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Nutritional management using elemental diet for adult patients with severe short bowel syndrome



Nutritional management using elemental diet for adult patients with severe short bowel syndrome



Acta Medica et Biologica 40(3): 97-103



This paper reviews the problems and methods in the treatment of patients suffering from short bowel syndrome (SBS) after removal of large parts of the small intestine. Twenty-eight patients with severe SBS received medical treatment at our department from 1966 through 1989. All patients who could pass through the first postoperative period with the help of intravenous hyperalimentation (IVH) received further IVH or enteral hyperalimentation at home to maintain nuritional condition and promote social rehabilitation. Six patients unable to receive hyperalimentation died from insufficient nutrition within 2 years after the intestinal resection. Seventeen (77%) of the 22 patients who received parenteral or enteral hyperalimentation at home survived and rehabilitated socially. Of five patients (23%) whose remnant small intestines were shorter than 70 cm, four died of pneumonia caused by malnutrition in spite of receiving parenteral or enteral hyperalimentation. The other died of senility 13 years after the operation. The nutritional assessment indicated that the serum concentrations of albumin in those patients who died of malnutrition were significantly decreased compared with those of the survivors. Among many other nutritional parameters, only the percentage of AMC (arm muscle circumference) and serum concentrations of PA (prealbumin), RBP (retinol binding protein) and Zn showed statistically significant decreases from the normal range in the longer surviving patients. Among the causes of the nutritional deficiency of patients with SBS, statisically significant derangements of digestion and absorption of fat and protein were observed. In order to ensure hyperalimentation at home for SBS patients the following measures are essential: 1) Patients whose remnant small intestine is shorter than 30 cm will need home parenteral nutrition (HPN) throughout life. 2) Although 2/3 of patients whose remnant small intestine is 30-70 cm in length gradually become able to tolerate natural foods, 1/3 will necessitate home enteral nutrition (HEN) using an elemental diet (ED) throughout life. 3) Patients with the small intestine longer than 70 cm will be able to take normal foods soon after the recovery from the first operative period. The techniques of HEN using ED introduced in this paper have proved useful for the nutritional support of severe SBS patients whose remnant small intestine was 30-70 cm in length.

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