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

Abstract

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.

Fat malabsorption in pancreatic cancer: Pathophysiology and management

“…These medications are used frequently in other malabsorptive conditions and have shown improvements in decreasing fecal output and improving stool consistency. 58 As with PERT, the timing of these medications is critical to optimize absorption. Antidiarrheal medications should be taken 30-60 min before meals to allow medication absorption and a subsequent increase in intestinal transit time before the food bolus entering the gastrointestinal tract.…”

“…There is a lack of consensus on dosing strategies; however, initiation of loperamide 2-4 mg before meals and at bedtime, before advancing to diphenoxylate/ atropine, codeine, and tincture of opium, is a common approach in other malabsorptive conditions. 58…”