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Reply To: Short bowel syndrome

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Hello again.

My general recommendations would be:

1. An isotonic, oligomeric, fat-restricted liquid diet can be fed initially, with a gradual transition first to a polymeric liquid diet and then to an easily assimilated, fat- and fiber-restricted diet. I have recently been discussing with Hills their new microbiome diet. I wonder if this might be a good option here?

2. Malabsorption of fat- and water-soluble vitamins and minerals also can occur, and dietary or parenteral supplementation could be required. Parenteral cobalamin supplementation is essential if the ileum has been resected. I would consider Cobalaplex (Protexin). I think this is a good option as there is a probiotic as well as folate too.

3. Proton pump inhibitors can be used in the postoperative period to counteract possible hypergastrinemia.

4. Antimicrobial agents can be necessary if the ileocecocolic junction has been resected or if secondary SIBO is suspected. If metronidazole has not been helpful I would consider tylosin at 10mg/kg TID. This comes in powder form and has to be made up in gelatin capsules (which is obviously a massive pain). The alternative is to get the re-formulated tablets from Summit Medical.

5. If the response to diet and antibiotics is poor, antisecretory agents (loperamide, diphenoxylate, or octreotide) could be required. Bile salt binding resin (e.g., cholestyramine) might help reduce colonic secretion caused by bile salts malabsorbed after ileal resection; ursodeoxycholic acid has been shown to enhance intestinal adaptation in a feline surgical model.

Hope that helps.

Scott 🙂