Tiger Food for Short Bowel: Two Cases.

Abstract

Dear Sir, Short Bowel Syndrome (SBS) refers to a critical reduction in the length of the intestine, leading to chronic diarrhoea, dehydration, malnutrition, weight loss and growth failure [1]. SBS is clinically evident when the total available length of small bowel is <200 cm and commonly caused by resection [2]. The nonsurgical options for management of SBS are: (a) total parenteral nutrition (TPN), which is costly, invasive and un-physiological; (b) para-sympathomimetics drugs, which cause dilatation of the bowel; (c) proton pump inhibitors and others. TPN in addition can lead to thrombosis of canulated vessel, bowel atrophy and sepsis. The surgical options are described to slow intestinal transit, taper dilated bowel segments in children in proximal to atretic segment and intestinal lengthening procedures such as serial transverse entero-plasty (STEP) and Bianchi’s procedure [3]. The third option is small bowel transplant. The standard dietary management of SBS with colon is 50-60% of caloric intake with complex carbohydrate, 20-30% with fat and 20-30% with protein. Complex carbohydrate in small bowel will cause diarrhoea as these will take long time and has to cover more distance to break down and undergo absorption. These reach colon and work as osmotic agent causing diarrhoea and hence simple sugars (mono/diasacharides) are used as these get absorbed in stomach and in available proximal small bowel. Diet rich in fat and protein cause delay in gastric emptying, higher gastric acid and bile and pancreatic juice secretion. Whereas, protein part get broken down and get absorbed in proximal jejunum and fat in the terminal ileum. The presence of Ileo Caecal valve (ICV) delays the discharge of fat rich fluid and bile acid. Living beings are divided into carnivorous (Flesh eating), herbivorous (plant eating) and omnivorous (eat flesh and plant). The herbivorous has got the longest small bowel, the carnivorous the shortest and omnivorous remain in the middle. Loss of a part of small bowel in human makes the bowel equivalent to carnivorous, where carnivorous diet (tiger food) is appropriate is the novel thinking.