Key pointshighlights

• The management of short bowel syndrome is complex and frequently requires PN support to ensure the sufficient administration of nutrients and fluids. Despite advances in the provision of PN, this mode of nutritional support carries with it significant risks to the patient, impairs the quality of life and is costly.

• An understanding of the physiological abnormalities that occur in SBS is important to better understand the rationale for the therapeutic strategies employed in the care of these patients.

• Dietary and fluid recommendations are dependent upon the remaining bowel anatomy. Those SBS patients with colon remaining may benefit from a high carbohydrate, low fat, oxalate-restricted diet while those without a colon will benefit from the use of an oral rehydration solution.

• The aggressive use of antimotility and antisecretory medications is frequently necessary to control stool losses in SBS.

• Small intestinal bacterial overgrowth may be an important complication in some SBS patients and should be investigated in suspected patients and treated aggressively if present.

• Intestinal adaptation plays a key role in the successful management of patients with SBS. Recent investigations have focused on the use of trophic substances to increase the absorptive function of the remaining gut. Glucagon-like peptide 2 appears to be a promising trophic factor. Ongoing studies will determine its efficacy on the weaning of parenteral nutrition.

• In a recent randomized, controlled trial of somatropin (i.e., recombinant-human growth hormone), glutamine and a specialized oral diet in patients with PN-dependent short bowel syndrome, there was a significant reduction in PN requirements amongst the treatment group as compared to the control group. The United States Food and Drug Administration recently approved the use of somatropin in patients with SBS on parenteral nutrition as an aid in weaning. Further study is needed regarding the optimal dosage and length of administration of somatropin as well as its safety, long-term benefit and use in the pediatric and geriatric populations.

• Non-transplant surgical procedures have been devised with the goal of maximizing the function of the SBS patient's existing intestine. The choice of surgery can be divided into procedures that optimize function (e.g., lengthen, taper) or slow transit (e.g., reversed segment). These procedures should only be considered after the initial adaptive period and after medical and dietary management has been maximized.

• Intestinal transplantation may be considered in SBS patients when complications of parenteral nutrition such as liver disease, loss of venous access sites or recurrent episodes of life-threatening catheter sepsis occur. While substantial improvements in outcome after intestinal transplantation have been seen in recent years, before it can be recommended to more SBS patients, improved patient and graft survival and an increased likelihood of graft function must be seen.

• A critical component of PN weaning is to have goals in mind when deciding the frequency and amount of PN to wean. Micronutrient supplementation becomes necessary as PN is weaned and levels require periodic monitoring. The frequency of monitoring will depend upon the stage of PN weaning and the presence of existing or prior deficiencies.

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Good Carb Diet

Good Carb Diet

WHAT IT IS A three-phase plan that has been likened to the low-carbohydrate Atkins program because during the first two weeks, South Beach eliminates most carbs, including bread, pasta, potatoes, fruit and most dairy products. In PHASE 2, healthy carbs, including most fruits, whole grains and dairy products are gradually reintroduced, but processed carbs such as bagels, cookies, cornflakes, regular pasta and rice cakes remain on the list of foods to avoid or eat rarely.

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