Role of enteral nutrition in adult short bowel syndrome undergoing intestinal rehabilitation: the long-term outcome.
The objective of this study is to evaluate the long-term clinical significance of enteral nutrition (EN) in weaning adult short bowel patients off parenteral nutrition (PN) undergoing intestinal rehabilitation therapy (IRT). Sixty-one adult patients with small bowel length 47.95+/-19.37 cm were retrospectively analyzed. After a 3-week IRT program, including recombinant human growth hormone (rhGH, 0.05 mg/kg/d), glutamine (30 g/d), and combined EN and PN support, patients were maintained on EN or plus a high-carbohydrate, low fat (HCLF) diet. Continuous tube feeding was used when EN was started. Patients were followed up for 50.34+/-24.38 months and had an overall survival rate 95.08% (58/61). On last evaluation, 85.24% (52/61) of the patients were free of PN. For 77.42% patients (24/31) with small bowel length<35 cm in jejunoileocolic anastomosis (type III) and <60 cm in jejunocolic anastomosis (type II), weaning off PN was achieved. EN comprised of 52.56+/-13.47% of patients' daily calorie requirements on follow-up. Five patients were maintained on home PN (HPN) plus EN. Nutritional and anthropometric parameters, urine 5-hr D-xylose excretion and serum citrulline levels all increased significantly after IRT and on follow-up compared with baseline. In conclusion, with proper EN management during and after IRT, a significant number of SBS patients could be weaned from PN, especially for those who were considered as permanent intestinal failure; continuous tube feeding is recommended for enteral access, and long-term EN support could meet the daily nutritional requirement in majority of SBS patients.
Gong
Jian-feng
JF
Research Institute of General Surgery, Jinling Hospital, Nanjing, 210002, PR China.
Zhu
Wei-ming
WM
Yu
Wen-kui
WK
Li
Ning
N
Li
Jie-shou
JS
D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D001835:Body Weight; D004750:Enteral Nutrition; D005260:Female; D019382:Human Growth Hormone / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D009751:Nutritional Requirements; D010288:Parenteral Nutrition; D016331:Parenteral Nutrition, Home; D011994:Recombinant Proteins / Q000008:administration & dosage; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000150:complications / Q000534:rehabilitation*; D016896:Treatment Outcome
D011994:Recombinant Proteins; D019382:Human Growth Hormone