{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T06:56:07Z","timestamp":1788850567523,"version":"build-2803163510"},"reference-count":24,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2023,6,16]],"date-time":"2023-06-16T00:00:00Z","timestamp":1686873600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/nu15122763","type":"journal-article","created":{"date-parts":[[2023,6,16]],"date-time":"2023-06-16T02:02:20Z","timestamp":1686880940000},"page":"2763","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Real-World Management of High Stool Output in Patients with Short Bowel Syndrome: An International Multicenter Survey"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3166-0856","authenticated-orcid":false,"given":"Narisorn","family":"Lakananurak","sequence":"first","affiliation":[{"name":"Division of Clinical Nutrition, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Wall","sequence":"additional","affiliation":[{"name":"Clinical Nutrition, University of Chicago Medicine, Chicago, IL 60637, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilary","family":"Catron","sequence":"additional","affiliation":[{"name":"College of Allied Health, University of Nebraska Medical Center, Omaha, NE 68198, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adela","family":"Delgado","sequence":"additional","affiliation":[{"name":"Royal Alexandra Hospital, Alberta Health Services, Edmonton, AB T5H 3V9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1315-8766","authenticated-orcid":false,"given":"Sophie","family":"Greif","sequence":"additional","affiliation":[{"name":"Department of Hepatology and Gastroenterology, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean","family":"Herlitz","sequence":"additional","affiliation":[{"name":"Clinical Nutrition, University of Chicago Medicine, Chicago, IL 60637, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Moccia","sequence":"additional","affiliation":[{"name":"Center for Human Nutrition, Cleveland Clinic, Cleveland, OH 44195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Mercer","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68198, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8728-0903","authenticated-orcid":false,"given":"Tim","family":"Vanuytsel","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology, Katholieke Universiteit Leuven, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3390-3869","authenticated-orcid":false,"given":"Vanessa","family":"Kumpf","sequence":"additional","affiliation":[{"name":"Center for Human Nutrition, Vanderbilt University Medical Center, Nashville, TN 37232, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Berner-Hansen","sequence":"additional","affiliation":[{"name":"Digestive Disease Center K, Bispebjerg University Hospital of Copenhagen, 2400 Copenhagen, Denmark"},{"name":"Zealand Pharma, 2860 Soeborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leah","family":"Gramlich","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T5B 4E4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"5196","DOI":"10.1016\/j.clnu.2021.07.002","article-title":"ESPEN practical guideline: Clinical nutrition in chronic intestinal failure","volume":"40","author":"Cuerda","year":"2021","journal-title":"Clin. Nutr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.clnu.2016.01.020","article-title":"ESPEN guidelines on chronic intestinal failure in adults","volume":"35","author":"Pironi","year":"2016","journal-title":"Clin. Nutr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1177\/0148607113512678","article-title":"Short bowel syndrome: Highlights of patient management, quality of life, and survival","volume":"38","author":"Kelly","year":"2014","journal-title":"JPEN J. Parenter. Enteral Nutr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/S0261-5614(96)80019-7","article-title":"Home parenteral nutrition in adults: A multicentre survey in Europe in 1993","volume":"15","author":"Group","year":"1996","journal-title":"Clin. Nutr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e211","DOI":"10.1016\/j.clnme.2012.08.001","article-title":"Home parenteral nutrition: An international benchmarking exercise","volume":"7","author":"Baxter","year":"2012","journal-title":"e-SPEN J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1002\/jpen.1958","article-title":"High Parenteral Support Volume Is Associated With Reduced Quality of Life Determined by the Short-Bowel Syndrome Quality of Life Scale in Nonmalignant Intestinal Failure Patients","volume":"45","author":"Nordsten","year":"2021","journal-title":"JPEN J. Parenter. Enteral Nutr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1016\/j.clnu.2012.05.004","article-title":"Outcome on home parenteral nutrition for benign intestinal failure: A review of the literature and benchmarking with the European prospective survey of ESPEN","volume":"31","author":"Pironi","year":"2012","journal-title":"Clin. Nutr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1441","DOI":"10.1002\/jpen.2051","article-title":"Short-Bowel Syndrome: Epidemiology, Hospitalization Trends, In-Hospital Mortality, and Healthcare Utilization","volume":"45","author":"Siddiqui","year":"2021","journal-title":"JPEN J. Parenter. Enteral Nutr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1007\/s11938-022-00385-y","article-title":"Dietary Strategies for Managing Short Bowel Syndrome","volume":"20","author":"Limtrakun","year":"2022","journal-title":"Curr. Treat. Options Gastroenterol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1650","DOI":"10.1002\/jpen.2372","article-title":"Impact of intestinal failure and parenteral support on adult patients with short-bowel syndrome: A multinational, noninterventional, cross-sectional survey","volume":"46","author":"Jeppesen","year":"2022","journal-title":"JPEN J. Parenter. Enteral Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"38S","DOI":"10.1177\/0148607113520618","article-title":"Pharmacologic management of diarrhea in patients with short bowel syndrome","volume":"38","author":"Kumpf","year":"2014","journal-title":"JPEN J. Parenter. Enteral Nutr."},{"key":"ref_12","unstructured":"Elizabeth Wall, H.C., Lakananurak, N., and Gramlich, L. A Multidisciplinary Team Evaluation of Management Guidelines for Adult Short Bowel Syndrome. Clin. Nutr. ESPEN, 2023. in press."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1002\/ncp.10926","article-title":"Characteristics of adult intestinal failure centers: An international multicenter survey","volume":"38","author":"Lakananurak","year":"2022","journal-title":"Nutr. Clin. Pract."},{"key":"ref_14","unstructured":"ClinicalTrials.gov (2023, March 07). Efficacy And Safety Evaluation of Glepaglutide in Treatment of SBS (EASE SBS 1), Available online: https:\/\/www.clinicaltrials.gov\/ct2\/show\/NCT03690206."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1177\/0148607112469818","article-title":"Nutrition and fluid optimization for patients with short bowel syndrome","volume":"37","author":"Matarese","year":"2013","journal-title":"JPEN J. Parenter. Enteral Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/S0140-6736(94)91220-3","article-title":"Colon as a digestive organ in patients with short bowel","volume":"343","author":"Nordgaard","year":"1994","journal-title":"Lancet"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1093\/ajcn\/64.2.222","article-title":"Importance of colonic support for energy absorption as small-bowel failure proceeds","volume":"64","author":"Nordgaard","year":"1996","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.clnesp.2018.10.006","article-title":"High amylase resistant starch to decrease stool output in people with short bowel syndrome: A pilot trial","volume":"29","author":"Hamilton","year":"2019","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1111\/apt.14136","article-title":"Systematic review: Pharmacotherapy for high-output enterostomies or enteral fistulas","volume":"46","author":"Reeskamp","year":"2017","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"14S","DOI":"10.1177\/0148607113520005","article-title":"Pathophysiology of short bowel syndrome: Considerations of resected and residual anatomy","volume":"38","author":"Tappenden","year":"2014","journal-title":"JPEN J. Parenter. Enteral Nutr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"iv1","DOI":"10.1136\/gut.2006.091108","article-title":"Guidelines for management of patients with a short bowel","volume":"55","author":"Nightingale","year":"2006","journal-title":"Gut"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1136\/gut.26.9.914","article-title":"Gastric acid secretion and gastrin production in the short bowel syndrome","volume":"26","author":"Williams","year":"1985","journal-title":"Gut"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/S0140-6736(68)90235-3","article-title":"Bile-salts in small intestinal contents after ileal resection and in other malabsorption syndromes","volume":"1","author":"McLeod","year":"1968","journal-title":"Lancet"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1056\/NEJM196708172770704","article-title":"Bile-salt deficiency in the steatorrhea following resection of the ileum and proximal colon","volume":"277","author":"Hardison","year":"1967","journal-title":"N. Engl. J. Med."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/12\/2763\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:56:07Z","timestamp":1760126167000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/12\/2763"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,16]]},"references-count":24,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,6]]}},"alternative-id":["nu15122763"],"URL":"https:\/\/doi.org\/10.3390\/nu15122763","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,16]]}}}