Page 22 - To keep a balance in disease specific intestinal insufficiency. Diagnostics and practical nutritional aspects - Nicolette Wierdsma

Chapter 2
20
Abstract
(Case-study: Energy losses from a short bowel, not only fat)
Two adult patients, men aged 43 and 45 years, with Crohn’s disease, complicated by high-output small-bowel-stomy and short-bowel syndrome due to several intestinal resections, presented with extreme weight loss. Although both patients followed a high-calorie diet combining solid foods and enteral nutrition by nasogastric tube, containing 3800 kcal and 5000 kcal, respectively, weight loss continued. Fecal fat excretion and basal metabolic rate were determined, but these could not explain the caloric deficit. Therefore, fecal bomb calorimetry, a measurement of total fecal energy content, was also performed, revealing a considerably higher fecal energy loss than had been calculated from fecal fat excretion; this indicates that fecal carbohydrate loss plays an important supplementary role. A stable weight was achieved in both patients by prescribing extra food. Therefore, fecal fat excretion is an insufficient indicator of total fecal calorie loss in patients with high-output stomata and short-bowel syndrome. Bomb calorimetry may be considered as a tool to determine the remaining absorptive capacity in short-bowel patients.