Effects of Changes in Dietary Lipids on Intestinal Fluid Loss in the Short-Bowel Syndrome

Seven patients underwent massive intestinal resection. Fecal losses of water and electrolytes were life threatening in four patients, who required constant or repeated intravenous replacement. All patients received symptomatic treatment and vitamin replacement. Lowering the amount of dietary fat, bile salt replacement, and supplementation of diet with micellar fat were ineffective. A regimen consisting of 50 to 75% replacement of dietary long-chain fat with medium-chain triglyceride proved beneficial, leading to gradual decline in fecal loss of water and electrolytes and great improvement in nutritional status. Gastric secretory studies showed minimal increase in basal and 12-hr overnight acid output in two patients and no increase in maximal acid output. Pyloroplasty and vagotomy attempted in one patient and directed toward reduction of gastric secretion proved disastrous. Such treatment should be reserved for patients demonstrating massive gastric hypersecretion unresponsive to medical management, and a conservative program should be followed.