A multidisciplinary team evaluation of management guidelines for adult short bowel syndrome

Wall, Elizabeth; Catron, Hilary; Delgado, Adela; Greif, Sophie; Herlitz, Jean; Moccia, Lisa; Lozano, Edward; Mercer, David F.; Vanuytsel, Tim; Berner-Hansen, Mark; Lakananurak, Narisorn; Gramlich, Leah

doi:10.1016/j.clnesp.2022.12.029

Cited by 4 publications

(5 citation statements)

References 5 publications

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“…Short bowel syndrome (SBS) is a rare malabsorption condition because of the patient's lack of small intestine [32]. Usually, symptoms of SBS can be noticed when a patient is left with less than 200 cm of the small intestine [33]. SBS goes hand in hand with a reduction in gut function and impaired absorption of micronutrients, water, and electrolytes.…”

Section: Discussionmentioning

confidence: 99%

A Novel Mutation of MSH2 Gene in a Patient with Lynch Syndrome Presenting with Thirteen Metachronous Malignancies

Silinskaite,

Gavelienė,

Stulpinas

et al. 2023

JCM

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Lynch syndrome (LS), also known as hereditary nonpolyposis colorectal cancer (HNPCC), accounts for 2–3% of all colorectal cancers. This autosomal dominant disorder is associated with a predisposition to endometrial, stomach, small bowel, pancreatic, biliary tract, ovary, urinary tract, brain, and skin tumors. Lynch syndrome is caused by the mutation of the MLH1, MSH2 (EPCAM), MSH6, and PMS2 genes. In this article, a case study of a 70-year-old female patient with Lynch syndrome is presented. Over a span of 30 years, the patient underwent multiple surgical procedures for a total of thirteen different malignancies. She was found to have a deleterious pathogenic gene MSH2 (NM_000251.2) variant (mutation) c.1774_1775insT in the 12th exon. This variant, c.1774_1775insT, represents a novel finding, as it has not been previously reported in existing databases or literature. No other case of 13 metachronous tumors in a patient with Lynch syndrome was found in the literature.

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Section: Discussionmentioning

confidence: 99%

A Novel Mutation of MSH2 Gene in a Patient with Lynch Syndrome Presenting with Thirteen Metachronous Malignancies

Silinskaite,

Gavelienė,

Stulpinas

et al. 2023

JCM

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“…The gaps determined by the group were then prioritized, and a questionnaire was developed to address these gaps. The methods of this process have been described in detail previously [ 12 , 13 ]. HSO was considered one of the major problems in patients with SBS.…”

Section: Methodsmentioning

confidence: 99%

Real-World Management of High Stool Output in Patients with Short Bowel Syndrome: An International Multicenter Survey

et al. 2023

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Background: International practice guidelines for high-stool-output (HSO) management in short bowel syndrome (SBS) are available, but data on implementation are lacking. This study describes the approach used to manage HSO in SBS patients across different global regions. Methods: This is an international multicenter study evaluating medical management of HSO in SBS patients using a questionnaire survey. Thirty-three intestinal-failure centers were invited to complete the survey as one multidisciplinary team. Results: Survey response rate was 91%. Dietary recommendations varied based on anatomy and geographic region. For patients without colon-in-continuity (CiC), clinical practices were generally consistent with ESPEN guidelines, including separation of fluid from solid food (90%), a high-sodium diet (90%), and a low-simple-sugar diet (75%). For CiC patients, practices less closely followed guidelines, such as a low-fat diet (35%) or a high-sodium diet (50%). First-line antimotility and antisecretory medications were loperamide and proton-pump inhibitors. Other therapeutic agents (e.g., pancreatic enzymes and bile acid binders) were utilized in real-world practices, and usage varied based on intestinal anatomy. Conclusion: Expert centers largely followed published HSO-management guidelines for SBS patients without CiC, but clinical practices deviated substantially for CiC patients. Determining the reasons for this discrepancy might inform future development of practice guidelines.

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“…Recently, guidelines and recommendations have been developed by the American Gastroenterological Association (AGA) [ 55 ], ASPEN [ 85 , 90 ], and ESPEN [ 91 ]. Although an extensive review is beyond the scope of this manuscript, it is essential to highlight some basic concepts: Nutritional interventions to treat SBS include enteral and PN, intestinal rehabilitation techniques to increase the absorptive ability of the residual bowel, and surgical reconstruction designed to enhance the surface area for absorption [ 92 , 93 , 94 ]. Therefore, managing these patients requires a comprehensive and interdisciplinary approach in centers with proven experience in treating such challenging scenarios [ 93 , 94 , 95 , 96 , 97 ].…”

Section: Short Bowel Syndrome (Sbs)mentioning

confidence: 99%

“…Although an extensive review is beyond the scope of this manuscript, it is essential to highlight some basic concepts: Nutritional interventions to treat SBS include enteral and PN, intestinal rehabilitation techniques to increase the absorptive ability of the residual bowel, and surgical reconstruction designed to enhance the surface area for absorption [ 92 , 93 , 94 ]. Therefore, managing these patients requires a comprehensive and interdisciplinary approach in centers with proven experience in treating such challenging scenarios [ 93 , 94 , 95 , 96 , 97 ]. This issue is essential, as has been demonstrated by Geransar P et al, who reported a low level of awareness of chronic IF among non-specialist healthcare professionals [ 95 ].…”

Section: Short Bowel Syndrome (Sbs)mentioning

confidence: 99%

“…Nutritional interventions to treat SBS include enteral and PN, intestinal rehabilitation techniques to increase the absorptive ability of the residual bowel, and surgical reconstruction designed to enhance the surface area for absorption [ 92 , 93 , 94 ]. Therefore, managing these patients requires a comprehensive and interdisciplinary approach in centers with proven experience in treating such challenging scenarios [ 93 , 94 , 95 , 96 , 97 ].…”

Section: Short Bowel Syndrome (Sbs)mentioning

confidence: 99%

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Metabolic and Nutritional Issues after Lower Digestive Tract Surgery: The Important Role of the Dietitian in a Multidisciplinary Setting

Utrilla Fornals,

Costas-Batlle,

Medlin

et al. 2024

Nutrients

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Many patients undergo small bowel and colon surgery for reasons related to malignancy, inflammatory bowel disease (IBD), mesenteric ischemia, and other benign conditions, including post-operative adhesions, hernias, trauma, volvulus, or diverticula. Some patients arrive in the operating theatre severely malnourished due to an underlying disease, while others develop complications (e.g., anastomotic leaks, abscesses, or strictures) that induce a systemic inflammatory response that can increase their energy and protein requirements. Finally, anatomical and functional changes resulting from surgery can affect either nutritional status due to malabsorption or nutritional support (NS) pathways. The dietitian providing NS to these patients needs to understand the pathophysiology underlying these sequelae and collaborate with other professionals, including surgeons, internists, nurses, and pharmacists. The aim of this review is to provide an overview of the nutritional and metabolic consequences of different types of lower gastrointestinal surgery and the role of the dietitian in providing comprehensive patient care. This article reviews the effects of small bowel resection on macronutrient and micronutrient absorption, the effects of colectomies (e.g., ileocolectomy, low anterior resection, abdominoperineal resection, and proctocolectomy) that require special dietary considerations, nutritional considerations specific to ostomized patients, and clinical practice guidelines for caregivers of patients who have undergone a surgery for local and systemic complications of IBD. Finally, we highlight the valuable contribution of the dietitian in the challenging management of short bowel syndrome and intestinal failure.

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A multidisciplinary team evaluation of management guidelines for adult short bowel syndrome

Cited by 4 publications

References 5 publications

A Novel Mutation of MSH2 Gene in a Patient with Lynch Syndrome Presenting with Thirteen Metachronous Malignancies

A Novel Mutation of MSH2 Gene in a Patient with Lynch Syndrome Presenting with Thirteen Metachronous Malignancies

Real-World Management of High Stool Output in Patients with Short Bowel Syndrome: An International Multicenter Survey

Metabolic and Nutritional Issues after Lower Digestive Tract Surgery: The Important Role of the Dietitian in a Multidisciplinary Setting

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