Management of short bowel syndrome, high-output enterostomy, and high-output entero-cutaneous fistulas in the inpatient setting

Jake Hutto, Michelle Pearlman, Deepak Agrawal

Research output: Contribution to journalReview article

Abstract

Objective: To define intestinal failure and associated diseases that often lead to diarrhea and high-output states, and to provide a literature review on the current evidence and practice guidelines for the management of these conditions in the context of a clinical case. Methods: Database search on dietary and medical interventions as well as major societal guidelines for the management of intestinal failure and associated conditions. Results: Although major societal guidelines exist, the guidelines vary greatly amongst various specialties and are not supported by strong evidence from large randomized controlled trials. The majority of the guidelines recommend consideration of several drug classes, but do not specify medications within the drug class, optimal dose, frequency, mode of administration, and how long to trial a regimen before considering it a failure and adding additional medical therapies. Conclusions: Intestinal failure and high-output states affect a very heterogenous population with high morbidity and mortality. This subset of patients should be managed using a multidisciplinary approach involving surgery, gastroenterology, dietetics, internal medicine and ancillary services that include but are not limited to ostomy nurses and home health care. Implementation of a standardized protocol in the electronic medical record including both medical and nutritional therapies may be useful to help optimize efficacy of medications, aid in nutrient absorption, decrease cost, reduce hospital length of stay, and decrease hospital readmissions.

Original languageEnglish (US)
JournalJournal of Clinical Outcomes Management
Volume25
Issue number6
StatePublished - Jun 1 2018

Keywords

  • Diarrhea
  • Entero-cutaneous fistula
  • High-output ostomy
  • Malnutrition.
  • Short bowel syndrome

ASJC Scopus subject areas

  • Health Policy

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