Short Bowel Patients Research Articles

Digestion of bovine milk proteins in patients with a high jejunostomy

Digestion of milk proteins was studied in short-bowel patients. After ingestion of water, purified beta-lactoglobulin (beta-Ig), or skim milk, effluents were collected at the stoma. The flow rate of the effluent peaked in the first 30-min period after ingestion and returned to the basal value within the first 60 min. After milk ingestion 1) the nitrogen concentration of effluents peaked in the first 30 min, 2) SDS-polyacrylamide gel electrophoresis and Western blot indicated the presence of beta-Ig and alpha-lactalbumin (alpha-lac) in jejunal effluents but only during the first 30 min whereas caseins were detected during the initial 1-2 h effluents, and 3) immunoenzymo metric assay indicated that 64% and 44% of the beta-Ig and alpha-lac, respectively, were recovered in an intact antigenic form. Results indicate that the digestion of milk proteins in humans differs quantitatively. Digestion appeared partially incomplete in the upper jejunum, suggesting the importance of the ileum for completion of digestion.

The effects of octreotide, soy polysaccharide, codeine and loperamide on nutrient, fluid and electrolyte absorption in the short‐bowel syndrome

Four agents, which could delay intestinal transit, were tested in six short-bowel patients (jejunal length 30-120 cm) on long-term nutritional/electrolyte replacement therapy. Intestinal transit time of a liquid test meal and nutrient, water and sodium absorption were measured during a control study and with each test agent on separate days. Soy polysaccharide tended to increase transit time, but decreased the absorption of water, sodium and nutrients. Codeine phosphate and loperamide caused inconsistent and clinically unimportant changes. Octreotide, a long-acting analogue of somatostatin, delayed transit and increased water, sodium and calorie absorption from the meal. Octreotide appears to have the potential to reduce the need for electrolyte and nutritional supplements in patients with the short-bowel syndrome.

Energy absorption as a measure of intestinal failure in the short bowel syndrome.

Energy absorption from a liquid test meal, intestinal transit rate and water and sodium output over a six hour period were measured in five patients with an ileostomy and 12 patients with the short bowel syndrome, five of whom were on longterm parenteral nutrition. The proportion of total energy absorbed was greatest in the ileostomists (median 87%, range 82-92%), less in short bowel patients not on parenteral nutrition (median 67%, range 59-78%, p less than 0.01) and least in the short bowel group who needed it (median 27%, range 2-63%, p less than 0.01). Transit rate was more rapid in the short bowel patients compared with the ileostomists. A close correlation was observed between percentage energy absorption and the dry weight of the stools/stoma effluent collected during the six hour test period (r = -0.99, p less than 0.001). This simple non-invasive test quantitates the degree of intestinal failure and may be of practical help in management.

What is the Ideal Sodium Concentration of Oral Rehydration Solutions (ORS) for Short Bowel Patients?

What is the Ideal Sodium Concentration of Oral Rehydration Solutions (ORS) for Short Bowel Patients?

Iron, zinc, and copper balance in short bowel patients on oral nutrition

Data are presented of a 5-day balance study for iron, zinc, and copper in seven patients with short bowel syndrome on oral nutrition. The small bowel remnant of these patients varied from 40 to 110 cm (mean 64 cm) and was radiologically normal in all patients. The study was carried out an average 2.7 yr (range 1 to 5 yr) after intestinal resection. Balance materials (diets, urine, and stools) were measured with neutron activation analysis. Mean iron balance was +28.6 µmol/day (±10.6 SD). Mean zinc balance was +5.4 µmol/day (±6.5 SD) and mean copper balance was +1.5 µmol/day (±2.3 SD). These results are comparable to those reported in healthy controls. When taking into account integumentary losses of these substances, the balance of each individual trace element remained acceptable. It is concluded that a satisfying iron, zinc, and copper status can be achieved in patients after an extensive small bowel resection on oral nutrition.

Water soluble vitamin requirements in home parenteral nutrition patients

Ascorbic acid, thiamin, niacin, pyridoxine, and folic acid status was evaluated in eight physiologically stable home parenteral nutrition patients. Six of these subjects received these vitamins as a twice weekly bolus and were studied over a period of 6 days. All vitamin levels were normal except for blood thiamin which was low, 72 h after each bolus. Since transketolase levels remained normal, this fall in blood thiamin probably had no functional significance. The urine excretion pattern of niacin and pyridoxine indicated normal metabolism and retention of these vitamins. Two patients, who required only parenteral fluid and electrolytes to remain weight stable, received none of these vitamins parenterally, but also maintained adequate vitamin status. These results suggest that in long term home parenteral nutrition patients these five vitamins can safely be given twice weekly, rather than daily, and that short bowel patients who maintain their weight without intravenous calories and protein also assimilate adequate amounts of these proximally absorbed water soluble vitamins from their diet.