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

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.

A multidisciplinary team evaluation of management guidelines for adult short bowel syndrome.

BACKGROUND & AIMS: An international, multidisciplinary management working group (MWG) convened to review clinically useful short bowel syndrome (SBS) literature and identify gaps and inconsistencies in the management of adults with SBS. METHODS: Using nominal group technique for literature review, key publications were identified, discussed, and ranked by importance related to management of SBS. Gaps in management recommendations for SBS were identified upon critical review of the selected publications. RESULTS: Five guidelines, seven review articles, one series of six articles, and one single center series were selected and prioritized for their importance to SBS management. Evaluation of the articles by the MWG identified ten gaps and opportunities to standardize and improve SBS management. CONCLUSION: The main practice areas in need of more definitive guidelines are the management of high stool output and strategies to improve absorption of medications, nutrients, and fluids. An understanding of current real-world clinical practices related to these gaps could allow for development of best practice standards and improve patient-focused care.

Characteristics of adult intestinal failure centers: An international multicenter survey.

BACKGROUND: Current guidelines recommend that patients with chronic intestinal failure (CIF) should be managed by a multidisciplinary team (MDT). However, the characteristics of real-world IF centers and the patients they care for are lacking. The study aims to describe IF center characteristics as well as characteristics of patients with CIF across different global regions. METHODS: This is an international multicenter study of adult IF centers using a survey. The questionnaire survey included questions regarding program and patient characteristics. Thirty-three investigational centers were invited to participate. Each center was asked to answer the survey questions as one MDT. RESULTS: The survey center response rate was 91%. The median number of patients with CIF per center was 128 (range, 30-380). The most common disciplines reported were gastroenterologist (93%), dietitian (90%), nurse (83%), and advanced practitioner (nurse practitioner and physician assistant, 77%). There were centers that did not have a pharmacist, surgeon, psychologist, and social worker (30%, 37%, 60%, and 70%, respectively). The median full-time equivalents (FTEs) per 100 patients were 1.1 for nurses, 1 for dietitians, 1 for advanced practitioners, and 0.9 for gastroenterologists. Short bowel syndrome was the most common cause of CIF (50%) followed by intestinal dysmotility (20%). CONCLUSION: The majority of centers were managing around 100 patients with CIF. Despite the widespread use of the MDT, there are some variances in team characteristics. Gastroenterologists were the most common physicians supporting MDTs. In IF centers, one FTE of each core discipline was supported to manage 100 patients with CIF.

Alteraciones proliferativas de la mama en lesiones no palpables detectadas por mamografía / Proliferative changes in nonpalpable breast lesions detected by mammography

Objetivo: Realizar un análisis retrospectivo de los hallazgos radiológicos en lesiones no palpables detectadas por mamografía, que originan la indicación de biopsia quirúrgica con resultado histológico de mastopatía proliferativa con y sin atipia.Material y métodos: Se seleccionaron 421 mujeres con 429 biopsias con resultado histológico de mastopatía proliferativa con y sin atipia, procedentes de un total de 1.252 biopsias quirúrgicas en lesiones no palpables con resultado de benignidad en dos hospitales. En todas las pacientes se registró la edad, antecedentes personales y familiares de cáncer de mama, motivo de petición de la mamografía y signo radiológico que originó la indicación de biopsia quirúrgica.Resultados: En 347 mujeres con 354 biopsias, el diagnóstico fue de mastopatía proliferativa (hiperplasia epitelial) y en las 74 mujeres restantes, con 75 biopsias, de hiperplasia atípica, lo que representa el 28 por ciento y 6 por ciento, respectivamente, de las 1.252 biopsias con resultado de benignidad. De los 354 casos con diagnóstico histológico de hiperplasia epitelial y de los 75 casos con diagnóstico de hiperplasia atípica, en 221 (62 por ciento) y 45 (60 por ciento), respectivamente, el signo radiológico más frecuente que originó la indicación de biopsia fue un grupo de calcificaciones (p < 0,05). La distorsión parenquimatosa con o sin calcificaciones fue el segundo signo radiológico en frecuencia, mostrando en el estudio histológico una estrecha asociación de estos procesos proliferativos con la cicatriz radial.Conclusiones: Las calcificaciones son el hallazgo radiológico que más frecuentemente origina la indicación de biopsia quirúrgica por lesiones no palpables en pacientes con resultado de mastopatía proliferativa con y sin atipia (AU)