Short bowel syndrome secondary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

Overview

There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].

Secondary Prevention

• There are several ways to prevent complications of short bowel syndrome.
• Management strategies and regular follow-up is needed to find and treat complications accordingly.

Management

• • Effective measures for the secondary prevention of liver disease following TPN include:
    • High calorie diet including less than 30% fat
    • Treating nutrient deficiencies
    • Treating small bowel bacterial overgrowth
    • Ursodeoxycholic acid
    • Regular monitoring of liver function tests
    • Hepatobiliary ultrasound
    • Liver biopsy
  • Effective measures for the secondary prevention of cholelithiasis following TPN include:
    • Initiating enteral nutrition whenever feasible
    • Intermittent cholecystokinin and lipids injections
    • Prophylactic cholecystectomy
  • Effective measures for the secondary prevention of kidney stone following TPN include:
    • Low oxalate diet
    • Minimizing intraluminal fat
    • Providing calcium supplements
    • Maintaining a high urinary volume
    • Cholestyramine
  • Effective measures for the secondary prevention of small bowel bacterial overgrowth following TPN include:
    • Long term antibiotic therapy
  • Effective measures for the secondary prevention of lactic acidosis include:
    • Hydration
    • Antibiotic therapy
  • Effective measures for the secondary prevention of osteoporosis include:

Follow-up

• Close long-term follow-up is needed.
• Monitoring and measuring blood levels of nutrients are required.

Table below summarizes the tests and imaging studies which are required in patients with short bowel syndrome when discharge from the hospital.

Measurement	Frequency
Clinic visit	Every 6 to 12 months
Weight	Every week to check for malnutrition and dehydration
Intake and output	Every 1 to 4 weeks to check for malnutrition and dehydration
Comprehensive metabolic panel including magnesium	Every 4 weeks to check for malnutrition and dehydration
Essential fatty acids	Every 6 to 12 months to check for malnutrition
Vitamin levels	Every 6 to 12 months to check for malnutrition
Minerals	Every 6 to 12 months to check for malnutrition
Liver function tests	Every 6 months to check for liver disease
Dual-energy x-ray absorptiometry scan	Every 2 years to check for osteoporosis