Nutritional support and therapy in the short bowel syndrome.

The clinical response of a patient to intestinal resection depends on several factors. With more than 60 to 80 cm of bowel remaining, refeeding usually will be progressive until a full oral diet is reached. The type of diet and vitamin supplements are then prescribed according to the site of resection. In general, the diet should not be restricted in terms of fat. In the case of ileal resection and a preserved colon, a low-oxalate diet should be prescribed along with calcium supplements. These patients may also develop a cholereic diarrhea, depending on the size of the ileal resection. Cholestyramine should then be added. With a very short bowel (less than 60 to 80 cm), parenteral nutrition is started immediately. This type of nutrition may be tapered progressively over a period of time as enteral feeding is gradually increased, according to the amount of residual disease and the rate of adaptation of the intestinal remnant. If patients cannot maintain their nutritional status and also be free of serious diarrhea when on a normal or modified oral or enteral diet, then long-term parenteral nutrition is considered.