Intestinal adaptation in short bowel syndrome without tube feeding or home parenteral nutrition: report of four consecutive cases

Nutrition
T R SalesE B Carvalho

Abstract

Because home total parenteral nutrition (TPN) is not available to most of the Brazilian population, an alternative treatment for short bowel syndrome was evaluated. Four patients ages 40-65 y (mean: 53.75 +/- 10.59), three with mesenteric thrombosis, and one with Crohn's disease were studied. The average length of the remaining small bowel in these patients was 54.5 +/- 6.4 cm; the ileocecal valve was preserved in 3 cases. A progressive step diet was used for intestinal adaptation. Administration of pectin was started at the beginning of the special oral diet (step 1), followed by medium-chain triacylglycerols (MCTs) and complex, nonfermentable sugars (step 2); coconut oil (47% MCTs) and simple sugars (step 3); and long-chain triacylglycerols and lactose (step 4). TPN was interrupted at step 3 or 4 when the energy content of the diet reached 150% of the patient's resting energy expenditure, if serum albumin and weight were stable or increasing, and if the frequency, amount, and consistency of stools remained unchanged. Nutritional follow-up showed that patients responded well to this approach; also, patients returned to their previous professional activities. Thus, enteral formulas were not essential for gastrointestinal adapta...Continue Reading

References

Jun 1, 1975·Archives of Surgery·Y KogaN Hashimoto
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Aug 1, 1993·Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition·D K Bernard, M J Shaw

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Citations

Jan 15, 2009·Nature Reviews. Cancer·María Elena MartínezEdward Giovannucci
Nov 2, 2001·Seminars in Pediatric Surgery·D A Beals
Feb 8, 2002·World Journal of Gastroenterology : WJG·Cameron F E PlatellJohn C Hall
Apr 28, 2007·Seminars in Perinatology·Jacqueline J Wessel, Samuel A Kocoshis

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