Short bowel syndrome medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Medical Therapy

• Management of short bowel syndrome is complicated and requires close collaboration of all medical team members including the physician, nutritionist, and nurse with the patient and their families.
• Management of short bowel syndrome consists of medical therapy and surgical interventions.
• Medical therapy consists of nutritional therapy and pharmacotherapy.
• Lifelong follow-up is usually needed.

Nutritional therapy

• Nutritional therapy is essential for short bowel syndrome and to restore the intestinal adaptation. It could be provided through oral, enteral and parenteral routes.
  • 1 Fluid
    • 1.1 Acute phase
      • Preferred regimen (1): drug name 100 mg PO q12h for 10-21 days (Contraindications/specific instructions)
      • Preferred regimen (1): drug name 100 mg PO q12h for 10-21 days (Contraindications/specific instructions)
    • 1.2 Maintenance phase
      • Water
      • Sports drinks
      • Sodas without caffeine
      • Salty broths
  • 2 Parenteral infusion
    • 2.1 Acute phase
      • 2.1.1 Diet
        • Preferred regimen (1): 30-40 kcal/kg/day diet consists of carbohydrate 55-60%, fat 20-25%, and protein 20%
        • Note (1):
      • 2.1.2 Electrolytes
        • 2.1.2.1 Sodium
        • 2.1.2.2 Potassium
    • 2.2 Maintenance phase
      • Preferred regimen (1): 30-40 kcal/kg/day diet consists of carbohydrate 55-60%, fat 20-25%, and protein 20%
  • 3 Enteral nutrition
    • 1.2.1 Adult
      • Preferred regimen (1): drug name 500 mg PO q8h
    • 1.2.2 Pediatric
      • Preferred regimen (1): drug name 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
  • 4 Supplement
    • 4.1 Vitamins
      • 4.1.1 Vitamin A
      • 4.1.2 Vitamin B12
      • 4.1.3 Vitamin D
      • 4.1.4 Vitamin E
    • 4.2 Minerals
      • 4.2.1 Calcium
        • Preferred regimen (1): Calcium 1000-1500 mg PO qd
      • 4.2.2 Iron
      • 4.2.3 Magnesium
      • 4.2.4 Zinc
    • 4.3 Exogenous enzyme replacement 
      • 4.3.1 Pancreatic enzyme
      • 4.3.2 Lactase
    • 4.4 Bile acid sequestrants

Pharmacotherapy

• Medications are used to control symptoms of short bowel syndrome. They include:
  • 1 Antimotility agents
    • Preferred regimen (1): Loperamide 
    • Preferred regimen (2): Codeine 60 mg IM q4h
    • Preferred regimen (3): Lomotil (diphenoxylate and atropine) 2.5-5 mg q6h
    • Alternative regimen (1): Clonidine
    • Alternative regimen (2): Tincture of opium 5-10 mL q4h
  • 2 Antisecretory agents
    • Histamine H2 antagonists
      • Preferred regimen (1):
    • Proton pump inhibitors
      • Preferred regimen (1):
  • 3 Hormones
    • 3.1 Growth hormone
      • Preferred regimen (1): Somatropin 0.03-0.14 mg/kg SC qd for up to 4 weeks (not to exceed 8 mg/day)
    • 3.2 Somatostatin analogue
      • Preferred regimen (1): Octreotide 100 μg SC q8h