Real-World Management of High Stool Output in Patients with Short Bowel Syndrome: An International Multicenter Survey
Background: International practice guidelines for high-stool-output (HSO) management in short bowel syndrome (SBS) are available, but data on implementation are lacking. This study describes the approach used to manage HSO in SBS patients across different global regions. Methods: This is an internat...
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| Format: | Article |
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MDPI AG
2023-06-01
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| Series: | Nutrients |
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| Online Access: | https://www.mdpi.com/2072-6643/15/12/2763 |
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| author | Narisorn Lakananurak Elizabeth Wall Hilary Catron Adela Delgado Sophie Greif Jean Herlitz Lisa Moccia David Mercer Tim Vanuytsel Vanessa Kumpf Mark Berner-Hansen Leah Gramlich |
| author_facet | Narisorn Lakananurak Elizabeth Wall Hilary Catron Adela Delgado Sophie Greif Jean Herlitz Lisa Moccia David Mercer Tim Vanuytsel Vanessa Kumpf Mark Berner-Hansen Leah Gramlich |
| author_sort | Narisorn Lakananurak |
| collection | DOAJ |
| description | Background: International practice guidelines for high-stool-output (HSO) management in short bowel syndrome (SBS) are available, but data on implementation are lacking. This study describes the approach used to manage HSO in SBS patients across different global regions. Methods: This is an international multicenter study evaluating medical management of HSO in SBS patients using a questionnaire survey. Thirty-three intestinal-failure centers were invited to complete the survey as one multidisciplinary team. Results: Survey response rate was 91%. Dietary recommendations varied based on anatomy and geographic region. For patients without colon-in-continuity (CiC), clinical practices were generally consistent with ESPEN guidelines, including separation of fluid from solid food (90%), a high-sodium diet (90%), and a low-simple-sugar diet (75%). For CiC patients, practices less closely followed guidelines, such as a low-fat diet (35%) or a high-sodium diet (50%). First-line antimotility and antisecretory medications were loperamide and proton-pump inhibitors. Other therapeutic agents (e.g., pancreatic enzymes and bile acid binders) were utilized in real-world practices, and usage varied based on intestinal anatomy. Conclusion: Expert centers largely followed published HSO-management guidelines for SBS patients without CiC, but clinical practices deviated substantially for CiC patients. Determining the reasons for this discrepancy might inform future development of practice guidelines. |
| first_indexed | 2024-03-11T02:04:04Z |
| format | Article |
| id | doaj.art-4743a58191704218bc9b164e92b5f986 |
| institution | Directory Open Access Journal |
| issn | 2072-6643 |
| language | English |
| last_indexed | 2024-03-11T02:04:04Z |
| publishDate | 2023-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Nutrients |
| spelling | doaj.art-4743a58191704218bc9b164e92b5f9862023-11-18T11:57:16ZengMDPI AGNutrients2072-66432023-06-011512276310.3390/nu15122763Real-World Management of High Stool Output in Patients with Short Bowel Syndrome: An International Multicenter SurveyNarisorn Lakananurak0Elizabeth Wall1Hilary Catron2Adela Delgado3Sophie Greif4Jean Herlitz5Lisa Moccia6David Mercer7Tim Vanuytsel8Vanessa Kumpf9Mark Berner-Hansen10Leah Gramlich11Division of Clinical Nutrition, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok 10330, ThailandClinical Nutrition, University of Chicago Medicine, Chicago, IL 60637, USACollege of Allied Health, University of Nebraska Medical Center, Omaha, NE 68198, USARoyal Alexandra Hospital, Alberta Health Services, Edmonton, AB T5H 3V9, CanadaDepartment of Hepatology and Gastroenterology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, 10117 Berlin, GermanyClinical Nutrition, University of Chicago Medicine, Chicago, IL 60637, USACenter for Human Nutrition, Cleveland Clinic, Cleveland, OH 44195, USADepartment of Surgery, University of Nebraska Medical Center, Omaha, NE 68198, USAGastroenterology and Hepatology, Katholieke Universiteit Leuven, 3000 Leuven, BelgiumCenter for Human Nutrition, Vanderbilt University Medical Center, Nashville, TN 37232, USADigestive Disease Center K, Bispebjerg University Hospital of Copenhagen, 2400 Copenhagen, DenmarkDepartment of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T5B 4E4, CanadaBackground: International practice guidelines for high-stool-output (HSO) management in short bowel syndrome (SBS) are available, but data on implementation are lacking. This study describes the approach used to manage HSO in SBS patients across different global regions. Methods: This is an international multicenter study evaluating medical management of HSO in SBS patients using a questionnaire survey. Thirty-three intestinal-failure centers were invited to complete the survey as one multidisciplinary team. Results: Survey response rate was 91%. Dietary recommendations varied based on anatomy and geographic region. For patients without colon-in-continuity (CiC), clinical practices were generally consistent with ESPEN guidelines, including separation of fluid from solid food (90%), a high-sodium diet (90%), and a low-simple-sugar diet (75%). For CiC patients, practices less closely followed guidelines, such as a low-fat diet (35%) or a high-sodium diet (50%). First-line antimotility and antisecretory medications were loperamide and proton-pump inhibitors. Other therapeutic agents (e.g., pancreatic enzymes and bile acid binders) were utilized in real-world practices, and usage varied based on intestinal anatomy. Conclusion: Expert centers largely followed published HSO-management guidelines for SBS patients without CiC, but clinical practices deviated substantially for CiC patients. Determining the reasons for this discrepancy might inform future development of practice guidelines.https://www.mdpi.com/2072-6643/15/12/2763high stool outputshort bowel syndromeintestinal failuredietary managementantimotility medicationantisecretory medication |
| spellingShingle | Narisorn Lakananurak Elizabeth Wall Hilary Catron Adela Delgado Sophie Greif Jean Herlitz Lisa Moccia David Mercer Tim Vanuytsel Vanessa Kumpf Mark Berner-Hansen Leah Gramlich Real-World Management of High Stool Output in Patients with Short Bowel Syndrome: An International Multicenter Survey Nutrients high stool output short bowel syndrome intestinal failure dietary management antimotility medication antisecretory medication |
| title | Real-World Management of High Stool Output in Patients with Short Bowel Syndrome: An International Multicenter Survey |
| title_full | Real-World Management of High Stool Output in Patients with Short Bowel Syndrome: An International Multicenter Survey |
| title_fullStr | Real-World Management of High Stool Output in Patients with Short Bowel Syndrome: An International Multicenter Survey |
| title_full_unstemmed | Real-World Management of High Stool Output in Patients with Short Bowel Syndrome: An International Multicenter Survey |
| title_short | Real-World Management of High Stool Output in Patients with Short Bowel Syndrome: An International Multicenter Survey |
| title_sort | real world management of high stool output in patients with short bowel syndrome an international multicenter survey |
| topic | high stool output short bowel syndrome intestinal failure dietary management antimotility medication antisecretory medication |
| url | https://www.mdpi.com/2072-6643/15/12/2763 |
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