Factors predicting a successful outcome after pharmacologic bowel compensation.
OBJECTIVE
The authors determined those factors that predict a successful outcome in patients who receive pharmacologic agents to promote bowel absorption after massive intestinal resection.


BACKGROUND
Patients with the short bowel syndrome are maintained on long-term total parenteral nutrition (TPN) or more frequently considered for intestinal transplantation as part of their treatment program. The authors have administered a combination of trophic agents and a specialized diet to further enhance intestinal compensation and optimize nutrient absorption in patients with intestinal failure.


METHODS
Forty-five TPN-dependent adults with a jejunal-ileal remnant < or = 50 cm and a portion of colon in continuity were treated with growth hormone, glutamine, and a modified diet for 4 weeks and observed for an average of 1.8 years.


RESULTS
The average age of the patients was 43 years, the average jejunal-ileal length was 23 cm, and the average length of time the patient received TPN was 4.3 years. After 4 weeks of therapy, 26 (58%) were free of TPN support. Predictors of a favorable response included greater bowel length, lower body weight, and greater bowel length-body weight ratio. At follow-up, the percentage of patients who were not receiving TPN had fallen to 40%.


CONCLUSIONS
Approximately half of a group of patients, thought to have absorptive surface area inadequate to be independent of TPN support, can maintain themselves on enteral feedings after this intestinal rehabilitation program. Because of the risk, costs, and alterations in lifestyle associated with long-term TPN or intestinal transplantation or both, it seems prudent to consider a program of bowel rehabilitation with an individual patient before embarking on another therapeutic plan.
Wilmore
D W
DW
Department of Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Lacey
J M
JM
Soultanakis
R P
RP
Bosch
R L
RL
Byrne
T A
TA
D000328:Adult; D000368:Aged; D001835:Body Weight; D004040:Dietary Carbohydrates / Q000008:administration & dosage*; D004041:Dietary Fats / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D005973:Glutamine / Q000627:therapeutic use*; D013006:Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D007408:Intestinal Absorption; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total; D012372:ROC Curve; D012008:Recurrence; D012044:Regression Analysis; D012778:Short Bowel Syndrome / Q000401:mortality / Q000628:therapy*; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome
D004040:Dietary Carbohydrates; D004041:Dietary Fats; D005973:Glutamine; D013006:Growth Hormone