Division of Clinical Nutrition, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand.
Clinical Nutrition, University of Chicago Medicine, Chicago, IL 60637, USA.
Nutrients. 2023 Jun 16;15(12):2763. doi: 10.3390/nu15122763.
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.
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.
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.
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.
国际上有针对短肠综合征（SBS）高流量排便（HSO）管理的实践指南，但缺乏实施数据。本研究描述了在不同全球区域管理 SBS 患者 HSO 的方法。
这是一项国际多中心研究，采用问卷调查评估 HSO 在 SBS 患者中的医学管理。邀请 33 个肠衰竭中心作为一个多学科团队完成调查。
调查的回复率为 91%。饮食建议因解剖结构和地理位置而异。对于没有连续性结肠（CiC）的患者，临床实践通常与 ESPEN 指南一致，包括将液体与固体食物分离（90%）、高钠饮食（90%）和低糖饮食（75%）。对于 CiC 患者，实践不太符合指南，例如低脂肪饮食（35%）或高钠饮食（50%）。一线抗动力药和抗分泌药物是洛哌丁胺和质子泵抑制剂。在现实实践中还使用了其他治疗药物（如胰酶和胆汁酸结合剂），并根据肠道解剖结构的不同而有所差异。
专家中心在很大程度上遵循了发表的无 CiC SBS 患者 HSO 管理指南，但 CiC 患者的临床实践存在很大差异。确定这种差异的原因可能为未来指南的制定提供信息。
