Traitement diététique et nutritionnel des résections intestinales

Abstract

Intestinal resections have a wide clinical spectrum where the length of simple iléal resection may lead to Vitamine B12 deficiency (resected terminal ileum ≥ 60 cm), cholerrheic diarrhea (resection < 100 cm, steathorrhea < 20 g/d,) or malabsorptive diarrhea (steatorrhea > 20 g/d with deficit of liposoluble vitamins (D > K > E > A) if resection is more than 100 cm of terminal ileum. In case of extensive resection of the small bowel (≥ 2 m with less than 2 m of remnant post duodenal small bowel) ± partial or total colonic resection, short bowel syndrome (SBS) may follows depending of the site (ileum more critical than jejunum) and the length of the remnant bowel. Severe malabsorptive diarrhea (between 30% and 80% of ingesta) follows with malnutrition, increased hydro-mineral losses and micronutrient deficits. A remaining colon spares hydro-mineral losses and carbohydrate energy malabsorption through colonic hyperfermentation and absorption of short chain fatty acids but is associated with enteric oxalic renal lithiasis (25% of cases) and D lactate encephalopathy (2% of cases). Dietetic, along with supplements (either IM : B12, or oral : Ca, Mg, Vitamine D metabolites, vitamine E), are necessary treatments of small bowel resections. Hyperphagia of solid foods should be encouraged with no futile restriction (Lipids when no colon is left in continuity, complex carbohydtates when colon is present and in continuity) whereas liquid dietetic rules have to be firmly implemented according also to the type of bowel resection. Oral autonomy may then be observed despite very SBS. This review based upon the physiopathology of intestinal resections, indicates dietetic and nutritional recommanded guidelines.