AGA offers 12 best practice recommendations for managing short bowel syndrome
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The AGA has released a clinical practice update and expert review on the characterization and management of patients with short bowel syndrome, which recently was published in Clinical Gastroenterology and Hepatology.
“There is general agreement that a residual small intestinal length of 200 cm or less meets criteria for [short bowel syndrome], although there are reports suggesting that a residual length of 150 cm or less may be more appropriate,” Kishore Iyer, MBBS, director of adult and pediatric intestinal rehabilitation and transplantation at Mount Sinai Medical Center in New York, and colleagues wrote. “Specific consequences are related to the regions of the gastrointestinal tract that are missing, such as vitamin B12 deficiency or bile acid-induced diarrhea from resection of the terminal ileum. Such specific findings provide important clinical clues that can help refine management.”
Using available published evidence — including recently published systematic reviews and clinical guidelines — Iyer and colleagues developed 12 best practice advice statements for the management of adult patients with short bowel syndrome (SBS) and SBS-associated intestinal failure (IF). Highlights include:
- Accurate estimation and reporting of residual bowel length is key for an accurate diagnosis of SBS; experts advised that surgeons involved with massive bowel resections should report the residual bowel length rather than the length of bowel resected.
- Dietitians who specialize in SBS should perform an initial comprehensive nutritional assessment with subsequent long-term monitoring of laboratory studies, fluid balance, weight change, serum micronutritional levels and bone density.
- Dietary therapy for SBS should focus on maintaining compensatory hyperphagia rather than on excessive dietary restrictions. Intake must be increased by at least 50% of a patient’s estimated needs to account for significant malabsorption.
- Antisecretory medications, including proton-pump inhibitors or histamine-2 receptor agonists, may be beneficial in reducing the volume of gastric secretions and controlling stool losses.
- Medications in solid dosage forms, such as tablets, must undergo disintegration and dissolution before being absorbed.
- Surgical intervention may be necessary to recruit unused distal bowel, augment function of residual bowel through “specific lengthening and tapering operations” or slow intestinal transit.
- “Unacceptable side-effects and questionable long-term efficacy” have led to the discontinued use of recombinant human growth hormone among these patients.
“The care of patients with SBS requires a comprehensive approach and attention to detail,” Iyer and colleagues concluded. “A multidisciplinary approach consisting of dietitians, nurses, surgeons, gastroenterologists or internists, and social workers experienced in the care of patients with IF is essential for the successful management of these patients.”
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