Real-World Management of High Stool Output in Patients with Short Bowel Syndrome: An International Multicenter Survey

Narisorn Lakananurak, Elizabeth Wall, Hilary Catron, Adela Delgado, Sophie Greif, Jean Herlitz, Lisa Moccia, David Mercer, Tim Vanuytsel, Vanessa Kumpf, Mark Berner-Hansen, Leah Gramlich

Research output: Contribution to journalArticlepeer-review


Background: International practice guidelines for high-stool-output (HSO) management in short bowel syndrome (SBS) are available, but data on implementation are lacking. This study describes the approach used to manage HSO in SBS patients across different global regions. Methods: This is an international multicenter study evaluating medical management of HSO in SBS patients using a questionnaire survey. Thirty-three intestinal-failure centers were invited to complete the survey as one multidisciplinary team. Results: Survey response rate was 91%. Dietary recommendations varied based on anatomy and geographic region. For patients without colon-in-continuity (CiC), clinical practices were generally consistent with ESPEN guidelines, including separation of fluid from solid food (90%), a high-sodium diet (90%), and a low-simple-sugar diet (75%). For CiC patients, practices less closely followed guidelines, such as a low-fat diet (35%) or a high-sodium diet (50%). First-line antimotility and antisecretory medications were loperamide and proton-pump inhibitors. Other therapeutic agents (e.g., pancreatic enzymes and bile acid binders) were utilized in real-world practices, and usage varied based on intestinal anatomy. Conclusion: Expert centers largely followed published HSO-management guidelines for SBS patients without CiC, but clinical practices deviated substantially for CiC patients. Determining the reasons for this discrepancy might inform future development of practice guidelines.

Original languageEnglish (US)
Article number2763
Issue number12
StatePublished - Jun 2023


  • antimotility medication
  • antisecretory medication
  • dietary management
  • high stool output
  • intestinal failure
  • short bowel syndrome

ASJC Scopus subject areas

  • Food Science
  • Nutrition and Dietetics


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