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Artificial nutrition for the treatment of short bowel syndrome.

Authors
  • Giammanco, M1
  • Caldiero, G
  • Raimondo, D
  • Sammartano, A
  • Frazzetta, M
  • Vetri, G
  • Di Gesù, G
  • 1 Unit of Surgical Pathophysiology, Division of General Surgery, Department of Surgery, Anatomy and Oncological Science, University of Palermo, Palermo, Italy. , (Italy)
Type
Published Article
Journal
Minerva chirurgica
Publication Date
Aug 01, 2003
Volume
58
Issue
4
Pages
545–549
Identifiers
PMID: 14603167
Source
Medline
Language
English
License
Unknown

Abstract

In the short bowel syndromes (SBS) it is often difficult to grant a correct and sufficient alimentary supply only by ordinary natural nutrition. In the present research, we will study the prospective possibilities of integrating the nutritional supply making resort to artificial nutrition techniques in patients with SBS. We have treated 7 patients with SBS, 6 males and 1 female, whose age was ranging from 29 and 70 years. They all underwent wide intestinal resection, 2 of them for massive infarct, 4 for Crohn's disease, 1 for bowel volvolus. An evaluation of nutritional and immunological conditions was performed on all of them, determining: albumin, transferrin, C-reactive protein, prealbumin, leukocyte count, skin test. In a second time, a protocol was implemented, based on total parenteral nutrition for the first 5 days, with scalar calorie supply up to a total of 35 kcal/kg/die; on day 6 after the operation, the parenteral caloric supply was reduced of 500 kcal/die, being compensated by the introduction of an equal caloric ration by nasointestinal tube with peristaltic pump having a flow of 20 mL/h. In the following days, the parenteral caloric supply was reduced of 500 cal each 48 hours, being substituted with an equal enteral supply in order to progressively reach a complete abandonment of parenteral nutrition. All the patients have a follow-up of 2 to 5 years; today they follow a high-calorie hyperglycidic, hypolipidic diet; no signs of malnutrition are shown by clinical and laboratory analysis. In the light of the data in our possession, it can be understood that nutritional therapy is the main treatment for SBS; parenteral subministration has to be abandoned during the postoperatory course to give way to enteral nutrition, in order to create a physiological stimulus able to make the digestive system rapidly adapt to the new situation.

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