A new definition of
intestinal failure is of reduced intestinal absorption so that macronutrient and/or water and
electrolyte supplements are needed to maintain health or growth. Severe
intestinal failure is when
parenteral nutrition and/or fluid are needed and mild
intestinal failure is when oral supplements or
dietary modification suffice. Treatment aims to reduce the severity of
intestinal failure. In the peri-operative period avoiding the administration of excessive amounts of intravenous saline (9 g NaCl/l) may prevent a prolonged
ileus. Patients with intermittent bowel obstruction may be managed with a liquid or low-residue diet. Patients with a distal bowel
enterocutaneous fistula may be managed with an enteral feed absorbed by the proximal small bowel while no oral intake may be needed for a proximal bowel
enterocutaneous fistula. Patients undergoing high-dose
chemotherapy can usually tolerate jejunal feeding. Rotating
antibiotic courses may reduce small bowel bacterial overgrowth in patients with chronic
intestinal pseudoobstruction. Restricting oral hypotonic fluids, sipping a
glucose-
saline solution (Na concentration of 90-120 mmol/l) and taking anti-diarrhoeal or anti-secretory drugs, reduces the high output from a
jejunostomy. This treatment allows most patients with a
jejunostomy and > 1 m functioning jejunum remaining to manage without parenteral support. Patients with a short bowel and a colon should consume a diet high in
polysaccharides, as these compounds are fermented in the colon, and low in
oxalate, as 25% of the
oxalate will develop as
calcium oxalate renal stones.
Growth factors normally produced by the colon (e.g. glucagon-like peptide-2) to induce structural jejunal adaptation have been given in high doses to patients with a
jejunostomy and do marginally increase the daily energy absorption.