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The Role of Nutrition in the Prevention and Treatment of Malnutrition in Short Bowel Syndrome: A Traditional Review

Year 2024, Volume: 9 Issue: 2, 83 - 97, 30.08.2024
https://doi.org/10.52881/gsbdergi.1442998

Abstract

Short bowel syndrome is not common in the general population, but it is thought to have a 2-fold increase in prevalence in the last four decades. In this disease, which is accompanied by different pathophysiologic mechanisms depending on the type of congenital anomaly or surgical resection, one of the biggest problems of patients is malabsorption. Malabsorption and associated stoma loss lead to the risk of severe malnutrition. In cases where oral nutrition is inadequate, this situation requires the patient to be treated with long-term enteral and/or parenteral nutrition. After determining the nutritional requirements of the patients in accordance with their metabolic and physiologic conditions, a diet rich in sufficient energy, protein and micronutrients is essential in treatment. A diet containing 20-35 kcal/kg energy and 0.8-1.4 g/kg protein to meet daily energy and protein requirements should be planned by a specialized dietician. Some recent studies have shown that supplements such as probiotics, omega-3 and citrulline have positive effects on metabolic processes related to short bowel syndrome. Bacterial genera such as Lactobacillus and Bifidobacterium have come to the fore in probiotic studies. Omega-3 fatty acids may be effective in the treatment of cholestasis due to parenteral nutrition and may be a new protective agent of the liver in case of parenteral nutrition. However, clinical trials with a high level of evidence for the use of these supplements in the clinic are still needed. Patients with short bowel syndrome should be followed by a multidisciplinary team for medical and nutritional therapy.

References

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Kısa Bağırsak Sendromunda Malnutrisyonun Önlenmesi ve Tedavisinde Beslenmenin Rolü: Geleneksel Derleme

Year 2024, Volume: 9 Issue: 2, 83 - 97, 30.08.2024
https://doi.org/10.52881/gsbdergi.1442998

Abstract

Kısa bağırsak sendromu toplumda yaygın görülmemekle birlikte son kırk yılda prevalansında 2 kat artış olduğu düşünülen bir hastalıktır. Konjenital anomalinin türü veya uygulanan cerrahi rezeksiyona bağlı olarak farklı patofizyolojik mekanizmaların eşlik ettiği bu hastalıkta, hastaların en büyük problemlerinden biri malabsorpsiyondur. Malabsorpsiyon ve buna bağlı stoma kayıpları hastada ciddi malnütrisyon gelişme riskini doğurmaktadır. Bu durum oral beslenmenin yetersiz olduğu durumlarda ek olarak hastanın uzun dönem enteral ve/veya parenteral beslenme ile tedavi edilmesini gerektirmektedir. Hastaların metabolik ve fizyolojik koşullarına uygun beslenme gereksinimleri saptandıktan sonra yeterli enerji, protein ve mikrobesin ögelerinden zengin bir diyet içeriğinin olması tedavide elzemdir. Günlük enerji ve protein gereksinimlerini karşılamak adına 20-35 kkal/kg enerji ve 0.8-1.4 g/kg protein içeren bir diyet, konu ile ilgili uzman bir diyetisyen tarafından planlanmalıdır. Son dönemde yapılan bazı araştırmalar, probiyotik, omega-3 ve sitrulin gibi takviyelerin kısa bağırsak sendromuna ilişkin metabolik süreçlerde olumlu etkileri olduğunu ortaya koymuştur. Probiyotik çalışmalarında özellikle Lactobacillus ve Bifidobacterium gibi bakteri cinsleri ön plana çıkmıştır. Omega-3 yağ asitlerinin parenteral beslenmeye bağlı kolestaz tedavisinde etkili olabileceği ve parenteral beslenme durumunda karaciğerin yeni bir koruyucu ajanı olabileceği ortaya koyulmuştur. Sitrulin takviyesinin 0.1-3.0 mg/kg/gün doz aralığında uygulandığında bağırsak sağlığı üzerinde potansiyel etkiler geliştirebileceği saptanmıştır. Bununla beraber bu takviyelerin klinikte kullanımına ilişkin hala kanıt düzeyi yüksek klinik araştırmalara ihtiyaç vardır. Kısa bağırsak sendromu hastaları, medikal tedavi ve tıbbi beslenme tedavisi açısından multidisipliner bir ekiple takip edilmelidir.

References

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  • 3. Pironi L, Hébuterne X, Van Gossum A, et al. Candidates for intestinal transplantation: a multicenter survey in Europe. Am J Gastroenterol. 2006;101(7):1633-1643. doi:10.1111/J.1572-0241.2006.00710.X
  • 4. Massironi S, Cavalcoli F, Rausa E, Invernizzi P, Braga M, Vecchi M. Understanding short bowel syndrome: Current status and future perspectives. Digestive and Liver Disease. 2020;52(3):253-261. doi:10.1016/J.DLD.2019.11.013
  • 5. Cuerda C, Pironi L, Arends J, et al. ESPEN practical guideline: Clinical nutrition in chronic intestinal failure. Clinical Nutrition. 2021;40(9):5196-5220. doi:10.1016/J.CLNU.2021.07.002
  • 6. Brandt CF, Hvistendahl M, Naimi RM, et al. Home Parenteral Nutrition in Adult Patients With Chronic Intestinal Failure: The Evolution Over 4 Decades in a Tertiary Referral Center. JPEN J Parenter Enteral Nutr. 2017;41(7):1178-1187. doi:10.1177/0148607116655449
  • 7. Van Gossum A, Bakker H, Bozzetti F, et al. Home parenteral nutrition in adults: a european multicentre survey in 1997. ESPEN-Home Artificial Nutrition Working Group. Clin Nutr. 1999;18(3):135-140. doi:10.1054/CLNU.1999.0021
  • 8. Howard L, Ament M, Richard Fleming C, Shike M, Steiger E. Current use and clinical outcome of home parenteral and enteral nutrition therapies in the United States. Gastroenterology. 1995;109(2):355-365. doi:10.1016/0016-5085(95)90321-6
  • 9. Nightingale J, Woodward JM. Guidelines for management of patients with a short bowel. Gut. 2006;55 Suppl 4(Suppl 4). doi:10.1136/GUT.2006.091108
  • 10. Cummings JH, James WPT, Wiggins HS. ROLE OF THE COLON IN ILEAL-RESECTION DIARRHŒA. The Lancet. 1973;301(7799):344-347. doi:10.1016/S0140-6736(73)90131-1
  • 11. Pironi L, Corcos O, Forbes A, et al. Intestinal failure in adults: Recommendations from the ESPEN expert groups. Clinical Nutrition. 2018;37(6):1798-1809. doi:10.1016/J.CLNU.2018.07.036
  • 12. Dudrick SJ, Latifi R, Fosnocht DE. Management of the short-bowel syndrome. Surg Clin North Am. 1991;71(3):625-643. doi:10.1016/S0039-6109(16)45438-1
  • 13. Stump SE. Nutrition and Diagnosis-Related Care. 3rd ed. Philadelphia: Lea & Febiger; 1993.
  • 14. Andersson H, Bosaeus I, Brummer RJ, et al. Nutritional and metabolic consequences of extensive bowel resection. Dig Dis. 1986;4(4):193-202. doi:10.1159/000171149
  • 15. Delin K, Fasth S, Andersson H, Aurell M, Hultén L, Jagenburg R. Factors regulating sodium balance in proctocolectomized patients with various ileal resections. Scand J Gastroenterol . 1984;19(2):145-149.
  • 16. Hessov I, Hasselblad C, Fasth S, Hultén L. Magnesium deficiency after ileal resections for Crohn’s disease. Scand J Gastroenterol. 1983;18(5):643-649. doi:10.3109/00365528309181651
  • 17. Hofmann AF. Bile Acid Malabsorption Caused by Ileal Resection. Arch Intern Med. 1972;130(4):597-605. doi:10.1001/ARCHINTE.1972.03650040121011
  • 18. Andersson H, Filipsson S, Hultén L. Determination of the faecal excretion of labelled bile salts after i.v. administration of 14C-cholic acid. An evaluation of the bile salt malabsorption before and after surgery in patients with Crohn’s disease. Scand J Gastroenterol. 1978;13(2):249-255. doi:10.3109/00365527809181756
  • 19. Bambach CP, Hill GL. Long term nutritional effects of extensive resection of the small intestine. Aust N Z J Surg. 1982;52(5):500-506. doi:10.1111/J.1445-2197.1982.TB06039.X
  • 20. Engels LGJ, Van den Hamer CJA, Van Tongeren JHM. Iron, zinc, and copper balance in short bowel patients on oral nutrition. Am J Clin Nutr. 1984;40(5):1038-1041. doi:10.1093/AJCN/40.5.1038
  • 21. Nightingale JMD, Kamm MA, Van Der Sijp JRM, Ghatei MA, Bloom SR, Lennard-Jones JE. Gastrointestinal hormones in short bowel syndrome. Peptide YY may be the “colonic brake” to gastric emptying. Gut. 1996;39(2):267. doi:10.1136/GUT.39.2.267
  • 22. Carroll RE, Benedetti E, Schowalter JP, Buchman AL. Management and Complications of Short Bowel Syndrome: an Updated Review. Curr Gastroenterol Rep. 2016;18(7). doi:10.1007/S11894-016-0511-3
  • 23. Martin GR, Wallace LE, Hartmann B, et al. Nutrient-stimulated GLP-2 release and crypt cell proliferation in experimental short bowel syndrome. Am J Physiol Gastrointest Liver Physiol. 2005;288(3). doi:10.1152/AJPGI.00242.2004
  • 24. Le HD, De Meijer VE, Robinson EM, et al. Parenteral fish-oil-based lipid emulsion improves fatty acid profiles and lipids in parenteral nutrition-dependent children. Am J Clin Nutr. 2011;94(3):749-758. doi:10.3945/AJCN.110.008557
  • 25. Sukhotnik I, Shany A, Bashenko Y, et al. Parenteral but not enteral omega-3 fatty acids (Omegaven) modulate intestinal regrowth after massive small bowel resection in rats. JPEN J Parenter Enteral Nutr. 2010;34(5):503-512. doi:10.1177/0148607110362586
  • 26. Sevela S, Meisnerova E, Vecka M, et al. High Dose Fish Oil Added to Various Lipid Emulsions Normalizes Superoxide Dismutase 1 Activity in Home Parenteral Nutrition Patients. Nutrients. 2024;16(4). doi:10.3390/NU16040485
  • 27. Channabasappa N, Girouard S, Nguyen V, Piper H. Enteral Nutrition in Pediatric Short-Bowel Syndrome. Nutrition in Clinical Practice. 2020;35(5):848-854. doi:10.1002/NCP.10565
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There are 66 citations in total.

Details

Primary Language Turkish
Subjects Clinical Nutrition
Journal Section Makaleler
Authors

Tuba Kahraman 0000-0001-7720-3162

Zekiye Zeynep Bostan 0000-0001-9783-0972

Gülhan Samur 0000-0003-0456-4623

Publication Date August 30, 2024
Submission Date February 26, 2024
Acceptance Date July 3, 2024
Published in Issue Year 2024 Volume: 9 Issue: 2

Cite

APA Kahraman, T., Bostan, Z. Z., & Samur, G. (2024). Kısa Bağırsak Sendromunda Malnutrisyonun Önlenmesi ve Tedavisinde Beslenmenin Rolü: Geleneksel Derleme. Gazi Sağlık Bilimleri Dergisi, 9(2), 83-97. https://doi.org/10.52881/gsbdergi.1442998
AMA Kahraman T, Bostan ZZ, Samur G. Kısa Bağırsak Sendromunda Malnutrisyonun Önlenmesi ve Tedavisinde Beslenmenin Rolü: Geleneksel Derleme. Gazi Health Sci. August 2024;9(2):83-97. doi:10.52881/gsbdergi.1442998
Chicago Kahraman, Tuba, Zekiye Zeynep Bostan, and Gülhan Samur. “Kısa Bağırsak Sendromunda Malnutrisyonun Önlenmesi Ve Tedavisinde Beslenmenin Rolü: Geleneksel Derleme”. Gazi Sağlık Bilimleri Dergisi 9, no. 2 (August 2024): 83-97. https://doi.org/10.52881/gsbdergi.1442998.
EndNote Kahraman T, Bostan ZZ, Samur G (August 1, 2024) Kısa Bağırsak Sendromunda Malnutrisyonun Önlenmesi ve Tedavisinde Beslenmenin Rolü: Geleneksel Derleme. Gazi Sağlık Bilimleri Dergisi 9 2 83–97.
IEEE T. Kahraman, Z. Z. Bostan, and G. Samur, “Kısa Bağırsak Sendromunda Malnutrisyonun Önlenmesi ve Tedavisinde Beslenmenin Rolü: Geleneksel Derleme”, Gazi Health Sci, vol. 9, no. 2, pp. 83–97, 2024, doi: 10.52881/gsbdergi.1442998.
ISNAD Kahraman, Tuba et al. “Kısa Bağırsak Sendromunda Malnutrisyonun Önlenmesi Ve Tedavisinde Beslenmenin Rolü: Geleneksel Derleme”. Gazi Sağlık Bilimleri Dergisi 9/2 (August 2024), 83-97. https://doi.org/10.52881/gsbdergi.1442998.
JAMA Kahraman T, Bostan ZZ, Samur G. Kısa Bağırsak Sendromunda Malnutrisyonun Önlenmesi ve Tedavisinde Beslenmenin Rolü: Geleneksel Derleme. Gazi Health Sci. 2024;9:83–97.
MLA Kahraman, Tuba et al. “Kısa Bağırsak Sendromunda Malnutrisyonun Önlenmesi Ve Tedavisinde Beslenmenin Rolü: Geleneksel Derleme”. Gazi Sağlık Bilimleri Dergisi, vol. 9, no. 2, 2024, pp. 83-97, doi:10.52881/gsbdergi.1442998.
Vancouver Kahraman T, Bostan ZZ, Samur G. Kısa Bağırsak Sendromunda Malnutrisyonun Önlenmesi ve Tedavisinde Beslenmenin Rolü: Geleneksel Derleme. Gazi Health Sci. 2024;9(2):83-97.