Real-World Management of High Stool Output in Patients with Short Bowel Syndrome: An International Multicenter Survey
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
Affiliations
Narisorn Lakananurak
Division of Clinical Nutrition, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
Elizabeth Wall
Clinical Nutrition, University of Chicago Medicine, Chicago, IL 60637, USA
Hilary Catron
College of Allied Health, University of Nebraska Medical Center, Omaha, NE 68198, USA
Adela Delgado
Royal Alexandra Hospital, Alberta Health Services, Edmonton, AB T5H 3V9, Canada
Sophie Greif
Department of Hepatology and Gastroenterology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, 10117 Berlin, Germany
Jean Herlitz
Clinical Nutrition, University of Chicago Medicine, Chicago, IL 60637, USA
Lisa Moccia
Center for Human Nutrition, Cleveland Clinic, Cleveland, OH 44195, USA
David Mercer
Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68198, USA
Tim Vanuytsel
Gastroenterology and Hepatology, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
Vanessa Kumpf
Center for Human Nutrition, Vanderbilt University Medical Center, Nashville, TN 37232, USA
Mark Berner-Hansen
Digestive Disease Center K, Bispebjerg University Hospital of Copenhagen, 2400 Copenhagen, Denmark
Leah Gramlich
Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T5B 4E4, Canada
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.
