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Journal of Nutrition Research
An official journal of IAPEN India association

Article

Nutritional Management in the Compromised Gut: Short Bowel Syndrome, Enterocutaneous Fistula, and Stoma
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Journal of Nutrition Research

DOI: 10.55289/jnutres/v11i2_23.20

Year: 2023, Volume: 11, Issue: 2, Pages: 38-46

Guideline

Nutritional Management in the Compromised Gut: Short Bowel Syndrome, Enterocutaneous Fistula, and Stoma

Gourav Kaushal 1 , S Anand​ ✉ 2 , Raksha Ranjan 3 , Ridashisha Bani 4

1 Assistant Professor, Department of Surgical Gastroenterology, Department of Paediatrics, AIIMS Bathinda, Punjab, India
2 Consultant minimally invasive GI and HPB surgeon, Apollo main hospital, Greams road, Chennai, India
3 Assistant Professor, Department of Paediatrics, Adesh Institute of medical sciences and Research, Bathinda, Punjab, India
4 Nursing officer, Department of Surgical Gastroenterology, AIIMS Rishikesh, Uttarakhand, India

Corresponding author ✉: [email protected]

Received Date:21 June 2023, Accepted Date:29 July 2023, Published Date:11 August 2023

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This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Nutrition in patients with a compromised gut is a challenge requiring a multidisciplinary management and necessitates individualized nutritional planning. Intestinal failure is defined as significant deficit in gut absorption of micro and macronutrients such that intravenous supplementation is necessary to sustain life. If absorption is inadequate, however intravenous supplementation is not required, it is called intestinal insufficiency. Short bowel syndrome and entero cutaneous fistula are the most common conditions leading to intestinal insufficiency and failure. These conditions in the initial phase may lead to significant loss of fluids and electrolytes and require multidisciplinary team management. Definite plan for restoration of adequately functioning bowel after stabilization of patient is important. Based on evidences, recommendations for nutritional management in such patients were thoroughly discussed and approved by the Gastrointestinal nutrition core committee of the Indian Association of Parenteral and enteral nutrition (IAPEN).

Keywords: Short bowel syndrome, Enterocutaneous fistula, Nutrition

References

  1. O'Keefe SJD, Buchman AL, Fishbein TM, Jeejeebhoy KN, Jeppesen PB, Shaffer J. Short Bowel Syndrome and Intestinal Failure: Consensus Definitions and Overview. Clinical Gastroenterology and Hepatology. 2006;4(1):6–10. Available from: https://doi.org/10.1016/j.cgh.2005.10.002
  2. Cuerda C, Pironi L, Arends J, Bozzetti F, Gillanders L, Jeppesen PB, et al. ESPEN practical guideline: Clinical nutrition in chronic intestinal failure. Clinical Nutrition. 2021;40(9):5196–5220. Available from: https://doi.org/10.1016/j.clnu.2021.07.002
  3. Pironi L. Definitions of intestinal failure and the short bowel syndrome. Best Practice & Research Clinical Gastroenterology. 2016;30(2):173–185. Available from: https://doi.org/10.1016/j.bpg.2016.02.011
  4. Tappenden KA. Pathophysiology of short bowel syndrome: considerations of resected and residual anatomy. JPEN - Journal of Parenteral and Enteral Nutrition. 2014;38(1S):14S–22S. Available from: https://doi.org/10.1177/0148607113520005
  5. Carbonnel F, Cosnes J, Chevret S, Beaugerie L, Ngô Y, Malafosse M, et al. The Role of Anatomic Factors in Nutritional Autonomy After Extensive Small Bowel Resection. Journal of Parenteral and Enteral Nutrition. 1996;20(4):275–280. Available from: https://doi.org/10.1177/0148607196020004275
  7. Ramakrishna BS, Mathan M, Mathan VI. Alteration of Colonic Absorption by Long-Chain Unsaturated Fatty Acids: Influence of Hydroxylation and Degree of Unsaturation. Scandinavian Journal of Gastroenterology. 1994;29(1):54–58. Available from: https://doi.org/10.3109/00365529409090437
  8. Ladefoged K, Ølgaard K. Fluid and Electrolyte Absorption and Renin-Angiotensin-Aldosterone Axis in Patients with Severe Short-Bowel Syndrome. Scandinavian Journal of Gastroenterology. 1979;14(6):729–735. Available from: https://doi.org/10.3109/00365527909181945
  9. Ladefoged K, Olgaard K. Sodium Homeostasis After Small-Bowel Resection. Scandinavian Journal of Gastroenterology. 1985;20(3):361–369. Available from: https://doi.org/10.3109/00365528509091665
  10. Nightingale JM, Lennard-Jones JE, Walker ER, Farthing MJ. Jejunal efflux in short bowel syndrome. The Lancet. 1990;336(8718):765–768. Available from: https://doi.org/10.1016/0140-6736(90)93238-K
  11. Wright EM, Loo DDF. Coupling between Na+, Sugar, and Water Transport across the Intestine. Annals of the New York Academy of Sciences. 2000;915(1):54–66. Available from: https://doi.org/10.1111/j.1749-6632.2000.tb05223.x
  12. Oral Rehydration Solutions: Made at Home. Rehydration Project. Available from: https://rehydrate.org/solutions/homemade.htm#recipe (accessed )
  13. Iyer K, Dibaise JK, Rubio-Tapia A. AGA Clinical Practice Update on Management of Short Bowel Syndrome: Expert Review. Clinical Gastroenterology and Hepatology. 2022;20(10):2185–2194. Available from: https://doi.org/10.1016/j.cgh.2022.05.032
  14. Newton CR, Mcintyre PB, Lennard-Jones JE, Gonvers JJ, Preston DM. Effect of Different Drinks on Fluid and Electrolyte Losses from a Jejunostomy. Journal of the Royal Society of Medicine. 1985;78(1):27–34. Available from: https://doi.org/10.1177/014107688507800106
  16. Nightingale J, Woodward JM. Guidelines for management of patients with a short bowel. Gut. 2006;55(suppl_4):iv1–iv12. Available from: https://gut.bmj.com/content/55/suppl_4/iv1
  17. Vries FEED, Reeskamp LF, Ruler OV, Arum IV, Kuin W, Dijksta G, et al. Systematic review: pharmacotherapy for high-output enterostomies or enteral fistulas. Alimentary Pharmacology & Therapeutics. 2017;46(3):266–273. Available from: https://doi.org/10.1111/apt.14136
  19. Kusuhara K, Kusunoki M, Okamoto T, Sakanoue Y, Utsunomiya J. Reduction of the effluent volume in high-output ileostomy patients by a somatostatin analogue, SMS 201-995. International Journal of Colorectal Disease. 1992;7:202–205. Available from: https://doi.org/10.1007/BF00341221
  21. Gao X, Zhang L, Wang S, Xiao Y, Song D, Zhou D, et al. Prevalence, Risk Factors, and Complications of Cholelithiasis in Adults With Short Bowel Syndrome: A Longitudinal Cohort Study. Frontiers in Nutrition. 2021;8:1–9. Available from: https://doi.org/10.3389/fnut.2021.762240
  22. Nightingale JMD. Hepatobiliary, renal and bone complications of intestinal failure. Best Practice & Research Clinical Gastroenterology. 2003;17(6):907–929. Available from: https://pubmed.ncbi.nlm.nih.gov/14642857/
  23. Massironi S, Cavalcoli F, Rausa E, Invernizzi P, Braga M, Vecchi M. Understanding short bowel syndrome: Current status and future perspectives. Digestive and Liver Disease. 2020;52(3):253–261. Available from: https://doi.org/10.1016/j.dld.2019.11.013
  24. Stokes CS, Gluud LL, Casper M, Lammert F. Ursodeoxycholic Acid and Diets Higher in Fat Prevent Gallbladder Stones During Weight Loss: A Meta-analysis of Randomized Controlled Trials. Clinical Gastroenterology and Hepatology. 2014;12(7):1090–1100. Available from: https://doi.org/10.1016/j.cgh.2013.11.031
  25. Ławiński M, Jachnis A, Ukleja A, Pertkiewicz M. Cholelithiasis in Home Parenteral Nutrition (Hpn) Patients – Complications of the Clinical Nutrition: Diagnosis, Treatment, Prevention. Polish Journal of Surgery. 2014;86(3):111–115. Available from: https://pubmed.ncbi.nlm.nih.gov/24791812/
  26. Thompson JS, Mercer DF, Vargas LM, Grant WJ, Rochling FA, Langnas AN. Prophylactic cholecystectomy in short bowel syndrome: Is it being utilized? The American Journal of Surgery. 2018;216(1):73–77. Available from: https://doi.org/10.1016/j.amjsurg.2018.04.002
  27. Johnson E, Vu L, Matarese LE. Bacteria, Bones, and Stones: Managing Complications of Short Bowel Syndrome. Nutrition in Clinical Practice. 2018;33(4):454–466. Available from: https://doi.org/10.1002/ncp.10113
  28. SCN, Savage GP. Oxalate content of foods and its effect on humans. Asia Pacific Journal of Clinical Nutrition. 1999;8(1):64–74. Available from: https://apjcn.nhri.org.tw/server/APJCN/8/1/64.pdf
  29. Matsumoto ED, Heller HJ, Adams-Huet B, Brinkley LJ, Pak C, Pearle MS. Effect of High and Low Calcium Diets on Stone Forming Risk During Liberal Oxalate Intake. Journal of Urology. 2006;176(1):132–136. Available from: https://doi.org/10.1016/S0022-5347(06)00565-9
  30. Bielawska B, Allard JP. Parenteral Nutrition and Intestinal Failure. Nutrients. 2017;9(5):1–14. Available from: https://doi.org/10.3390/nu9050466
  31. Frankenfield DC, Rowe WA, Smith JS, Cooney RN. Validation of several established equations for resting metabolic rate in obese and nonobese people. Journal of the Academy of Nutrition and Dietetics. 2003;103(9):1152–1159. Available from: https://doi.org/10.1016/S0002-8223(03)00982-9
  32. Staun M, Pironi L, Bozzetti F, Baxter J, Forbes A, Joly F, et al. ESPEN Guidelines on Parenteral Nutrition: Home Parenteral Nutrition (HPN) in adult patients. Clinical Nutrition. 2009;28(4):467–479. Available from: https://doi.org/10.1016/j.clnu.2009.04.001
  33. Anderegg BA, Worrall C, Barbour E, Simpson KN, Delegge M. Comparison of Resting Energy Expenditure Prediction Methods With Measured Resting Energy Expenditure in Obese, Hospitalized Adults. Journal of Parenteral and Enteral Nutrition. 2009;33(2):168–175. Available from: https://doi.org/10.1177/0148607108327192
  34. Pironi L, Arends J, Bozzetti F, Cuerda C, Gillanders L, Jeppesen PB, et al. ESPEN guidelines on chronic intestinal failure in adults. Clinical Nutrition. 2016;35(2):247–307. Available from: https://doi.org/10.1016/j.clnu.2016.01.020
  35. Cuerda C, Pironi L, Arends J, Bozzetti F, Gillanders L, Jeppesen PB, et al. ESPEN practical guideline: Clinical nutrition in chronic intestinal failure. Clinical Nutrition. 2021;40(9):5196–5220. Available from: https://doi.org/10.1016/j.clnu.2021.07.002
  37. Lloyd DAJ, Gabe SM, Windsor ACJ. Nutrition and management of enterocutaneous fistula. British Journal of Surgery. 2006;93(9):1045–1055. Available from: https://doi.org/10.1002/bjs.5396
  38. Whelan JF, Ivatury RR. Enterocutaneous fistulas: an overview. European Journal of Trauma and Emergency Surgery. 2011;37:251–258. Available from: https://doi.org/10.1007/s00068-011-0097-2
  39. Dubose JJ, Lundy JB. Enterocutaneous fistulas in the setting of trauma and critical illness. Clinics in Colon and Rectal Surgery. 2010;23(3):182–189. Available from: https://doi.org/10.1055/s-0030-1262986
  40. Dudrick SJ, Panait L. Metabolic consequences of patients with gastrointestinal fistulas. European Journal of Trauma and Emergency Surgery. 2011;37:215–225. Available from: https://doi.org/10.1007/s00068-011-0102-9
  41. Bleier JIS, Hedrick T. Metabolic Support of the Enterocutaneous Fistula Patient. Clinics in Colon and Rectal Surgery. 2010;23(03):142–148. Available from: https://doi.org/10.1055/s-0030-1262981
  42. Schecter WP. Management of Enterocutaneous Fistulas. Surgical Clinics of North America. 2011;91(3):481–491. Available from: https://doi.org/10.1016/j.suc.2011.02.004
  43. Draus JM, Huss SA, Harty NJ, Cheadle WG, Larson GM. Enterocutaneous fistula: Are treatments improving? Surgery. 2006;140(4):570–578. Available from: https://doi.org/10.1016/j.surg.2006.07.003
  44. Yanar F, Yanar H. Nutritional support in patients with gastrointestinal fistula. European Journal of Trauma and Emergency Surgery. 2011;37:227–231. Available from: https://doi.org/10.1007/s00068-011-0105-6
  45. Evenson AR, Fischer JE. Current Management of Enterocutaneous Fistula. Journal of Gastrointestinal Surgery. 2006;10(3):455–464. Available from: https://doi.org/10.1016/j.gassur.2005.08.001
  46. Pfeifer J, Tomasch G, Uranues S. The surgical anatomy and etiology of gastrointestinal fistulas. European Journal of Trauma and Emergency Surgery. 2011;37:209–213. Available from: https://doi.org/10.1007/s00068-011-0104-7
  47. Lee SH. Surgical Management of Enterocutaneous Fistula. Korean Journal of Radiology. 2012;13(Suppl 1):S17–S20. Available from: https://doi.org/10.3348/kjr.2012.13.S1.S17
  49. Edmunds LH, Williams GM, Welch CE. External Fistulas Arising from the Gastro-intestinal Tract. Annals of Surgery. 1960;152(3):470–471. Available from: https://doi.org/10.1097/00000658-196015230-00009
  50. Cheatham ML, SK, Brzezinski SJ, Lube MW. Nitrogen balance, protein loss, and the open abdomen. Critical Care Medicine. 2007;35(1):127–131. Available from: https://doi.org/10.1097/01.CCM.0000250390.49380.94
  53. Harkness L. The History of Enteral Nutrition Therapy. Journal of the Academy of Nutrition and Dietetics. 2002;102(3):399–404. Available from: https://doi.org/10.1016/S0002-8223(02)90092-1
  54. Collier B, Guillamondegui O, BC, Donahue R, Conrad A, KG, et al. Feeding the Open Abdomen. Journal of Parenteral and Enteral Nutrition. 2007;31(5):410–415. Available from: https://doi.org/10.1177/0148607107031005410
  57. Dudrick SJ, ARM, AAM. Artificial Nutritional Support in Patients with Gastrointestinal Fistulas. World Journal of Surgery. 1999;23:570–576. Available from: https://doi.org/10.1007/PL00012349
  58. DHA. Enteral feeding and gut atrophy. Current Opinion in Clinical Nutrition and Metabolic Care. 2002;5(6):679–683. Available from: https://journals.lww.com/co-clinicalnutrition/Abstract/2002/11000/Enteral_feeding_and_gut_atrophy.11.aspx
  59. Sedman PC, MacFie J, Palmer MD, Mitchell CJ, Sagar PM. Preoperative total parenteral nutrition is not associated with mucosal atrophy or bacterial translocation in humans . British Journal of Surgery. 1995;82(12):1663–1667. Available from: https://doi.org/10.1002/bjs.1800821226
  61. Bertolini G, Iapichino G, Radrizzani D, Facchini R, Simini B, Bruzzone P, et al. Early enteral immunonutrition in patients with severe sepsis. Intensive Care Medicine. 2003;29:834–840. Available from: https://doi.org/10.1007/s00134-003-1711-5
  62. Zhou T, Wu XT, Zhou YJ, Huang X, Fan W, Li YC. Early removing gastrointestinal decompression and early oral feeding improve patients' rehabilitation after colorectostomy. World Journal of Gastroenterology. 2006;12(15):2459–2463. Available from: https://www.wjgnet.com/1007-9327/full/v12/i15/2459.htm
  63. Black PK. Colostomy. Prof Nurse. 1998;13(12):851–857. Available from: https://pubmed.ncbi.nlm.nih.gov/10095680/
  64. Bradshaw E, Collins B. Managing a colostomy or ileostomy in community nursing practice. British Journal of Community Nursing. 2013;13(11):514–518. Available from: https://doi.org/10.12968/bjcn.2008.13.11.31523
  65. DiBaise J, Matarese L, Messing B, Steiger E. Strategies for Parenteral Nutrition Weaning in Adult Patients With Short Bowel Syndrome. Journal of Clinical Gastroenterology. 2006;40:S94–S98. Available from: https://doi.org/10.1097/01.mcg.0000212679.14172.33
  66. Taylor C, Morgan L. Quality of life following reversal of temporary stoma after rectal cancer treatment. European Journal of Oncology Nursing. 2011;15(1):59–66. Available from: https://doi.org/10.1016/j.ejon.2010.06.002
  68. Subtotal colectomy/panproctocolectomy and j-pouch reconstruction. In: VPK, JAA., eds. Operative Surgery Manual (1). (pp. 20-35) Philadelphia, USA. Saunders Elsevier. 2003.
  69. Tsao SKK, MB, JMDN. High-output stoma after small-bowel resections for Crohn's disease. Nature Clinical Practice Gastroenterology & Hepatology. 2005;2:604–608. Available from: https://doi.org/10.1038/ncpgasthep0343
  71. CVF. Dietary choices of people with ostomies. Journal of WOCN. 2001;28(1):28–31. Available from: https://doi.org/10.1067/mjw.2001.112079
  72. Tsao SKK, Baker M, JMDN. High-output stoma after small-bowel resections for Crohn's disease. Nature Clinical Practice Gastroenterology & Hepatology. 2005;2:604–608. Available from: https://doi.org/10.1038/ncpgasthep0343
  74. Akbulut G. Nutrition in Stoma Patients: A Practical View of Dietary Therapy. International Journal of Hematology and Oncology. 2011;21(1):61–66. Available from: https://www.uhod.org/pdf/PDF_452.pdf

Copyright

© This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Published By India Association for Parenteral and Enteral Nutrition (IAPEN)

  • 11 August 2023

Year: 2023, Volume: 11, Issue: 2


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