title=Short bowel syndrome: treatment options|journal=Journal of Coloproctology|volume=36|issue=4|year=2016|pages=262–272|issn=22379363|doi=10.1016/j.jcol.2016.07.002}}</ref><ref name="pmid15494290">{{cite journal |vauthors=Keller J, Panter H, Layer P |title=Management of the short bowel syndrome after extensive small bowel resection |journal=Best Pract Res Clin Gastroenterol |volume=18 |issue=5 |pages=977–92 |year=2004 |pmid=15494290 |doi=10.1016/j.bpg.2004.05.002 |url=}}</ref><ref name="pmid17198059">{{cite journal |vauthors=Misiakos EP, Macheras A, Kapetanakis T, Liakakos T |title=Short bowel syndrome: current medical and surgical trends |journal=J. Clin. Gastroenterol. |volume=41 |issue=1 |pages=5–18 |year=2007 |pmid=17198059 |doi=10.1097/01.mcg.0000212617.74337.e9 |url=}}</ref><ref name="pmid16207689">{{cite journal |vauthors=Matarese LE, O'Keefe SJ, Kandil HM, Bond G, Costa G, Abu-Elmagd K |title=Short bowel syndrome: clinical guidelines for nutrition management |journal=Nutr Clin Pract |volume=20 |issue=5 |pages=493–502 |year=2005 |pmid=16207689 |doi=10.1177/0115426505020005493 |url=}}</ref><ref name="pmid11873098">{{cite journal |vauthors=Sundaram A, Koutkia P, Apovian CM |title=Nutritional management of short bowel syndrome in adults |journal=J. Clin. Gastroenterol. |volume=34 |issue=3 |pages=207–20 |year=2002 |pmid=11873098 |doi= |url=}}</ref><ref name="pmid14642862">{{cite journal |vauthors=Vanderhoof JA, Young RJ |title=Enteral and parenteral nutrition in the care of patients with short-bowel syndrome |journal=Best Pract Res Clin Gastroenterol |volume=17 |issue=6 |pages=997–1015 |year=2003 |pmid=14642862 |doi= |url=}}</ref> | ||
*Medical therapy consists of nutritional therapy and pharmacotherapy. | *Medical therapy consists of nutritional therapy and pharmacotherapy. | ||
*Lifelong follow-up is usually needed. | *Lifelong follow-up is usually needed. | ||
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**** Preferred regimen (1): Octreotide 100 mcg SC q8h (maximum 1,500 mcg per day) | **** Preferred regimen (1): Octreotide 100 mcg SC q8h (maximum 1,500 mcg per day) | ||
*** 2.4 Clonidine 0.1–0.2 mg PO q12h | *** 2.4 Clonidine 0.1–0.2 mg PO q12h | ||
** 3 Trophic agents | ** 3 Trophic agents<ref name="pmid25052938">{{cite journal |vauthors=Bechtold ML, McClave SA, Palmer LB, Nguyen DL, Urben LM, Martindale RG, Hurt RT |title=The pharmacologic treatment of short bowel syndrome: new tricks and novel agents |journal=Curr Gastroenterol Rep |volume=16 |issue=7 |pages=392 |year=2014 |pmid=25052938 |doi=10.1007/s11894-014-0392-2 |url=}}</ref> | ||
*** 3.1 Growth hormone | *** 3.1 Growth hormone<ref name="pmid16770169">{{cite journal |vauthors=Steiger E, DiBaise JK, Messing B, Matarese LE, Blethen S |title=Indications and recommendations for the use of recombinant human growth hormone in adult short bowel syndrome patients dependent on parenteral nutrition |journal=J. Clin. Gastroenterol. |volume=40 Suppl 2 |issue= |pages=S99–106 |year=2006 |pmid=16770169 |doi=10.1097/01.mcg.0000212680.52290.02 |url=}}</ref> | ||
**** Preferred regimen (1): Somatropin 0.03-0.14 mg/kg SC qd for up to 4 weeks (not to exceed 8 mg/day) | **** Preferred regimen (1): Somatropin 0.03-0.14 mg/kg SC qd for up to 4 weeks (not to exceed 8 mg/day) | ||
*** 3.2 Glutamine | *** 3.2 Glutamine |
Revision as of 04:20, 3 December 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
- Management of short bowel syndrome is complicated and requires close collaboration of all medical team members including the physician, nutritionist, and nurse with the patient and their families.[1][2]
- Management of short bowel syndrome consists of medical therapy and surgical interventions.[3][4][4][5][6][7][8][9][10][11][12]
- Medical therapy consists of nutritional therapy and pharmacotherapy.
- Lifelong follow-up is usually needed.
Nutritional therapy
- Nutritional therapy is essential for short bowel syndrome and to restore the intestinal adaptation. It could be provided through oral, enteral and parenteral routes.
- Patients should eat more than usual to overcome the malabsorption.
- 1 Fluid
- 1.1 Acute phase
- Preferred regimen (1): Normal saline
- Preferred regimen (1): Ringer lactate
- 1.1 Acute phase
- 1.2 Maintenance phase
- Water
- Sports drinks
- Sodas without caffeine
- Salty broths
- 1 Fluid
- Note (1): 300-500 ml must be added to fluid loss as an insensible loss.
- Note (2): Urine output should be at least 1 L per day.
- 2 Parenteral infusion
- 2.1 Acute phase
- 2.1.1 Diet
- Preferred regimen (1): 30-40 kcal/kg/day diet consists of carbohydrate 55-60%, fat 20-25%, and protein 20%
- 2.1.2 Electrolytes
- 2.1.2.1 Sodium
- 2.1.2.2 Potassium
- 2.1.2.3 Magnesium
- 2.1.1 Diet
- 2.2 Maintenance phase
- Preferred regimen (1): 30-40 kcal/kg/day diet consists of carbohydrate 55-60%, fat 20-25%, and protein 20%
- 2.1 Acute phase
- 2 Parenteral infusion
- Note (1): Small and frequent diet is recommended.
- Note (2): Foods high in sugar, protein, fat, and fiber must be avoided.
- Note (3):
- 3 Enteral nutrition
- 4 Supplement
- 4.1 Vitamins
- 4.1.1 Vitamin A
- 4.1.2 Vitamin B12
- 4.1.3 Vitamin D
- 4.1.4 Vitamin E
- 4.2 Minerals
- 4.2.1 Calcium
- Preferred regimen (1): Calcium 1000-1500 mg PO qd
- 4.2.2 Iron
- 4.2.3 Zinc
- 4.2.1 Calcium
- 4.3 Exogenous enzyme replacement
- 4.3.1 Pancreatic enzyme
- 4.3.2 Lactase
- 4.4 Bile acid sequestrants
- 4.5 Probiotics
- 4.1 Vitamins
Pharmacotherapy
- Medications are used to control symptoms of short bowel syndrome. They include:
- 1 Antimotility agents
- Preferred regimen (1): Loperamide
- Preferred regimen (2): Codeine phosphate 30-60 mg PO q6h as needed
- Preferred regimen (3): Lomotil (diphenoxylate and atropine) 2.5-7.5 mg q6h (maximum 30 mg per day)
- Alternative regimen (1): Cholestyramine 24 g PO qd (recommended for patients with an intact colon and partial ileal resection of <100 cm)
- Alternative regimen (2): Codeine 60 mg IM q4h
- Alternative regimen (3): Tincture of opium 5-10 mL PO q4h
- 1 Antimotility agents
- Note (1): Antimotility agents reduce peristalsis and increase transit time which improve nutrient absorption.
- Note (2): Antimotility agents must be used 30 minutes before meal and at bedtime.
- Note (3): Patients who receive opiates to control their diarrhea must be closely monitored.
- 2 Antisecretory agents
- 2.1 Histamine H2 antagonists
- Preferred regimen (1):
- 2.2 Proton pump inhibitors
- Preferred regimen (1): Omeprazole 40 mg PO BID or TID
- 2.3 Somatostatin analogue
- Preferred regimen (1): Octreotide 100 mcg SC q8h (maximum 1,500 mcg per day)
- 2.4 Clonidine 0.1–0.2 mg PO q12h
- 2.1 Histamine H2 antagonists
- 3 Trophic agents[3]
- 3.1 Growth hormone[13]
- Preferred regimen (1): Somatropin 0.03-0.14 mg/kg SC qd for up to 4 weeks (not to exceed 8 mg/day)
- 3.2 Glutamine
- Preferred regimen (1): Glutamine 0.16 g/kg IV qd
- Preferred regimen (2): Glutamine 30 g PO qd
- 3.3 Glucagon-like peptide-2 analogue
- Preferred regimen (1): Teduglutide 0.1–0.2 mg PO q12h
- 3.1 Growth hormone[13]
- 4 Antibiotics
- Preferred regimen (1):
- 2 Antisecretory agents
Note (1): Antibiotic is used to prevent and treat small bowel bacterial overgrowth.
References
- ↑ Matarese LE, Steiger E (2006). "Dietary and medical management of short bowel syndrome in adult patients". J. Clin. Gastroenterol. 40 Suppl 2: S85–93. doi:10.1097/01.mcg.0000212678.14172.7a. PMID 16770167.
- ↑ Kelly DG, Tappenden KA, Winkler MF (2014). "Short bowel syndrome: highlights of patient management, quality of life, and survival". JPEN J Parenter Enteral Nutr. 38 (4): 427–37. doi:10.1177/0148607113512678. PMID 24247092.
- ↑ 3.0 3.1 Bechtold ML, McClave SA, Palmer LB, Nguyen DL, Urben LM, Martindale RG, Hurt RT (2014). "The pharmacologic treatment of short bowel syndrome: new tricks and novel agents". Curr Gastroenterol Rep. 16 (7): 392. doi:10.1007/s11894-014-0392-2. PMID 25052938.
- ↑ 4.0 4.1 Rodrigues, Gabriel; Seetharam, Prasad (2011). "Short bowel syndrome: A review of management options". Saudi Journal of Gastroenterology. 17 (4): 229. doi:10.4103/1319-3767.82573. ISSN 1319-3767.
- ↑ Wall, Elizabeth A. (2013). "An Overview of Short Bowel Syndrome Management: Adherence, Adaptation, and Practical Recommendations". Journal of the Academy of Nutrition and Dietetics. 113 (9): 1200–1208. doi:10.1016/j.jand.2013.05.001. ISSN 2212-2672.
- ↑ Thompson, Jon S.; Weseman, Rebecca; Rochling, Fedja A.; Mercer, David F. (2011). "Current Management of the Short Bowel Syndrome". Surgical Clinics of North America. 91 (3): 493–510. doi:10.1016/j.suc.2011.02.006. ISSN 0039-6109.
- ↑ Eça, Rosário; Barbosa, Elisabete (2016). "Short bowel syndrome: treatment options". Journal of Coloproctology. 36 (4): 262–272. doi:10.1016/j.jcol.2016.07.002. ISSN 2237-9363.
- ↑ Keller J, Panter H, Layer P (2004). "Management of the short bowel syndrome after extensive small bowel resection". Best Pract Res Clin Gastroenterol. 18 (5): 977–92. doi:10.1016/j.bpg.2004.05.002. PMID 15494290.
- ↑ Misiakos EP, Macheras A, Kapetanakis T, Liakakos T (2007). "Short bowel syndrome: current medical and surgical trends". J. Clin. Gastroenterol. 41 (1): 5–18. doi:10.1097/01.mcg.0000212617.74337.e9. PMID 17198059.
- ↑ Matarese LE, O'Keefe SJ, Kandil HM, Bond G, Costa G, Abu-Elmagd K (2005). "Short bowel syndrome: clinical guidelines for nutrition management". Nutr Clin Pract. 20 (5): 493–502. doi:10.1177/0115426505020005493. PMID 16207689.
- ↑ Sundaram A, Koutkia P, Apovian CM (2002). "Nutritional management of short bowel syndrome in adults". J. Clin. Gastroenterol. 34 (3): 207–20. PMID 11873098.
- ↑ Vanderhoof JA, Young RJ (2003). "Enteral and parenteral nutrition in the care of patients with short-bowel syndrome". Best Pract Res Clin Gastroenterol. 17 (6): 997–1015. PMID 14642862.
- ↑ Steiger E, DiBaise JK, Messing B, Matarese LE, Blethen S (2006). "Indications and recommendations for the use of recombinant human growth hormone in adult short bowel syndrome patients dependent on parenteral nutrition". J. Clin. Gastroenterol. 40 Suppl 2: S99–106. doi:10.1097/01.mcg.0000212680.52290.02. PMID 16770169.