[Treatment of intestinal failure in adults. I. Dietary measures]

Patients with intestinal failure, predominantly caused by short-bowel syndrome, have impaired quality of life due to the frequent development of complications. Dietary modifications have an established role in the treatment of short-bowel syndrome. Treatment of short-bowel syndrome includes optimising the balance of fluids and nutrients in the presence of reduced absorption. The population is heterogeneous due to differences in anatomical structure and the functional status of the remaining intestine. Diet must therefore be tailored to the individual patient. Determining the appropriate amount of carbohydrates is based on the presence of the colon, because carbohydrates are processed in the colon by bacterial fermentation. Patients with a jejunostomy rapidly become dehydrated because they lose more sodium and fluids than are taken up enterally. The jejunum rapidly absorbs solutions with high salt concentrations, such as the WHO-recommended oral rehydration solution. Replacement of long-chain fatty acids with water-soluble medium-chain fatty acids increases the energy intake in patients with short-bowel syndrome and a colon. Extra attention should be given to electrolytes, trace elements and vitamins. Patients with short-bowel syndrome and a colon are at risk for oxalate nephropathy. For these patients, a low oxalate diet is recommended. With these interventions, many patients with intestinal failure will ultimately become independent of total parenteral nutrition.