Short bowel syndrome secondary prevention
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]
Overview
There are several ways to prevent complications of short bowel syndrome. Management strategies and regular follow-up are needed to find and treat complications accordingly. Effective measures must be adopted for secondary prevention of complications following total parenteral nutrition including liver disease, cholelithiasis, kidney stone, small bowel bacterial overgrowth, lactic acidosis, lactic acidosis. Hydration, consumption of supplements, antibiotic therapy, and regular monitoring with blood tests, ultrasound and scans are recommended.
Secondary Prevention
There are several ways to prevent complications of short bowel syndrome:
- Management strategies and regular follow-up are needed to find and treat complications accordingly.
Effective measures
- Effective measures for the secondary prevention of liver disease following total parenteral nutrition include:[1]
- High calorie diet including less than 30% fat
- Treating nutrient deficiencies
- Treating small bowel bacterial overgrowth
- Ursodeoxycholic acid
- Regular monitoring of liver function tests
- Regular follow up with hepatobiliary ultrasound if liver function tests are abnormal
- Performing liver biopsy if hepatobiliary ultrasound is abnormal
- Effective measures for the secondary prevention of cholelithiasis following total parenteral nutrition include:[1]
- Initiating enteral nutrition whenever feasible
- Intermittent cholecystokinin and lipids injections
- Prophylactic cholecystectomy
- Effective measures for the secondary prevention of kidney stones following total parenteral nutrition include:[1]
- Low oxalate diet
- Minimizing intraluminal fat
- Providing calcium supplements
- Maintaining a high urinary volume
- Cholestyramine
- Effective measures for the secondary prevention of small bowel bacterial overgrowth following total parenteral nutrition include:[1]
- Long term antibiotic therapy
- Effective measures for the secondary prevention of lactic acidosis include:[2]
- Effective measures for the secondary prevention of osteoporosis include:
- Providing vitamin D and calcium supplements
- Performing dual-energy x-ray absorptiometry scan every two years
Follow-up
- Close long-term follow-up is needed.
- Monitoring and measuring blood levels of nutrients are required.[2]
Table below summarizes the tests and imaging studies which are required in patients with short bowel syndrome when discharge from the hospital.
| Measurement | Frequency |
|---|---|
| Clinic visit | Every 6 to 12 months |
| Weight | Every week to check for malnutrition and dehydration |
| Intake and output | Every 1 to 4 weeks to check for malnutrition and dehydration |
| Comprehensive metabolic panel including magnesium | Every 4 weeks to check for malnutrition and dehydration |
| Essential fatty acids | Every 6 to 12 months to check for malnutrition |
| Vitamin levels | Every 6 to 12 months to check for malnutrition |
| Minerals | Every 6 to 12 months to check for malnutrition |
| Liver function tests | Every 6 months to check for liver disease |
| Dual-energy x-ray absorptiometry scan | Every 2 years to check for osteoporosis |
References
- ↑ 1.0 1.1 1.2 1.3 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.
- ↑ 2.0 2.1 Wilmore, Douglas W.; Robinson, Malcolm K. (2014). “Short Bowel Syndrome”. World Journal of Surgery. 24 (12): 1486–1492. doi:10.1007/s002680010266. ISSN 0364-2313.
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