Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:21

1344 Short Bowel Syndrome

Basic Urine

■Usually normal

Specific Diagnostic

■Small intestine by barium contrast X-ray usually less than 25% of the

normal length; not infrequently 10% of the normal length

■Functional tests of malabsorption: quantitative fecal fat (72-hour)

elevated; xylose absorption reduced (25 gm ingested; 5-hour urine

excretion)

differential diagnosis

■Maldigestion due to primary enteric diseases (especially celiac

sprue, hypogammaglobulinemia, tropical sprue, Whipple’s disease);

pancreatic insufficiency (chronic pancreatitis; fecal fat elevated but

xylose absorption normal) or pancreatic duct obstruction (pancre-

atic carcinoma)

management

What to Do First

■Confirm short bowel syndrome by history, barium studies and func-

tional tests of malabsorption

General Measures

■Increased caloric intake to tolerance with high protein diet; 4000

cal/day may be required, if tolerated

■High protein diet, nutritional supplements

■Add vitamin supplements (multivitamins, folic acid, fat-soluble vita-

mins [A,D,E]) and mineral supplements (especially magnesium, cal-

cium)

specific therapy

■Total parenteral nutrition (TPN) if enteric nutrition is insufficient to

maintain normal body weight and nutrition

■If TPN cannot be maintained (vascular access, liver dysfunction),

consider small intestinal (or intestinal plus hepatic) transplanta-

tion

■Parenteral epidermal growth factor (EGF), growth hormone (GH),

glucacon-like peptides,interleukin-11 (IR-11), and glutamine (oral

or parenteral) have been proposed to enhance intestinal adapta-

tion and consequent nutrient assimilation; more studies needed to

establish their effectiveness