S3-Guideline of the German Society for Nutritional Medicine (DGEM) in Cooperation with the GESKES, the AKE and the DGVS

Introduction: Enteral and parenteral nutrition are the cornerstone for the therapy of short bowel syndrome and intestinal failure. The underlying anatomic situation may be amendable to reconstructive surgery. Intestinal transplantation is currently an option in case of failure of parenteral nutrition. Methods: A systematic literature search for short bowel syndrome or intestinal failure coupled with a literature search for enteral or parenteral nutrition, reconstructive surgery or intestinal transplantation was performed. Based on this the working group developed recommendations, which were presented, discussed and confirmed in a consensus conference. Results: The guideline addresses only short bowel syndrome (intestinal failure) in adults. It contains a general part with definitions and a specific part with recommendations for the documentation of the postoperative anatomy and the nutritional status, for the indication, the compounding and the administration of parenteral nutrition (with special emphasis on the predominant fluid and electrolyte losses), for the principles of a specific diet, for the catheters and the management of their infectious complications, for the specific and symptomatic pharmacotherapy, for reconstructive surgery and for intestinal transplantation. Conclusion: Controlled studies addressing intestinal failure are sparse due to the orphan nature of the disease and due to the large interindividual variation. The anticipated short bowel situation (based on a detailed description of the postoperative situation) is the indication for nutritional intervention. Individually tailored (compounded) parenteral nutrition, prophylaxis and treatment of complications and reconstructive surgery should all be applied. Specific and symptomatic pharmacologic approaches can be used as well. Intestinal transplantation is a therapeutic option if parenteral nutrition fails.