The Role of Nutrition in the Prevention and Treatment of Malnutrition in Short Bowel Syndrome: A Traditional Review

Yıl 2024, , 83 - 97, 30.08.2024

Tuba Kahraman , Zekiye Zeynep Bostan , Gülhan Samur

https://doi.org/10.52881/gsbdergi.1442998

Öz

Short bowel syndrome is not common in the general population, but it is thought to have a 2-fold increase in prevalence in the last four decades. In this disease, which is accompanied by different pathophysiologic mechanisms depending on the type of congenital anomaly or surgical resection, one of the biggest problems of patients is malabsorption. Malabsorption and associated stoma loss lead to the risk of severe malnutrition. In cases where oral nutrition is inadequate, this situation requires the patient to be treated with long-term enteral and/or parenteral nutrition. After determining the nutritional requirements of the patients in accordance with their metabolic and physiologic conditions, a diet rich in sufficient energy, protein and micronutrients is essential in treatment. A diet containing 20-35 kcal/kg energy and 0.8-1.4 g/kg protein to meet daily energy and protein requirements should be planned by a specialized dietician. Some recent studies have shown that supplements such as probiotics, omega-3 and citrulline have positive effects on metabolic processes related to short bowel syndrome. Bacterial genera such as Lactobacillus and Bifidobacterium have come to the fore in probiotic studies. Omega-3 fatty acids may be effective in the treatment of cholestasis due to parenteral nutrition and may be a new protective agent of the liver in case of parenteral nutrition. However, clinical trials with a high level of evidence for the use of these supplements in the clinic are still needed. Patients with short bowel syndrome should be followed by a multidisciplinary team for medical and nutritional therapy.

Anahtar Kelimeler

short bowel syndrome, malnutrition, diet therapy

Kısa Bağırsak Sendromunda Malnutrisyonun Önlenmesi ve Tedavisinde Beslenmenin Rolü: Geleneksel Derleme

Öz

Kısa bağırsak sendromu toplumda yaygın görülmemekle birlikte son kırk yılda prevalansında 2 kat artış olduğu düşünülen bir hastalıktır. Konjenital anomalinin türü veya uygulanan cerrahi rezeksiyona bağlı olarak farklı patofizyolojik mekanizmaların eşlik ettiği bu hastalıkta, hastaların en büyük problemlerinden biri malabsorpsiyondur. Malabsorpsiyon ve buna bağlı stoma kayıpları hastada ciddi malnütrisyon gelişme riskini doğurmaktadır. Bu durum oral beslenmenin yetersiz olduğu durumlarda ek olarak hastanın uzun dönem enteral ve/veya parenteral beslenme ile tedavi edilmesini gerektirmektedir. Hastaların metabolik ve fizyolojik koşullarına uygun beslenme gereksinimleri saptandıktan sonra yeterli enerji, protein ve mikrobesin ögelerinden zengin bir diyet içeriğinin olması tedavide elzemdir. Günlük enerji ve protein gereksinimlerini karşılamak adına 20-35 kkal/kg enerji ve 0.8-1.4 g/kg protein içeren bir diyet, konu ile ilgili uzman bir diyetisyen tarafından planlanmalıdır. Son dönemde yapılan bazı araştırmalar, probiyotik, omega-3 ve sitrulin gibi takviyelerin kısa bağırsak sendromuna ilişkin metabolik süreçlerde olumlu etkileri olduğunu ortaya koymuştur. Probiyotik çalışmalarında özellikle Lactobacillus ve Bifidobacterium gibi bakteri cinsleri ön plana çıkmıştır. Omega-3 yağ asitlerinin parenteral beslenmeye bağlı kolestaz tedavisinde etkili olabileceği ve parenteral beslenme durumunda karaciğerin yeni bir koruyucu ajanı olabileceği ortaya koyulmuştur. Sitrulin takviyesinin 0.1-3.0 mg/kg/gün doz aralığında uygulandığında bağırsak sağlığı üzerinde potansiyel etkiler geliştirebileceği saptanmıştır. Bununla beraber bu takviyelerin klinikte kullanımına ilişkin hala kanıt düzeyi yüksek klinik araştırmalara ihtiyaç vardır. Kısa bağırsak sendromu hastaları, medikal tedavi ve tıbbi beslenme tedavisi açısından multidisipliner bir ekiple takip edilmelidir.

Anahtar Kelimeler

Kısa bağırsak sendromu, malnütrisyon, beslenme tedavisi

Kaynakça

• 1. Pironi L. Definitions of intestinal failure and the short bowel syndrome. Best Pract Res Clin Gastroenterol. 2016;30(2):173-185. doi:10.1016/J.BPG.2016.02.011
• 2. Nightingale J, Woodward JM. Guidelines for management of patients with a short bowel. Gut. 2006;55(suppl 4):iv1-iv12. doi:10.1136/GUT.2006.091108
• 3. Pironi L, Hébuterne X, Van Gossum A, et al. Candidates for intestinal transplantation: a multicenter survey in Europe. Am J Gastroenterol. 2006;101(7):1633-1643. doi:10.1111/J.1572-0241.2006.00710.X
• 4. Massironi S, Cavalcoli F, Rausa E, Invernizzi P, Braga M, Vecchi M. Understanding short bowel syndrome: Current status and future perspectives. Digestive and Liver Disease. 2020;52(3):253-261. doi:10.1016/J.DLD.2019.11.013
• 5. Cuerda C, Pironi L, Arends J, et al. ESPEN practical guideline: Clinical nutrition in chronic intestinal failure. Clinical Nutrition. 2021;40(9):5196-5220. doi:10.1016/J.CLNU.2021.07.002
• 6. Brandt CF, Hvistendahl M, Naimi RM, et al. Home Parenteral Nutrition in Adult Patients With Chronic Intestinal Failure: The Evolution Over 4 Decades in a Tertiary Referral Center. JPEN J Parenter Enteral Nutr. 2017;41(7):1178-1187. doi:10.1177/0148607116655449
• 7. Van Gossum A, Bakker H, Bozzetti F, et al. Home parenteral nutrition in adults: a european multicentre survey in 1997. ESPEN-Home Artificial Nutrition Working Group. Clin Nutr. 1999;18(3):135-140. doi:10.1054/CLNU.1999.0021
• 8. Howard L, Ament M, Richard Fleming C, Shike M, Steiger E. Current use and clinical outcome of home parenteral and enteral nutrition therapies in the United States. Gastroenterology. 1995;109(2):355-365. doi:10.1016/0016-5085(95)90321-6
• 9. Nightingale J, Woodward JM. Guidelines for management of patients with a short bowel. Gut. 2006;55 Suppl 4(Suppl 4). doi:10.1136/GUT.2006.091108
• 10. Cummings JH, James WPT, Wiggins HS. ROLE OF THE COLON IN ILEAL-RESECTION DIARRHŒA. The Lancet. 1973;301(7799):344-347. doi:10.1016/S0140-6736(73)90131-1
• 11. Pironi L, Corcos O, Forbes A, et al. Intestinal failure in adults: Recommendations from the ESPEN expert groups. Clinical Nutrition. 2018;37(6):1798-1809. doi:10.1016/J.CLNU.2018.07.036
• 12. Dudrick SJ, Latifi R, Fosnocht DE. Management of the short-bowel syndrome. Surg Clin North Am. 1991;71(3):625-643. doi:10.1016/S0039-6109(16)45438-1
• 13. Stump SE. Nutrition and Diagnosis-Related Care. 3rd ed. Philadelphia: Lea & Febiger; 1993.
• 14. Andersson H, Bosaeus I, Brummer RJ, et al. Nutritional and metabolic consequences of extensive bowel resection. Dig Dis. 1986;4(4):193-202. doi:10.1159/000171149
• 15. Delin K, Fasth S, Andersson H, Aurell M, Hultén L, Jagenburg R. Factors regulating sodium balance in proctocolectomized patients with various ileal resections. Scand J Gastroenterol . 1984;19(2):145-149.
• 16. Hessov I, Hasselblad C, Fasth S, Hultén L. Magnesium deficiency after ileal resections for Crohn’s disease. Scand J Gastroenterol. 1983;18(5):643-649. doi:10.3109/00365528309181651
• 17. Hofmann AF. Bile Acid Malabsorption Caused by Ileal Resection. Arch Intern Med. 1972;130(4):597-605. doi:10.1001/ARCHINTE.1972.03650040121011
• 18. Andersson H, Filipsson S, Hultén L. Determination of the faecal excretion of labelled bile salts after i.v. administration of 14C-cholic acid. An evaluation of the bile salt malabsorption before and after surgery in patients with Crohn’s disease. Scand J Gastroenterol. 1978;13(2):249-255. doi:10.3109/00365527809181756
• 19. Bambach CP, Hill GL. Long term nutritional effects of extensive resection of the small intestine. Aust N Z J Surg. 1982;52(5):500-506. doi:10.1111/J.1445-2197.1982.TB06039.X
• 20. Engels LGJ, Van den Hamer CJA, Van Tongeren JHM. Iron, zinc, and copper balance in short bowel patients on oral nutrition. Am J Clin Nutr. 1984;40(5):1038-1041. doi:10.1093/AJCN/40.5.1038
• 21. Nightingale JMD, Kamm MA, Van Der Sijp JRM, Ghatei MA, Bloom SR, Lennard-Jones JE. Gastrointestinal hormones in short bowel syndrome. Peptide YY may be the “colonic brake” to gastric emptying. Gut. 1996;39(2):267. doi:10.1136/GUT.39.2.267
• 22. Carroll RE, Benedetti E, Schowalter JP, Buchman AL. Management and Complications of Short Bowel Syndrome: an Updated Review. Curr Gastroenterol Rep. 2016;18(7). doi:10.1007/S11894-016-0511-3
• 23. Martin GR, Wallace LE, Hartmann B, et al. Nutrient-stimulated GLP-2 release and crypt cell proliferation in experimental short bowel syndrome. Am J Physiol Gastrointest Liver Physiol. 2005;288(3). doi:10.1152/AJPGI.00242.2004
• 24. Le HD, De Meijer VE, Robinson EM, et al. Parenteral fish-oil-based lipid emulsion improves fatty acid profiles and lipids in parenteral nutrition-dependent children. Am J Clin Nutr. 2011;94(3):749-758. doi:10.3945/AJCN.110.008557
• 25. Sukhotnik I, Shany A, Bashenko Y, et al. Parenteral but not enteral omega-3 fatty acids (Omegaven) modulate intestinal regrowth after massive small bowel resection in rats. JPEN J Parenter Enteral Nutr. 2010;34(5):503-512. doi:10.1177/0148607110362586
• 26. Sevela S, Meisnerova E, Vecka M, et al. High Dose Fish Oil Added to Various Lipid Emulsions Normalizes Superoxide Dismutase 1 Activity in Home Parenteral Nutrition Patients. Nutrients. 2024;16(4). doi:10.3390/NU16040485
• 27. Channabasappa N, Girouard S, Nguyen V, Piper H. Enteral Nutrition in Pediatric Short-Bowel Syndrome. Nutrition in Clinical Practice. 2020;35(5):848-854. doi:10.1002/NCP.10565
• 28. Yang H, Feng Y, Sun X, Teitelbaum DH. Enteral versus parenteral nutrition: effect on intestinal barrier function. Ann N Y Acad Sci. 2009;1165:338-346. doi:10.1111/J.1749-6632.2009.04026.X
• 29. Joly F, Dray X, Corcos O, Barbot L, Kapel N, Messing B. Tube Feeding Improves Intestinal Absorption in Short Bowel Syndrome Patients. Gastroenterology. 2009;136(3):824-831. doi:10.1053/J.GASTRO.2008.10.084
• 30. Izzo K, Feczko S, Park JS. Use of oral rehydration solution and intravenous fluid in home settings for adults with short bowel syndrome. Nutrition in Clinical Practice. 2022;37(5):1050-1058. doi:10.1002/NCP.10888
• 31. Hirschhorn N. The treatment of acute diarrhea in children. An historical and physiological perspective. Am J Clin Nutr. 1980;33(3):637-663. doi:10.1093/AJCN/33.3.637
• 32. Reduced osmolarity : oral rehydration salts (‎ORS)‎ formulation : a report from a meeting of experts jointly organised by UNICEF and WHO : UNICEF house, New York, USA, 18 July 2001. Accessed November 19, 2023. https://iris.who.int/handle/10665/67322
• 33. Aljarallah B, Fernandes G, Jeejeebhoy KN, et al. The Canadian Home Total Parenteral Nutrition (HTPN) Registry. Journal of Parenteral and Enteral Nutrition. 2012;36(4):415-420. doi:10.1177/0148607111431983
• 34. Banerjee A, Warwicker P. Acute renal failure and metabolic disturbances in the short bowel syndrome. QJM. 2002;95(1):37-40. doi:10.1093/QJMED/95.1.37
• 35. Agostini F, Sasdelli AS, Guidetti M, Comai G, La Manna G, Pironi L. Outcome of kidney function in adults on long-term home parenteral nutrition for chronic intestinal failure. Nutrition. 2019;60:212-216. doi:10.1016/J.NUT.2018.10.005
• 36. Johnson E, Vu L, Matarese LE. Bacteria, Bones, and Stones: Managing Complications of Short Bowel Syndrome. Nutrition in Clinical Practice. 2018;33(4):454-466. doi:10.1002/NCP.10113
• 37. Abitbol V, Roux C, Chaussade S, et al. Metabolic bone assessment in patients with inflammatory bowel disease. Gastroenterology. 1995;108(2):417-422. doi:10.1016/0016-5085(95)90068-3
• 38. Ferrone M, Geraci M. A Review of the Relationship Between Parenteral Nutrition and Metabolic Bone Disease. Nutrition in Clinical Practice. 2007;22(3):329-339. doi:10.1177/0115426507022003329
• 39. Petersen C. D-lactic acidosis. Nutr Clin Pract. 2005;20(6):634-645. doi:10.1177/0115426505020006634
• 40. Burnes JU, O’Keefe SJD, Fleming CR, Devine RM, Berkner S, Herrick L. Home Parenteral Nutrition—A 3-Year Analysis of Clinical and Laboratory Monitoring. Journal of Parenteral and Enteral Nutrition. 1992;16(4):327-332. doi:10.1177/0148607192016004327
• 41. Reimund JM, Duclos B, Cuby C, et al. Home parenteral nutrition: Clinical and laboratory analysis of initial experience (1994-1997). Implications for patient management. Ann Nutr Metab. 1999;43(6):329-338. doi:10.1159/000012801
• 42. Guo M, Li Y, Li J. Role of growth hormone, glutamine and enteral nutrition in pediatric short bowel syndrome: a pilot follow-up study. Eur J Pediatr Surg. 2012;22(2):121-126. doi:10.1055/S-0031-1273777
• 43. Wales PW, Nasr A, de Silva N, Yamada J. Human growth hormone and glutamine for patients with short bowel syndrome. Cochrane Database of Systematic Reviews. 2010;(6). doi:10.1002/14651858.CD006321.PUB2/MEDIA/CDSR/CD006321/IMAGE_N/NCD006321-CMP-004-04.PNG
• 44. Guo M, Li Y, Li J. Effect of growth hormone, glutamine, and enteral nutrition on intestinal adaptation in patients with short bowel syndrome. Turk J Gastroenterol. 2013;24(6):463-468. doi:10.4318/TJG.2013.0555
• 45. Seguy D, Darmaun D, Duhamel A, et al. Growth hormone enhances fat-free mass and glutamine availability in patients with short-bowel syndrome: an ancillary double-blind, randomized crossover study. Am J Clin Nutr. 2014;100(3):850-858. doi:10.3945/AJCN.113.071845
• 46. Fourati S, Hamon A, Daclat R, et al. Circulating Apolipoprotein B-48 as a Biomarker of Parenteral Nutrition Dependence in Adult Patients with Short Bowel Syndrome. Nutrients 2023, Vol 15, Page 3982. 2023;15(18):3982. doi:10.3390/NU15183982
• 47. Jirka A, Layec S, Picot D, et al. Effect of oral citrulline supplementation on whole body protein metabolism in adult patients with short bowel syndrome: A pilot, randomized, double-blind, cross-over study. Clin Nutr. 2019;38(6):2599-2606. doi:10.1016/J.CLNU.2018.12.030
• 48. Sukhotnik I, Levi R, Moran-Lev H. Impact of Dietary Protein on the Management of Pediatric Short Bowel Syndrome. Nutrients. 2023;15(13). doi:10.3390/NU15132826
• 49. Cox SE, Ellins EA, Marealle AI, et al. Ready-to-use food supplement, with or without arginine and citrulline, with daily chloroquine in Tanzanian children with sickle-cell disease: a double-blind, random order crossover trial. Lancet Haematol. 2018;5(4):e147-e160. doi:10.1016/S2352-3026(18)30020-6
• 50. Ruiz SS, Grosso CL, Tablada M, et al. Eficacia del suplemento de citrulina para disminuir el riesgo de hipertensión pulmonar post-cirugía de cardiopatía congénita. Una experiencia local. Rev Fac Cienc Med Cordoba. 2020;77(4):249-253. doi:10.31053/1853.0605.V77.N4.27936
• 51. Filippi J, Rubio A, Lasserre V, et al. Dose-dependent beneficial effects of citrulline supplementation in short bowel syndrome in rats. Nutrition. 2021;85. doi:10.1016/J.NUT.2020.111118
• 52. Joly F, Mayeur C, Bruneau A, et al. Drastic changes in fecal and mucosa-associated microbiota in adult patients with short bowel syndrome. Biochimie. 2010;92(7):753-761. doi:10.1016/J.BIOCHI.2010.02.015
• 53. Mayeur C, Gratadoux JJ, Bridonneau C, et al. Faecal D/L lactate ratio is a metabolic signature of microbiota imbalance in patients with short bowel syndrome. PLoS One. 2013;8(1). doi:10.1371/JOURNAL.PONE.0054335
• 54. Billiauws L, Thomas M, Le Beyec-Le Bihan J, Joly F. Intestinal adaptation in short bowel syndrome. What is new? Nutr Hosp. 2018;35(3):731-737. doi:10.20960/NH.1952
• 55. DiBaise JK, Young RJ, Vanderhoof JA. Enteric microbial flora, bacterial overgrowth, and short-bowel syndrome. Clin Gastroenterol Hepatol. 2006;4(1):11-20. doi:10.1016/J.CGH.2005.10.020
• 56. Bongaerts GPA, Severijnen RSVM. Arguments for a lower carbohydrate-higher fat diet in patients with a short small bowel. Med Hypotheses. 2006;67(2):280-282. doi:10.1016/J.MEHY.2006.02.015
• 57. Eizaguirre I, Aldazabal P, Urkia NG, Asensio A, Arenzxana JMG. Escherichia coli translocation in experimental short bowel syndrome: probiotic supplementation and detection by polymerase chain reaction. Pediatr Surg Int. 2011;27(12):1301-1305. doi:10.1007/S00383-011-2943-Z
• 58. Tolga Muftuoglu MA, Civak T, Cetin S, Civak L, Gungor O, Saglam A. Effects of probiotics on experimental short-bowel syndrome. Am J Surg. 2011;202(4):461-468. doi:10.1016/J.AMJSURG.2011.03.005
• 59. Mogilner JG, Srugo I, Lurie M, et al. Effect of probiotics on intestinal regrowth and bacterial translocation after massive small bowel resection in a rat. J Pediatr Surg. 2007;42(8):1365-1371. doi:10.1016/J.JPEDSURG.2007.03.035
• 60. Eizaguirre I, Urkia NG, Asensio AB, et al. Probiotic supplementation reduces the risk of bacterial translocation in experimental short bowel syndrome. J Pediatr Surg. 2002;37(5):699-702. doi:10.1053/jpsu.2002.32256
• 61. Metin M, Altun A, Köylüoğlu G. The effect of probiotics on ıntestinal motility in an experimental short bowel model. Acta Cir Bras. 2020;35(8):1-14. doi:10.1590/S0102-865020200080000004
• 62. Pauline M, Fouhse J, Hinchliffe T, et al. Probiotic treatment vs empiric oral antibiotics for managing dysbiosis in short bowel syndrome: Impact on the mucosal and stool microbiota, short-chain fatty acids, and adaptation. JPEN J Parenter Enteral Nutr. 2022;46(8):1828-1838. doi:10.1002/JPEN.2377
• 63. Sentongo TA, Cohran V, Korff S, Sullivan C, Iyer K, Zheng X. Intestinal permeability and effects of Lactobacillus rhamnosus therapy in children with short bowel syndrome. J Pediatr Gastroenterol Nutr. 2008;46(1):41-47. doi:10.1097/01.MPG.0000304452.92175.F5
• 64. Bartholome AL, Albin DM, Baker DH, Holst JJ, Tappenden KA, Jaksic T. Supplementation of total parenteral nutrition with butyrate acutely increases structural aspects of intestinal adaptation after an 80% jejunoileal resection in neonatal piglets. JPEN J Parenter Enteral Nutr. 2004;28(4):210-223. doi:10.1177/0148607104028004210
• 65. Tappenden KA, Thomson ABR, Wild GE, McBurney MI. Short-chain fatty acid-supplemented total parenteral nutrition enhances functional adaptation to intestinal resection in rats. Gastroenterology. 1997;112(3):792-802. doi:10.1053/gast.1997.v112.pm9041241
• 66. Nordgaard I, Hansen BS, Mortensen PB. Colon as a digestive organ in patients with short bowel. Lancet. 1994;343(8894):373-376. doi:10.1016/S0140-6736(94)91220-3