The Pharmacologic Treatment of Short Bowel Syndrome: New Tricks and Novel Agents

Bechtold, Matthew L.; McClave, Stephen A.; Palmér, Lena; Nguyen, Douglas L.; Urben, Lindsay; Martindale, Robert G.; Hurt, Ryan T.

doi:10.1007/s11894-014-0392-2

Cited by 29 publications

(17 citation statements)

References 68 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Loperamide is added to reduce gastrointestinal transit time through the reduction of circular and longitudinal muscle activity and to diminish gastric acid, biliary, and pancreatic secretions, thus reducing the fluid volume in the intestinal lumen. 22 At the time of restoring bowel continuity, the child then is more likely to have slower motility and therefore less perineal rash. In infants, high-output stomas are problematic because of the recurrent episodes of dehydration, electrolyte disturbance (particularly sodium loss), and failure to thrive, which might require repeated hospitalizations.…”

Section: Discussionmentioning

confidence: 99%

“…Also proton-pump inhibitors seem to be more effective than H2-blockers in reducing intestinal output, but only when associated with antidiarrheals/antimotility agents when the dose is maximized. 22,23 If at the time of the planned pull through and/or ileostomy closure the consistency and volume of the ileostomy output do not improve, the surgery should be delayed to optimize the medical management of the hypermotility (►Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…The mean age at pull through was 17.5 months (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). At the time of the ileoanal pull through, eight of nine of these patients were not toilet trained for urine.…”

Section: Patients Who Underwent a Primary Pull Through At Our Center mentioning

confidence: 99%

See 2 more Smart Citations

Total Colonic Hirschsprung's Disease: The Hypermotility and Skin Rash Protocol

et al. 2019

View full text Add to dashboard Cite

Introduction Total colonic Hirschsprung's disease (TCHD) presents a postoperative challenge due to multiple stools and perineal rash. We propose a protocol developed by pediatric surgeons and ostomy nurses to help prevent and treat hypermotility and severe perineal rash, especially in younger children who are not toilet trained. Materials and Methods We retrospectively reviewed our TCHD patients' charts from 2014 to 2017. All patients received a prescribed protocol for the treatment of hypermotility and perineal rash. We describe patients who underwent their pull through before and after the age of urine toilet training, and assessed the number of bowel movements, the perineal skin status, and growth. Results We treated 25 patients. Out of 25, 9 patients received a straight ileoanal pull through before the age of 18 months. Nine of 25 patients presented for a second opinion and had redo pull through. The remaining seven presented for bowel management after having a pull through at another institution. All these were treated following the hypermotility protocol. In total, 19 of 25 patients were not toilet trained. The mean number of bowel movements in all groups was 4 (3–5). All had a resolution of perineal rash and liquid stools after 3 months. Eleven of the 25 patients presented with failure to thrive. Two older patients experienced severe proctalgia requiring replacement of the ileostomy. Conclusion TCHD patients who underwent definitive pull through had nine high incidence of multiple stool, perineal rash, and low growth. With the implementation of bowel management care to slow the stools and a perineal skin protocol to treat the skin, we believe that these symptoms can be minimized even in patients who are not toilet trained. Since the implementation of this protocol, we have changed our practice to perform the pull through in such patients between the age of 6 and 18 months.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Total Colonic Hirschsprung's Disease: The Hypermotility and Skin Rash Protocol

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Loperamide is often the first antimotility agent employed because of its relatively benign composition in comparison with diphenoxylate‐atropine (Lomotil), codeine, and tincture of opium. Although loperamide is an intestinal opioid receptor antagonist, it does not cross the blood‐brain barrier (BBB), thereby avoiding the risk of central nervous system (CNS) side effects 77,78 . In the case of high‐output ECFs, reports have found that a dose <12–24 mg/day is unlikely to be effective secondary to rapid transit of the medication 78 .…”

Section: Pharmacological Interventionsmentioning

confidence: 99%

Nutrition Management of the High‐Output Fistulae

et al. 2020

View full text Add to dashboard Cite

Enterocutaneous fistulae (ECFs) are commonly encountered complications in medical and surgical practice. High-output fistulae are associated with significant morbidity and mortality, poor quality of life, and a substantial healthcare burden. An interdisciplinary team approach is crucial to prevent and mitigate the adverse clinical consequences of high-output ECFs including sepsis, metabolic derangements, and malnutrition. Patients with ECFs are at a significantly higher risk of developing malnutrition and close monitoring by nutrition support professionals and/or a nutrition support team is an essential component of their medical management. High-output ECFs often require the initiation of nutrition support through either enteral or parenteral routes. Historically, parenteral nutrition (PN) has been the primary method of nutrition support in these patients. However, oral and enteral nutrition (EN) should remain viable options if an evaluation of the location of the ECF, amount of remaining functional bowel, and volume of ECF output identifies favorable conditions. Additionally, in contrast to PN, oral nutrition and EN are the preferred method of feeding because of the maintenance of the structural and functional integrity of the gastrointestinal tract. The inclusion of pharmacological interventions can greatly assist with the reduction and stabilization of ECF output and thereby permit sustained enteral feeding. Initiation of supplemental or full PN will be required if oral nutrition and EN lead to metabolic derangements, fail to meet energy requirements, or do not maintain or improve the patient's nutrition status. The main focus of this review is to discuss the nutrition management of patients with high-output ECFs.

show abstract

“…Short bowel syndrome (SBS) is a highly disabling malabsorptive syndrome characterized by inability to maintain protein energy, fluid, electrolyte, and micronutrient balance in the body due to loss of intestinal absorptive capacity from congenital defect or extensive small bowel resection in the setting of diseases such as Crohn's disease, ischemic bowel disease, pseudomyxoma peritonei, and cancer 1 – 3 . One of the most common clinical presentations is chronic diarrhea associated with weight loss, fatigue, edema, cramps, and dehydration 4 .…”

mentioning

confidence: 99%