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Biomedical subjects

Alan L Buchman

Publications and source records attributed to Alan L Buchman.

42 records · Page 3Linked to original sources
PubMed2002

Nutritional management of short bowel syndrome.

Short-bowel syndrome refers to malabsorption, diarrhea, and weight loss following an extensive resection of small bowel. A main consequence is malabsorption of macro- and micronutrients. Nutritional outcome after intestinal resection depends on the extent and location of resection, presence of ileocecal valve and a colon, functional status of the residual intestine, and adaptation. Intraluminal nutrients and trophic factors are critical for intestinal adaptation. The dietary management is focused on the enhancement of intestinal adaptation and optimal caloric intake. Patients with short-bowel syndrome require an individualized diet, and some may require total parenteral nutrition indefinitely. Growth hormone, glutamine, and GLP-2 are reviewed with emphasis on their current use in clinical practice. The nutritional aspect of short-bowel syndrome is complex, with the ultimate goal of weaning the patients from parenteral nutrition. Intestinal transplant is a treatment option for select patients.

Clinical Trials as Topic↗
PubMedDate not supplied

Choline deficiency is associated with increased risk for venous catheter thrombosis.

BACKGROUND: Patients with intestinal failure who require long-term parenteral nutrition (PN) develop catheter thrombosis as a complication. This patient group may also develop choline deficiency because of a defect in the hepatic transsulfuration pathway in the setting of malabsorption. This study was undertaken to determine whether choline deficiency is a risk factor for development of catheter thrombosis. METHODS: Plasma free and phospholipid-bound choline concentrations were measured in a group of 41 patients that required long-term PN. Episodes of catheter thrombosis from onset of PN to the time of blood testing were recorded. RESULTS: Sixteen (39%) patients developed catheter thrombosis, and 5 of these had recurrent catheter thrombosis. Plasma free choline was 7.7 +/- 2.7 nmol/mL in patients with no history of catheter thrombosis and 6.2 +/- 1.7 nmol/mL in patients with previous catheter thrombosis (p = .076 by Wilcoxon rank-sum test). The partial correlation between plasma free choline concentration and the frequency of clots after controlling for catheter duration was r = -0.33 (p = .038). The relative risk for catheter thrombosis in subjects with a plasma free choline concentration <8 nmol/mL was 10.0, 95% confidence interval (1.134-88.167). Plasma phospholipid-bound choline concentration was 2191.7 +/- 679.0 nmol/mL in patients with previous catheter thrombosis and 2103.3 +/- 531.2 nmol/mL in patients without history of catheter thrombosis (p = NS). CONCLUSION: Choline deficiency is a significant risk factor for development of catheter thrombosis in patients with intestinal failure who require PN.

Adult↗
PubMedDate not supplied

Clonidine reduces diarrhea and sodium loss in patients with proximal jejunostomy: a controlled study.

BACKGROUND: Patients with short bowel syndrome have significant fluid losses. This represents a significant management problem, especially in patients with minimal residual intestine. We determined whether clonidine, an alpha2-adrenergic agonist, is effective in decreasing fecal water and sodium (Na) losses in patients with proximal jejunostomy. Eight parenteral nutrition (PN)-dependent subjects (3 men, 5 women), aged 49.9+/-10.2 years, with a residual small bowel length of 71.8+/-152.0 cm that ended in a jejunostomy, were studied. METHODS: Subjects were admitted to the North-western General Clinical Research Center (GCRC) for a 2-day equilibrium period while receiving a self-selected 100 g fat diet with protein 1.5 g/kg/d and 30 kcal/kg/d and 1 L/d of oral rehydration solution. A D-xylose test was performed after an overnight fast. On days 3-5, all stool and urine were collected for volume, weight, fat, nitrogen, energy, sodium, magnesium, potassium, and calcium. Meals were provided in duplicate and the equivalent portions consumed by each patient were analyzed for fluid volume, fat, nitrogen, energy, sodium, magnesium, calcium, and potassium in order to calculate nutrient balances. At the conclusion of the stool and urine collections (day 6), a clonidine (0.3 mg) patch was applied to the shoulder. Subjects were restudied after 1 week. RESULTS: Daily fecal volume and weight were 4.514+/-1.769 L/d and 4394+/-1727 g/d, respectively, at baseline. Five subjects were net "secretors" in that excreted fecal volume exceeded oral intake. Fecal volume decreased by 427+/-562 mL/d (8.9%, p=.07). Fecal weight decreased by 438+/-527 g/d (9.4%, p=.05). Urine volume correspondingly increased by 747+/-1934 mL (18.9%, p=not significant [NS]). The increase in urine output was weakly and negatively correlated with the decrease in fecal volume and weight (r=-0.37 and -0.41, respectively, p=NS). Oral fluid intake decreased slightly from 3.328+/-1.246 L/d baseline to 3.203+/-1.119 L/d with clonidine therapy (-3.8%, p=NS). Fecal Na loss was significantly decreased from baseline (887+/-996 mg/d, 11.2+/-12.3%; p=.036). This was not related to decreased oral Na intake, which actually increased from baseline (3.799+/-2.271 g/d) to 3.933+/-1.314 g/d after clonidine therapy (p=NS). No patient developed hypotension. CONCLUSIONS: Our results show the transdermal administration of clonidine is associated with a modest but clinically significant decrease in fecal output in patients with short bowel syndrome and high-output proximal jejunostomy that require chronic parenteral fluid infusion. This is accompanied by decreased fecal Na loss.

Administration, Cutaneous↗
PubMedDate not supplied

The nutritional management of short bowel syndrome.

Short bowel syndrome (SBS) is the predominant cause of intestinal failure and is associated with a high degree of morbidity and mortality. One of the reasons this occurs is because of the dramatic reduction in nutrient absorptive capacity. There are many causes for the development of SBS, but the most common is extensive surgical resection. The bowel has an impressive ability to adapt both morphologically and functionally. This adaptation becomes critical in decreasing morbidity and mortality. It is also critical for the improvement of quality of life and long-term outcomes. Provision of sufficient nutritional and fluid support is essential to the management of SBS patients. The primary goal is to prevent or eliminate the need for total parenteral nutrition. Specific diets and hormonal therapy may enhance the adaptation process depending on the characteristics of the remaining bowel. For those patients who experience both intestinal failure and life-threatening complications from total parenteral nutrition, bowel transplantation may be indicated.

Adaptation, Physiological↗