Consenso colombiano de Falla Intestinal Crónica en Síndrome de Intestino Corto
DOI:
https://doi.org/10.30944/20117582.2425Palabras clave:
síndrome del intestino corto, intestino delgado, enfermedades inflamatorias del intestino, programas y políticas de nutrición y alimentación, nutrición parenteral total, hormonas gastrointestinalesResumen
Introducción. Los términos falla intestinal crónica, síndrome de intestino corto (SIC) y nutrición parenteral total son muy frecuentes en la práctica clínica cotidiana. El objetivo de esta guía fue establecer un marco de referencia de práctica clínica basado en el mejor de nivel de evidencia en pacientes con falla intestinal crónica secundaria a síndrome de intestino corto.
Métodos. Se estableció un grupo de expertos interdisciplinarios en el manejo de la falla intestinal crónica quienes, previa revisión de la literatura escogida, se reunieron de manera virtual acogiendo el método Delphi para discutir una serie de preguntas seleccionadas, enfocadas en el contexto terapéutico de la falla intestinal crónica asociada al síndrome de intestino corto.
Resultados. La recomendación del grupo de expertos colombianos es que se aconseje a los pacientes con SIC consumir dietas regulares de alimentos integrales que genere hiperfagia para compensar la malabsorción. Las necesidades proteicas y energéticas dependen de las características individuales de cada paciente; la adecuación del régimen debe ser evaluada a través de pruebas clínicas, antropométricas y parámetros bioquímicos. Se sugiere, especialmente a corto plazo después de la resección intestinal, el uso de análogos de somatostatina para pacientes con yeyunostomía de alto gasto en quienes el manejo de líquidos y electrolitos es problemático. En pacientes con SIC, que son candidatos a tratamiento con enterohormonas, Teduglutida es la primera opción.
Conclusión. Existen recomendaciones en el manejo integral de la rehabilitación intestinal respaldadas ampliamente por este consenso y es importante el reconocimiento de alternativas terapéuticos enmarcadas en el principio de buenas prácticas clínicas.
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Referencias bibliográficas
Abushufa R, Reed P, Weinkove C, Wales S, Shaffer J. Essential fatty acid status in patients on long-term home parenteral nutrition. JPEN J Parenter Enteral Nutr. 1995;19:286- 90. https://doi.org/10.1177/0148607195019004286
American Diabetes Association. Standards of medical care in diabetes - 2012. Diabetes Care. 2012;35(Suppl 1):11- 63. https://doi.org/10.2337/dc12-s011
American Gastroenterological Association. American Gastroenterological Association medical position statement: short bowel syndrome and intestinal transplantation. Gastroenterology 2003;124:1105e10. https://doi.org/10.1053/gast.2003.50139
Baker ML, Williams RN, Nightingale JMD. Causes and management of a high-output stoma. Colorectal Dis. 2010;13:191-7. https://doi.org/10.1111/j.1463-1318.2009.02107.x
Berg JK, Kim EH, Li B, Joelsson B, Youssef NN. A randomized, double-blind, placebo-controlled, multiple-dose, parallel-group clinical trial to assess the effects of teduglutide on gastric emptying of liquids in healthy subjects. BMC Gastroenterol. 2014;14:25. https://doi.org/10.1186/1471-230X-14-25
Bethune K, Allwood M, Grainger C, Wormleighton C; British Pharmaceutical Nutrition Group Working Party. Use of filters during the preparation and administration of parenteral nutrition: position paper and guidelines prepared by a British pharmaceutical nutrition group working party. Nutrition. 2001;17:403-8. https://doi.org/10.1016/S0899-9007(01)00536-6
Boullata JI, Gilbert K, Sacks G, Labossiere RJ, Crill C, Goday P, et al. A.S.P.E.N. clinical guidelines: Parenteral nutrition ordering, order review, compounding, labeling, and dispensing. JPEN J Parenter Enteral Nutr. 2014;38:334-77. https://doi.org/10.1177/0148607114521833
Chandankhede SR, Kulkarni AP. Acute intestinal failure. Indian J Crit Care Med. 2020;24(Suppl 4):S168-S174. https://doi.org/10.5005/jp-journals-10071-23618
Chen K, Mu F, Xie J, Kelkar SS, Olivier C, Signorovitch J, et al. Impact of Teduglutide on quality of life among patients with short bowel syndrome and intestinal failure. JPEN J Parenter Enteral Nutr. 2020;44:119-28. https://doi.org/10.1002/jpen.1588
Chen KS, Xie J, Tang W, Zhao J, Jeppesen PB, Signorovitch JE. Identifying a subpopulation with higher likelihoods of early response to treatment in a heterogeneous rare disease: a post hoc study of response to teduglutide for short bowel syndrome. Ther Clin Risk Manag. 2018;14:1267-77. https://doi.org/10.2147/TCRM.S166081
Creutzfeldt W, Lembcke B, Folsch UR, Schleser S, Koop I. Effect of somatostatin analogue (SMS 201-995, Sandostatin) on pancreatic secretion in humans. Am J Med. 1987;82(Suppl 2):49-54. https://doi.org/10.1016/0002-9343(87)90426-8
Dharmsathaphorn K, Gorelick FS, Sherwin RS, Cataland S, Dobbins JW. Somatostatin decreases diarrhea in patients with the short-bowel syndrome. J Clin Gastroenterol. 1982;4:521-4. https://doi.org/10.1097/00004836-198212000-00008
DuPont AW, Sellin JH. Ileostomy diarrhea. Curr Treat Options Gastroenterol. 2006;9:39-48. https://doi.org/10.1007/s11938-006-0022-7
Fleming CR, Remington M. Intestinal failure. In: Hill GL, editor. Nutrition and the surgical patient. Edinburgh: Churchill Livingstone; 1981. p. 219e35.
Fujioka K, Jeejeebhoy K, Pape UF, Li B, Youssef NN, Schneider SM. Patients with short bowel on narcotics during 2 randomized trials have abdominal complaints independent of Teduglutide. JPEN J Parenter Enteral Nutr. 2017;41:1419-22. https://doi.org/10.1177/0148607116663481
Hoffer LJ, Bistrian BR. Appropriate protein provision in critical illness: a systematic and narrative review. Am J Clin Nutr. 2012;96:591-600. https://doi.org/10.3945/ajcn.111.032078
Iyer KR, Kunecki M, Boullata JI, Fujioka K, Joly F, Gabe S, et al. Independence from parenteral nutrition and intravenous fluid support during treatment with Teduglutide among patients with intestinal failure associated with short bowel syndrome. JPEN J Parenter Enteral Nutr. 2017;41:946-51. https://doi.org/10.1177/0148607116680791
Jeppesen PB, Christensen MS, Høy CE, Mortensen PB. Essential fatty acid deficiency in patients with severe fat malabsorption. Am J Clin Nutr. 1997;65:837-43. https://doi.org/10.1093/ajcn/65.3.837
Jeppesen PB, Gilroy R, Pertkiewicz M, Allard JP, Messing B, O’Keefe SJ. Randomised placebo-controlled trial of teduglutide in reducing parenteral nutrition and/or intravenous fluid requirements in patients with short bowel syndrome. Gut. 2011;60:902-14. https://doi.org/10.1136/gut.2010.218271
Jeppesen PB, Hartmann B, Thulesen J, Graff J, Lohmann J, Hansen BS, et al. Glucagon-like peptide 2 improves nutrient absorption and nutritional status in shortbowel patients with no colon. Gastroenterology. 2001;120:806-15. https://doi.org/10.1053/gast.2001.22555
Jeppesen PB, Mortensen PB. The influence of a preserved colon on the absorption of medium chain fat in patients with small bowel resection. Gut. 1998;43:478-83. https://doi.org/10.1136/gut.43.4.478
Jeppesen PB, Pertkiewicz M, Forbes A, Pironi L, Gabe SM, Joly F, et al. Quality of life in patients with short bowel syndrome treated with the new glucagon-like peptide-2 analogue teduglutide – Analyses from a randomised, placebo-controlled study. Clin Nutr. 2013;32:713-21. https://doi.org/10.1016/j.clnu.2013.03.016
Jeppesen PB, Pertkiewicz M, Messing B, Iyer K, Seidner DL, O’Keefe SJ, et al. Teduglutide reduces need for parenteral support among patients with short bowel syndrome with intestinal failure. Gastroenterology. 2012;143:1473-81. https://doi.org/10.1053/j.gastro.2012.09.007
Jeppesen PB, Sanguinetti EL, Buchman A, Howard L, Scolapio JS, Ziegler TR, et al. Teduglutide (ALX-0600), a dipeptidyl peptidase IV resistant glucagon-like peptide 2 analogue, improves intestinal function in short bowel syndrome patients. Gut. 2005;54:1224-31. https://doi.org/10.1136/gut.2004.061440
Kelly DG. Guidelines and available products for parenteral vitamins and trace elements. JPEN J Parenter Enteral Nutr. 2002;26(5 Suppl):S34-6. https://doi.org/10.1177/014860710202600510
Kocoshis SA, Merritt RJ, Hill S, Protheroe S, Carter BA, Horslen S, et al. Safety and efficacy of Teduglutide in pediatric patients with intestinal failure due to short bowel syndrome: A 24-week, phase III study. JPEN J Parenter Enteral Nutr. 2020;44:621-31. https://doi.org/10.1002/jpen.1690
Koletzko B, Jauch KW, Verwied-Jorky S, Krohn K, Mittal R. Guidelines on parenteral nutrition from the German society for nutritional medicine (DGEM) -overview. Ger Med Sci. 2009;7:27. https://doi.org/10.3205/000086
Lai HS, Chen WJ, Chen KM, Lee YN. Effects of monomeric and polymeric diets on small intestine following massive resection. Taiwan Yi Xue Hui Za Zhi. 1989;88:982-8.
Levy E, Frileux P, Sandrucci S, Ollivier JM, Masini JP, Cosnes J, et al. Continuous enteral nutrition during the early adaptive stage of the short bowel syndrome. Br J Surg. 1988;75:549-53. https://doi.org/10.1002/bjs.1800750615
Madsen KB, Askov-Hansen C, Naimi RM, Brandt CF, Hartmann B, Holst JJ, et al. Acute effects of continuous infusions of glucagon-like peptide (GLP)-1, GLP-2 and the combination (GLP-1 + GLP-2) on intestinal absorption in short bowel syndrome (SBS) patients. A placebo-controlled study. Regul Pept. 2013;184:30-9. https://doi.org/10.1016/j.regpep.2013.03.025
Matarese LE, O’Keefe SJ, Kandil HM, Bond G, Costa G, Abu-Elmagd K. Short bowel syndrome: clinical guidelines for nutrition management. Nutr Clin Pract. 2005;20:493- 502. https://doi.org/10.1177/0115426505020005493
McIntyre PB, Fitchew M, Lennard-Jones JE. Patients with a high jejunostomy do not need a special diet. Gastroenterology. 1986;91:25-33. https://doi.org/10.1016/0016-5085(86)90434-8
Messing B, Landais P, Goldfarb B, Irving M. Home parenteral nutrition in adults: a multicentre survey in Europe. Clin Nutr. 1989;8:3-9. https://doi.org/10.1016/0261-5614(89)90018-6
Messing B, Lémann M, Landais P, Gouttebel MC, Gérard-Boncompain M, Saudin F, et al. Prognosis of patients with nonmalignant chronic intestinal failure receiving longterm home parenteral nutrition. Gastroenterology. 1995;108:1005-10. https://doi.org/10.1016/0016-5085(95)90196-5
Mikalunas V, Fitzgerald K, Rubin H, McCarthy R, Craig RM. Abnormal vitamin levels in patients receiving home total parenteral nutrition. J Clin Gastroenterol. 2001;33:393-6. https://doi.org/10.1097/00004836-200111000-00010
National Collaborating Centre for Acute Care (UK). Nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition. London: National Collaborating Centre for Acute Care (UK); 2006 Feb. PMID: 21309138. Fecha de consulta: 7 de enero de 2014. Disponible en: www.rcseng.ac.uk
National Institute for Health and Care Excellence. Diabetes in adults - Quality standard. 2011. Disponible en: https://www.nice.org.uk/guidance/qs6 Nightingale
JMD, Lennard-Jones JE, Walker ER, Farthing MJG. Jejunal efflux in short bowel syndrome. Lancet. 1990;336:765-8. https://doi.org/10.1016/0140-6736(90)93238-K
Nightingale JMD, Walker ER, Farthing MJG, Lennard-Jones JE. Effect of omeprazole on intestinal output in the short bowel syndrome. Aliment Pharmacol Ther. 1991;5:405-12. https://doi.org/10.1111/j.1365-2036.1991.tb00044.x
Nightingale J, Woodward JM, Small Bowel and Nutrition Committee of the British Society of Gastroenterology. Guidelines for management of patients with a short bowel. Gut. 2006;55(Suppl. 4):iv1e12. https://doi.org/10.1136/gut.2006.091108
O’Keefe SJD, Haymond MW, Bennet WM, Oswald B, Nelson DK, Shorter RG. Long-acting somatostatin analogue therapy and protein metabolism in patients with jejunostomies. Gastroenterology. 1994;107:379-88. https://doi.org/10.1016/0016-5085(94)90162-7
O’Keefe SJD, Jeppesen PB, Gilroy R, Pertkiewicz M, Allard JP, Messing B. Safety and efficacy of teduglutide after 52 weeks of treatment in patients with short bowel intestinal failure. Clin Gastroenterol Hepatol. 2013;11:815- 23.e1-3. https://doi.org/10.1016/j.cgh.2012.12.029
Ovesen L, Chu R, Howard L. The influence of dietary fat on jejunostomy output in patients with severe short bowel syndrome. Am J Clin Nutr. 1983;38:270-7. https://doi.org/10.1093/ajcn/38.2.270
Pape UF, Iyer KR, Jeppesen PB, Kunecki M, Pironi L, Schneider SM, et al. Teduglutide for the treatment of adults with intestinal failure associated with short bowel syndrome: pooled safety data from four clinical trials. Therap Adv Gastroenterol. 2020;13:1756284820905766. https://doi.org/10.1177/1756284820905766
Pironi L, Arends J, Baxter J, Bozzetti F, Pelaez RB, Cuerda C, et al. ESPEN endorsed recommendations. Definition and classification of intestinal failure in adults. Clin Nutr. 2015;34:171-80. https://doi.org/10.1016/j.clnu.2014.08.017
Pironi L, Goulet O, Buchman A, Messing B, Gabe S, Candusso M, et al. Outcome on home parenteral nutrition for benign intestinal failure: A review of the literature and benchmarking with the European prospective survey of ESPEN. Clin Nutr. 2012;31:831-45. https://doi.org/10.1016/j.clnu.2012.05.004
Pironi L, Hebuterne X, van Gossum A, Messing B, Lyszkowska M, Colomb V, et al. Candidates for intestinal transplantation: A multicenter survey in Europe. Am J Gastroenterol. 2006;101:1633-43.
Pironi L, Paganelli F, Labate AMM, Merli C, Guidetti C, Spinucci G, et al. Safety and efficacy of home parenteral nutrition for chronic intestinal failure: a 16-year experience at a single centre. Dig Liver Dis. 2003;35:314-24. https://doi.org/10.1016/S1590-8658(03)00074-4
Preiser JC, Schneider SM. ESPEN disease-specific guideline framework. Clin Nutr. 2011;30:549-52. https://doi.org/10.1016/j.clnu.2011.07.006
Qvitzau S, Matzen P, Madsen P. Treatment of chronic diarrhoea: loperamide versus ispaghula husk and calcium. Scand J Gastroenterol. 1988;23:1237-40. https://doi.org/10.3109/00365528809090197
Reichlin S. Somatostatin. N Engl J Med. 1983;309:1556-63. https://doi.org/10.1056/NEJM198312223092506
Rolston DD, Zinzuvadia SN, Mathan VI. Evaluation of the efficacy of oral rehydration solutions using human whole gut perfusion. Gut. 1990;31:1115-9. https://doi.org/10.1136/gut.31.10.1115
Schwartz LK, O’Keefe SJD, Fujioka K, Gabe SM, Lamprecht G, Pape UF, et al. Long-term Teduglutide for the treatment of patients with intestinal failure associated with short bowel syndrome. Clin Transl Gastroenterol. 2016;7:e142. https://doi.org/10.1038/ctg.2015.69
Seidner DL, Joly F, Youssef NN. Effect of Teduglutide, a Glucagon-like Peptide 2 analog, on citrulline levels in patients with short bowel syndrome in two phase III randomized trials. Clin Transl Gastroenterol. 2015;6:e93. https://doi.org/10.1038/ctg.2015.15
Shaffer J. Intestinal failure: Definition and service development. Clin Nutr. 2002;21(Suppl. 1):144-5. https://doi.org/10.1016/S0261-5614(02)80034-6
Staun M, Pironi L, Bozzetti F, Baxter J, Forbes A, Joly F, et al. ESPEN Guidelines on Parenteral Nutrition: home parenteral nutrition (HPN) in adult patients. Clin Nutr. 2009;28:467-79. https://doi.org/10.1016/j.clnu.2009.04.001
Tappenden KA. Pathophysiology of short bowel syndrome: Considerations of resected and residual anatomy. JPEN J Parenter Enteral Nutr. 2014;38(Suppl 1):14S-22S. https://doi.org/10.1177/0148607113520005
Tappenden KA, Edelman J, Joelsson B. Teduglutide enhances structural adaptation of the small intestinal mucosa in patients with short bowel syndrome. J Clin Gastroenterol. 2013;47:602-7. https://doi.org/10.1097/MCG.0b013e3182828f57
Umpierrez GE, Hellman R, Korytkowski MT, Kosiborod M, Maynard GA, Montori VM, et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: An endocrine society clinical practice guideline. J Clin Endocrinol Metabolism. 2012;97:16-38. https://doi.org/10.1210/jc.2011-2098
Yarandi SS, Zhao VM, Hebbar G, Ziegler TR. Amino acid composition in parenteral nutrition: what is the evidence? Curr Opin Clin Nutr Metabolic Care. 2011;14:75-82. https://doi.org/10.1097/MCO.0b013e328341235a
Zheng H, Li Y, Zhang W, Zeng F, Zhou SY, Zheng HB, et al. Electroacupuncture for patients with diarrhea-predominant irritable bowel syndrome or functional diarrhea: A randomized controlled trial. Medicine (Baltimore). 2016;95:e3884. https://doi.org/10.1097/MD.0000000000003884. Erratum in: Medicine (Baltimore). 2016;95:e5074.
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