REGIONAL EXPERIENCE IN MANAGING PATIENTS WITH SHORT BOWEL SYNDROME

Abstract

Patients who have undergone extensive intestinal resections develop short bowel syndrome (SBS), manifested by diarrhea, low digestibility of micro- and macroelements, loss of fluid and electrolytes, and changes in intestinal mycobiota. Treatment of patients in such conditions is conservatively carried out, primarily through the use of parenteral nutrition, as well as through the use of medications that reduce peristalsis (loperamide, codeine), means that improve fat emulsification (ursodeoxycholic acid), antibacterial drugs aimed at inhibiting pathogenic intestinal biota (clindamycin, vancomycin, neomycin, kanamycin), as well as vitamins. The main problem of this treatment is a marked decrease in the quality of life of the patient and the need for his mandatory stay in the inpatient department of the hospital for the parenteral nutrition procedure (PN). Modern methods of treatment are aimed at eliminating this problem and are associated with an increase in the ability of the intestine to digest food. So, the intestines are able to adapt to the increased load on their own for 2 years, thanks to hormones synthesized in the intestinal L-cells. The use of analogues of these homons accelerates the rehabilitation process, allows you to reduce the volume of PN or abandon it, and, as a result, significantly improve the quality of life of the patient. The article presents an overview of current trends in the formation of an approach to the treatment of patients with short bowel syndrome (CCM), including examples of children’s patients who are under the supervision of specialists in the system of palliative care for children of the Tyumen region. After analyzing publications and evaluating the experience of working with children with CCM in the Tyumen region, we found that the analogue of glucagon-like peptide 2 (GLP-2) — teduglutide — makes it possible to reduce the volume of parenteral nutrition, infusion time, and also achieve a complete transition to enteral autonomy. The method of treatment with teduglutide is the most promising for patients of this category, as it reduces the risks associated with PP, which prima rily include catheter-associated infections and thrombotic complications, and improves not only the quality, but also the prognosis of later life.