Nutrition support for short bowel syndrome

Many patients require parenteral nutrition after significant bowel resection. However, adaptation in the remaining small bowel allows most patients to stop parenteral nutrition. To stimulate adaptation, oral nutrition or enteral nutrition is introduced as early as possible after resection. If enteral nutrition is required, a polymeric formula should be used.

The need for long-term parenteral nutrition and hydration depends on the degree of intestinal adaptation that occurs and the length of small bowel remaining. For oral or enteral nutrition to be appropriate, patients with a jejunocolic anastomosis require at least 50 cm of small bowel (plus remaining colon), while patients with a jejunostomy require at least 100 cm of small bowel (or more if the remaining bowel is not healthy).

Suggested dietary modifications for patients receiving oral or enteral nutrition support includePironi, 2016:

• small frequent meals, and separating solids from fluids
• a high-energy, high-protein diet (usually including oral nutritional supplements, keeping in mind that a high osmolar load can cause diarrhoea)
• reduced intake of insoluble fibre, particularly if no colon is present
• reduced intake of fat (if intake is excessive and steatorrhoea is present)
• consumption of fluids with appropriate glucose and electrolyte concentrations (avoid hypotonic and hypertonic fluids; see also Oral fluid replacement)
• a low-lactose diet (lactose intolerance is common)
• adding salt to meals
• a low-oxalate diet with calcium supplementation for patients who have hyperoxaluria and kidney stones (the risk of developing oxalate stones is 25% in patients who have a short bowel with an intact colon, because of increased absorption of oxalate through the colon).

Referral to an accredited practising dietitian with experience in managing short bowel syndrome is essential, because the nutritional management is often complex.