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Diarrhea. The cause of diarrhea
needs to be identified before appropriate treatment can be initiated.
Opiates are the most commonly used medications for the treatment
of diarrhea in SBS. These antidiarrheal agents control diarrhea
by reducing intestinal secretion, or by promoting the absorption
of nutrients and fluid and reducing intestinal motility. These drugs
should be taken on a regular basis, approximately one hour before
meals.
Cholestyramine is used when bile acid loss results in watery stools,
or cholerrheic diarrhea. It is usually used in patients with a colon
and with resection of less than 100 cm (about 39 inches) of terminal
ileum. This drug lessens diarrhea by attaching to bile acids, which
reduces their ability to impair fluid and electrolyte absorption
in the colon. However, cholestyramine may also impair absorption
of fat-soluble vitamins (A, D, E, and K), folate, calcium, and iron.
If the cause of the diarrhea is fat malabsorption rather than bile
acid malabsorption, taking this medication could exacerbate the
diarrhea by further depleting the amount of bile acids and leaving
more fat in the lumen, thereby increasing steatorrhea.
Octreotide works by suppressing pancreatic and gastric secretions.
It is used when diarrhea is severe. While octreotide may be used
in SBS patients to reduce diarrhea, it has the potential to impair
intestinal adaptation, which is an undesirable side effect of using
this drug.
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Gastric hypersecretion. Gastric hypersecretion
is common following intestinal resection, and can result in excessive
fluid and electrolyte loss and compromised intestinal absorption.
The excess stomach acid produced by this condition flows into the
duodenum and creates an acidic environment. This inactivates pancreatic
enzymes and bile acids, which work best in a neutral environment,
and, in turn, results in reduced intestinal fat absorption and steatorrhea.
Histamine-2 blockers or proton pump inhibitors can be used to treat
this condition. They work by reducing the production of stomach acid.
These are the same types of drugs often used to treat heartburn and
acid reflux disease. |
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Pancreatic enzymes. Pancreatic supplements,
taken with meals, may be useful for reducing steatorrhea. It is thought
that pancreatic supplements with high fat-digesting activity could
compensate for the pancreatic enzyme deficiency that might be caused
by excessive gastric secretions, inadequate mixing of enzymes with
ingested food, or inadequate stimulation of pancreatic secretion.
In general, pancreatic enzymes are used to aid digestion. |
