Short Bowel Syndrome

What is short bowel syndrome?

Patients who have a shortened bowel due to large surgical resection (with or without stoma formation).

• May require medical management to ensure adequate absorption of nutrients and fluid.

• Absorption of oral medication is also often impaired.

Most patients have a stoma.

Which specific nutrient’s absorption is affected?

• Fat soluble vitamins: A, D, E, K

• Essential fatty acids, zinc, and selenium

• Vitamin B12

• Reduction of hydration from water alone - drink glucose / salt solutions

What drugs can be used to reduce motility?

• Loperamide

• Codeine

Reducing motility can allow for more absorption (from food or water).

Non-pharmacological management for short bowel syndrome.

• Oral rehydration salts

• Food high in energy and protein

• Foods high in fibre will increase stoma so reduce - fruits, nuts, seeds, raw veg

• Avoid caffeinated drinks - may increase stoma output

Which formulation type is not suitable for patients with a stoma?

Enteric coated / modified release as there will be insufficient effect from the drug. (esp in ileostomy [end of the small intestine])

Immediate release formulations should only be used.

What medications cause diarrhoea in patients with stoma’s?

• Sorbitol

• Magnesium antacids

• Iron (in pts with ileostomy)

What medications cause constipation in patients with stoma’s?

• Opioids

• Calcium antacids

• Iron (in pts with colostomy [end of large intestine])

What medications cause GI irritation and bleeding in patients with stoma’s?

• Aspirin

• NSAIDs

Which electrolyte imbalance can be caused by dehydration caused by diuretics or laxatives?

How is this managed?

Hypokalaemia - use K-sparing diuretics or potassium supplements