A SURVEY OF ENTERAL FEEDING PRACTICES IN PATIENTS WITH SHORT BOWEL SYNDROME IN THE UNITED KINGDOM

Abstract

Aim: There is no consensus amongst clincians who manage patients with Short Bowel Syndrome (SBS) on the most appropriate enteral feeds and introduction of solids. Method: A questionnaire was sent to all dietitians (40) who are Associate Members of the British Society of Paediatric Gastroenterology, Hepatology and Nutrition to ascertain their current practice on the type of enteral feeds used, monitoring tolerance of feeds, anthropometry, the use of novel substrates (pectin, glutamine, pre and probiotics), and the introduction of solids in the management of patients with SBS. Results: Breast milk was the most commonly used feed initially. 68% of dietitians then used a hydrolysed protein formula when tolerance became a problem. Continuous feeds were given initially in 66% of patients. The most common reason for changing the type of feed was increased stool frequency, the presence of fat or reducing substances in stools and poor weight gain. 62% of dietitians occasionally used a modular feed. Weight was most commonly measured twice weekly, length/height and head circumference monthly. 80% of dietitians did not measure Mid-arm Circumference or Triceps skinfold thickness. 4 centres followed set protocols for biochemical monitoring. Investigations in other centers varied. Novel substrates were infrequently used. Solids were most commonly introduced at 6 months for patients on parenteral nutrition and between 5-6 months for those who were on complete enteral feeds. Exclusion of milk, gluten, eggs and soya varied between centres. Conclusion: Practice throughout the United Kingdom varied immensely on the dietetic management of patients with SBS with each unit following their own protocols and personal practice. A more consistent approach to the nutritional management of SBS patients should be pursued.