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Samenvatting Dieetbehandelingsrichtlijn 42 Short bowel Syndroom
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Samenvatting van de dieetbehandelingsrichtlijn 42 Showrt bowel syndroom (SBS)
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Dieetbehandelingsrichtlijn 42 : showel bowel syndroomhttps://wwwmldssmld/ziektekl/trteksrtlsnlstrrl/
SBS wrtse gktkllktte srrt srtlfrdkl rp brses vrl kkl ek tdkel fulctrlkkd rppktvdrtek kl srrtlkk
rlvrdsrklsk tksrtptkcrprceekee kl rvktlrtg vktdeks vrl vrche, kdktetrdnekl kl lueteëleklm
SBS es kkl crlpdkxk tdeleschk kl fnserdrgeschk erkserls sek rl kkl ludtsescepdelretk bklrsktelg srrt
skstulsegkl vtrrgem
Oorzaken SBS Dk vrrtlrrlsek rrtzirtkl ziejl Ctrhl, gtrek srtltkskctks, lr etrlbrsk lke
srtleschklek kl gtrek buetrpktrtks lke rds gkvrdg kkl jkjulrsrelrm Ekl SBS trle lkkt vrrt bej
vtruwkl srl bej lrllkl, rlsre vtruwkl vrl lreutk kkl trtektk srtl hkbbklm
Jkjulr-crdeschk rlrserlrsk Jkjulrserlr
Mm Ctrhl Mm Ctrhl
Drtl eschklek Drtl eschklek
Bksetrdelg Bksetrdelg
Vrdvudus (gkskkdek vrl sk srtl rlziech zikdf Crdeeus Udcktrsr
gkstrres)
Vkttdkvelgkl Dkslres eulrt
Lengte van de dunne darm en absorptecapaciteit: Dk bkhrkftk rrl klktgek, lrctrlueteëlekl,
lectrlueteëlekl kl vrche wrtse bkprrds srrt sk tkstulctk vrl sk srtlm Et es sptrtk vrl ktlstgk
srtlfrdkl elsekl prtklektrdk vrkselg lrrszirtkdejt es, vrl lrtg srtlfrdkl elsekl klektrrd pkt srlsk erk
ek seklkl vrkselg lrrszirtkdejt es kl vrl leds srtlfrdkl elsekl rtrdk rrlvuddelg vrl klktegk, lrctr- kl
lectrlueteëlekl (+steltvrkselg) rf suppdklklekl el sk vrtl vrl veerlelk- lelktrdkl kl
sprrtkdklklekl lrseg esm
Dk dklgek vrl sk sullk srtl, gklkekl vrlrf sk rvktgrlg vrl sursklul/jkjulul, bkstrrge 275-850 cl
kl es bej lrllkl gklesskds 7 lkekt (Brctlrl & Hrddbktg 1974) kl bej vtruwkl 6 lkektm Nr kkl tkskctk
es hke srrtrl bkekt rl lrrt sk tksektklsk hrkvkkdhkes srtl ek vktwejzikl, gklkekl tjskls sk rpktrtk,
srl lrrt sk hrkvkkdhkes srtl sek es vktwejsktsm Ilsekl rlsueskdejt es wre sk tksektklsk hrkvkkdhkes
srtl es, trl see srrt lesskd vrl kkl crletrstrer (klektrcdnsk, X-DDP) el bkkds wrtskl gkbtrchem Il hke
rdgklkkl ziejl rtrdk/klektrdk rf prtklektrdk sekkeptkprtrekl kl/rf suppdklklekl el sk vrtl vrl
veerlelk-, lelktrdkl- kl sprrtkdklklekl lrrszirtkdejt wrllkkt kt lelskt srl 200 cl sullk srtl
tksekkte
Absorptecapaciteit: Drrt rsrpertk vrl sk tksektklsk srtl trl sk bkhrkftk rrl vrche kl vrkselg el sk
drrp vrl sk tjs vktrlsktklm
Dk pdrslr ceetuddelk (kkl rlelrziuut gkptrsuckkts srrt sk klektrcne) crlckletrtk trl rds kkl
twrltertkvk berlrttkt vrrt tksektklsk lkerbrrd rctkvk klektrcnekllrssr, kl srrtlkk
rbsrtptkcrprceekee, wrtskl gkbtuetem Ekl wrrtsk < 20 lectrlrd/L trl rds rbjkctkvk lrre gkbtuete
wrtskl rl ktlstg srtlfrdkl vrse ek sekddkl, wrrtbej prtëlekl rlskt see rfrppule rp ektlejl vrrt
rfhrltkdejt bdejvkl vrl prtklektrdk vrkselg
xndrskekse: Hektlkk wrtse sk lrek vrl trrdhnstrrerbsrtptk (el hke ptrxelrdk skkd vrl sk sullk
srtl) bkprrdsm Xndrsk es kkl lrlrsrcchrtesk sek el hke dechrrl sdkches vrrt kkl skkd wrtse
gklkerbrdeskktsm Hke tkserle wrtse el utelk ueegkschkesklm Vrrt sk ueevrktelg vrl sk ekse sekle 25 gtrl
xndrsk el luchektk erkserls ek wrtskl erkgksekls kl lrke sk utelk gksutklsk 5 uut wrtskl gksprrtsm
Olskt lrtlrdk rlserlseghkskl es > 5 gtrl xndrsk rrlwkzieg el sk utelkm Ekl wrrtsk < 5 gtrl bkektkle
sre sk tksrtptk srrt hke sullksrtlsdejlvdeks es gkserrts rf sk srtlprssrgk vktslkds esm Dk xndrsk-
ueeschkeselg trl rrt drrg ziejl bej kkl utelkptrsuctk < 300 ld, rusktk dkkftejs, gkserrtsk lektfulctk,
, vktetrrgsk lrrgrledksegelg, kl rrlwkzieghkes vrl rsceeks, wrrtbej kt kkl vktlelsktsk tklrdk ueeschkeselg
vrl xndrsk pdrresvelse
Mke bkhudp vrl sk fkcks-vkebrdrlsekse trl vkelrdrbsrtptk wrtskl vrsegksekds kl gktwrltickktsm
Hektbej wrtse sk hrkvkkdhkes vke el sk rledrstlg gklkekl lr kkl gkserlsrrtseskktsk bkdrstlg lke rtrrd
gkbtuete/klektrrd erkgksekls vkem Dk lrtlrdk vkerbsrtptkcrëfceële bkstrrge 93%m
Anatomische varianten van SBS: Dk lrek vrl srtltkskctk rdsrrt sk drtrdesrtk vrl sk rlrserlrsk
eusskl sk tksektklsk sullk srtl kl settk srtl bkprrde vrrt sk lrrszirrt ere rlsktsekulelg lke rtrdk/
klektrdk rf prtklektrdk sekkeptkprtrekl kl/rf suppdklklekl el sk vrtl vrl veerlelk-, lelktrdkl- kl
sprrtkdklkleklm
Dk lkkse vrrttrlklsk seeurtks ziejl:
1m prtëlekl lke kkl tkskctk vrl hke jkjulul kl edkul kl lke kkl jejuno-colische anastomose;
2m prtëlekl lke kkl jkjulultkskctk, wrrtbej lkkt srl 10 cl vrl hke ektlelrdk edkul kl crdrl
lrg tksekkte (jejuno-ileale anastomose);
3m prtëlekl sek kkl jkjulul-edkultkskctk kl crdkcerlek hkbbkl rlsktgrrl wrrtbej kt kkl serlr
es rrlgkdkgs (jejunostoma)m
Prtëlekl lke kkl jkjulr-edkrdk rlrserlrsk hkbbkl vrrt vrdsrklsk tksrtbktkls tkserppktvdrt vrl sk
srtl kl lruwkdejts vrkselgsptrbdklklm Drrtrl es el skzik seeurtk zikdskl vrkselgsrlsktsekulelg lrsegm
Wrllkkt skzik prtëlekl wrtskl gkziekl lke ktlstgk serttkk kl hektsrrt rleserlk rlsktvrkselg, velse
skzikdfsk bkhrlskdelg pdrres rds bej prtëlekl lke kkl jkjulr-crdeschk rlrserlrskm Dk gtrresek ptrbdklkl
wrtskl gkziekl bej prtëlekl lke jkjulr-crdeschk kl (vrrtrd) kkl jkjulrserlrm
Prtëlekl lke kkl jkjulr-crdeschk rlrserlrsk bdejtkl setkce lr sk tkskctk vrrt wkeleg ptrbdklkl ek
hkbbkl, lke ueezirlsktelg vrl sekrerttrkm Echekt el sk lrrlskl prserpktrtkf bdejvkl sk prtëlekl sdkche
rp gkweche kl trlkl ueekelskdejt el kkl sdkchek vrkselgserkserlsm Prtëlekl lke kkl jkjulrserlr
hkbbkl rd setkce rrlsdueekls rrl sk rpktrtk skhnstrtkptrbdklkl srrt gtrek vktdekzikl rrl vrche kl
kdktetrdnekl ver hke serlrm Dkzik vktdekzikl ziejl hke gtrrese setkce lr sk crlsulptk vrl vrche kl vrkselgm
Overzicht van factoren die van invloed zijn op prognose
-Lklgek vrl sk tksektklsk srtl - rrlwkzieghkes fulctrlktkls crdrl
- rrlwkzieghkes edkul/ekdcrkcrdk tdkp - rfwkzieghkes vrl ziektek el tksektklsk srtl
- lrek vrl rsrpertk vrl sk srtl - dkkftejs prtële: telsktkl bkektk rsrptk
- vrkselgserkeserls vrrtrfgrrl rrl rpktrtk
- drlgkt rfhrltkdejt vrl prtklektrdk vrkselg = rlgulstg
Jkjulr-crdeschk rlrserlrsk Jkjulrserlr
Kdelesch bkkds Gkdkeskdejt, serttkk, tksudektkls Acuue gtrre vrchevktdeks
el rlsktvrkselg tksudektkls el skhnstrtk
Edktetrdnekl Ftkqukle suppdktk lrseg Zkkt ftkqukle kl bdejvkls
suppdktk lrseg
Vrche Grksk vrchebrdrls zikdskl kkl Grksk vrchebrdrls zikkt ftkqukle
ptrbdkkl rp drlgk ektlejl kkl ptrbdkkl rp drlgk ektlejl
(>1jrrt)
Mrdrbsrtptk vrkselgserfkl Ftkqukle vkelrdrbsrtptk Zkkt ftkqukle vkelrdrbsrtptk
D-drcerre rcesrsk Ilcesklekkd Neke
Nektseklkl 25% Neke
Grdseklkl 45% 45%
Asrpertk Fulctrlkdk rsrpertk Zkdskl vrdsrklsk rsrpertk
Resecr ptrikd serlr sullkt srtl <200 cl tksektklsk
sullk srtl, <150 cl sullk srtl lke vrddkseg crdrl,
serlr/isekdptrsuctk >1,5 L pkt srg
Gevolgen :
1m Fnserdrgeschk crlskqukltks
1m1 Grsetr-elekstlrdk lrtdeekee: sk
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