Results of Intestinal Rehabilitation in Patients With Short Bowel Syndrome With Residual Intestinal Length Less than 1 Meter
Introduction: Short bowel syndrome (SBS) associated with intestinal failure (IF) is defined as a state of transient intestinal insufficiency characterized by abundant enterostomy losses leading to electrolyte disturbances, malabsorption and malnutrition. In Peru, it occurs mainly as a result of inte...
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| Autores principales: | , |
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| Formato: | Artículo |
| Lenguaje: | inglés |
| Publicado: |
2017
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| Materias: | |
| Acceso en línea: | Enlace permanente (DOI o Handle) |
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| Sumario: | Introduction: Short bowel syndrome (SBS) associated with intestinal failure (IF) is defined as a state of transient intestinal insufficiency characterized by abundant enterostomy losses leading to electrolyte disturbances, malabsorption and malnutrition. In Peru, it occurs mainly as a result of intestinal ischemia and postoperative complications. The management of SBS by the Specialized Units has improved survival, however when residual intestinal length (RIL) is less than 1 meter there are factors in the treatment that are determinants for survival and analyzed in the present study. Patient Materials and Methods: Adult patients with a diagnosis of SBS associated with IF were selected, older than 18 years with RIL greater than or less than 1 meter. In addition, group A (2011-2013) was differentiated where patients were treated in a conventional way and in group B (2014-2016) where a rigid protocol was implemented for their management. Statistical package STATA-11 was used. Results: Between 2011 and 2016, 79 patients with a diagnosis of SBS associated to IF were treated. 34 of them with RIL less than 1 meter. Mortality was significantly higher in this group of patients (68% vs. 42% OR 2.8 IC 1.0-8.1, p <0.05 fraction attributable 65%); Mortality Autologous Gastrointestinal Reconstruction (AGIR) was also higher (46% vs. 21% p<0.05). When comparing both groups (A and B), they had the same behavior regarding a higher mortality when they had lower RIL. However, patients with RIL less than 1 meter had greater survival if they achieved enteral access (p < 0.05), received enteral glutamine (p < 0.05), AGIR (p < 0.05) and if they did not receive exclusive Parenteral Nutrition (ns). Conclusion: We found that the survival of the SBS associated with IF is directly related to the RIL; could also be associated with having enteral access, receiving enteral nutrition with glutamine and performing AGIR. In addition, a better evolution of patients was found in group B, in which a management protocol was established. |
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