de Vries F E E, Reeskamp L F, van Ruler O, van Arum I, Kuin W, Dijksta G, Haveman J W, Boermeester M A, Serlie M J
Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
Department of Surgery, IJsselland Ziekenhuis, Cappele a/d Ijssel, The Netherlands.
Aliment Pharmacol Ther. 2017 Aug;46(3):266-273. doi: 10.1111/apt.14136. Epub 2017 Jun 14.
High-output enterocutaneous fistula or enterostomies can cause intestinal failure. There is a wide variety of options in medical management of patients with high output.
To systematically review the literature on available pharmacotherapy to reduce output and to propose an algorithm for standard of care.
Relevant databases were systematically reviewed to identify studies on pharmacotherapy for reduction in (high-) output enterostomies or fistula. Randomised controlled trials and within subjects controlled prospective trials were included. An algorithm for standard of care was generated based on the outcomes of the systematic review.
Two studies on proton pump inhibitors, six on anti-motility agents, three on histamine receptor antagonists, one on an α2- receptor agonist and eight on somatostatin (analogues) were included. One study examined a proton pump inhibitor and a histamine receptor antagonist within the same patients. Overall, we found evidence for the following medical therapies to be effective: omeprazole, loperamide and codeine, ranitidine and cimetidine. On the basis of these outcomes and clinical experience, we proposed an algorithm for standard of care which consists of high-dose proton pump inhibitors combined with high-dose loperamide as the first step followed by addition of codeine in case of insufficient output reduction. So far, there is insufficient evidence for the standard use of somatostatin (analogues).
The available evidence on the efficacy of medication to reduce enterostomy or enterocutaneous fistula output is hampered by low quality studies. We propose an algorithm for standard of care output reduction in these patients.
高流量肠造口或肠外瘘可导致肠衰竭。对于高流量患者的医疗管理有多种选择。
系统回顾关于可用药物治疗以减少肠造口或肠外瘘流量的文献，并提出护理标准算法。
系统回顾相关数据库，以识别关于减少（高）流量肠造口或肠外瘘药物治疗的研究。纳入随机对照试验和自身对照前瞻性试验。根据系统评价结果生成护理标准算法。
纳入两项关于质子泵抑制剂的研究、六项关于抗动力药物的研究、三项关于组胺受体拮抗剂的研究、一项关于α2受体激动剂的研究和八项关于生长抑素（类似物）的研究。一项研究在同一患者中考察了质子泵抑制剂和组胺受体拮抗剂。总体而言，我们发现以下药物治疗有效：奥美拉唑、洛哌丁胺和可待因、雷尼替丁和西咪替丁。基于这些结果和临床经验，我们提出了一种护理标准算法，第一步是高剂量质子泵抑制剂联合高剂量洛哌丁胺，若流量减少不足则加用可待因。目前，生长抑素（类似物）的标准使用证据不足。
关于减少肠造口或肠外瘘流量药物疗效的现有证据因研究质量低而受到影响。我们提出了一种这些患者护理标准流量减少算法。
