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Factors predicting a successful outcome after pharmacologic bowel compensation
D W Wilmore1, J M Lacey, R P Soultanakis
1Department of Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Annals of Surgery
|October 27, 1997
Summary
Intestinal rehabilitation using trophic agents and diet can help nearly half of patients with short bowel syndrome reduce or eliminate total parenteral nutrition (TPN). Predictors of success include longer bowel length and lower body weight, offering an alternative to transplantation.
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Nutritional Support
Background:
- Short bowel syndrome (SBS) often necessitates long-term total parenteral nutrition (TPN) or intestinal transplantation.
- Intestinal rehabilitation programs aim to enhance intestinal compensation and nutrient absorption in patients with intestinal failure.
Purpose of the Study:
- To identify factors predicting successful outcomes in patients receiving pharmacologic agents for bowel absorption after massive intestinal resection.
- To evaluate the efficacy of a combined trophic agent and specialized diet therapy in SBS patients.
Main Methods:
- Forty-five TPN-dependent adults with short jejunal-ileal remnants (< or = 50 cm) and colonic continuity were treated.
- Therapy involved growth hormone, glutamine, and a modified diet for 4 weeks.
- Patients were observed for an average of 1.8 years.
Main Results:
- 58% of patients (26/45) were weaned off TPN after 4 weeks of therapy.
- Predictors of a favorable response included greater bowel length, lower body weight, and a higher bowel length-to-body weight ratio.
- At long-term follow-up, 40% of patients remained independent of TPN.
Conclusions:
- Intestinal rehabilitation can enable approximately half of TPN-dependent SBS patients to achieve enteral autonomy.
- This approach offers a prudent alternative to long-term TPN or intestinal transplantation, considering associated risks, costs, and lifestyle impacts.