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The ‘not so short‐bowel syndrome’: potential health problems in patients with an ileostomy
Author(s) -
Ng D. H. L.,
Pither C. A. R.,
Wootton S. A.,
Stroud M. A.
Publication year - 2013
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.12252
Subject(s) - medicine , short bowel syndrome , creatinine , bone mineral , ileostomy , urinary system , body mass index , lean body mass , gastroenterology , endocrinology , urology , body weight , parenteral nutrition , osteoporosis
Abstract Aim The study aimed to determine whether an ileostomy compromises nutritional, hydration and electrolyte status and bone mineral density. Method Body weight, body mass index ( BMI ) and fat and lean body mass ( LBM ) were measured in 60 patients with an ileostomy [14 small‐bowel resection ( SBR ); 46 non‐small‐bowel resection ( NSBR )] and in 60 age‐ and sex‐matched normal controls. Measurement of plasma sodium, potassium, calcium, magnesium, urea and creatinine and 24‐h urinary output of water, N a, K , C a and M g was made in 45 NSBR and 14 SBR ileostomists and in all the controls. Forty‐six NSBR and 13 SBR ileostomists had bone mineral density ( BMD ) measurements of lumbar spine ( LS ) and femoral neck ( FN ). Results The body weight of ileostomists was less than controls [median 67.8 (36.4–115.1) vs 77.7 (48.0–103.3) kg; P < 0.05]. BMI was also less [25.0 (14.3–43.0) vs 27.3 (20.2–32.2) kg/m 2 ; P < 0.05] with a lower LBM [47.8 (19.3–73.0) vs 52.9 (34.0–73.8) kg; P < 0.05]. The 24‐h urinary output of the ileostomists was lower than for controls [1380 (430–4690) vs 2000 (840–4440) ml/24 h; P < 0.05] suggesting some degree of dehydration. In 62.7% of ileostomists 24‐h urinary N a excretion was < 100 mmol/day vs 16.7% of controls, and ileostomists with lower urinary N a were more likely than ileostomists with normal N a excretion to have a low BMI [23.9 (14.3–33.0) vs 28.4 (16.6–43.0) kg/m 2 ; P < 0.001] and LBM [44.1 (19.3–73.0) vs 59.5 (36.6–67.9) kg; P < 0.001]. The respective 24‐h output of C a was [2.2 (0–6.1) vs 4.7 (0–13) mmol; P < 0.001] and M g was [2.0 (0–13.7) vs 3.9 (1.2–5.4) mmol; P < 0.001], and BMD Z ‐score LS was −0.15 (−2.0 to 5.2) vs 0.3 (−2.5 to 2.1), Z ‐score FN −0.5 (−1.9 to 3.1) vs 0.2 (−1.2 to 1.4), both P < 0.05. Conclusion Patients with an ileostomy tend to have low body weight, BMI , LBM and BMD . They also tend to have low urine volumes, and some are depleted of N a, C a and M g. Abnormalities are greater in those with a lower urinary N a and measuring this will identify ileostomists at risk of N a depletion who will be benefitted by N a supplements.