A small bowel resection is the surgical removal of sections of the small bowel. (Resection = removal)

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Why is nutritional therapy important?

Nutritional therapy supports you in relieving and eventually resolving abdominal discomfort. (Diarrhea, gas, bloating, pressure in the abdomen, pain) and thereby have a positive effect on your health.

The aim is to supply all of the fatty acids, micronutrients (vitamins and minerals) that are important to you, energy and protein in the measure that your body is optimally supplied with. For this purpose, foods that promote inflammation are specifically avoided and plenty of anti-inflammatory foods are consumed. Weight reduction is recommended if you are overweight / obese. An anti-inflammatory diet can improve the state of health. The diet is adapted to your current weight and a jointly defined goal for weight gain / or loss.

Causes in adults:

• Crohn's disease

• Mesenteric infarction (mesentery = mesentery of the small intestine = fixation of the small intestine - hanging strap of the jejunum and ileum)

• Mesenteric ischemia (= reduced blood flow to the mesentery)

• Accidental Injuries

• Necrotizing enterocolitis

• Tumors of the intestine or adjacent organs

• Insufficient blood flow to the intestine, for example due to a thrombosis or narrowing of a vessel

Causes in children:

• necrotizing enterocolitis   (= Form of Crohn's disease)

• Volvulus (= twisting, mostly in babies)

• Small intestine atresia (= small intestine is not properly positioned / functional)

• congenital malformation

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Classification according to the extent of the resection (removal):

Loss of <50% - minor to medium resection:

• unproblematic (compensable) according to p.po. Diet build-up & adaptation phase (3-6 months), if no special sections are affected

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Loss of> 50)%: critical

• pronounced maldigestion and malabsorption

• Diarrhea (diarrhea) / steatorrhoea (fat in stool), high stool frequency (up to 15 stools / d)

• long adaptation phase (adjustment phase) approx. 6-12 months required

• Diet with malassimilation (low-fiber diet) or light whole food as a permanent diet

Loss of> 70% (less than 1 meter remaining bowel length):

• Short bowel syndrome (short bowl syndrome)

• pronounced malassimilation syndrome

• persistent dietary problems

• Permanent parenteral nutrition is often necessary (= nutrition bypassing the digestive tract via the vein)

• Testing what is possible orally via the gastrointestinal tract.

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In addition, the following sections of the intestine must be observed postoperatively:

Resection of the terminal ileum:

• Disturbed enterohepatic circulation of the bile acids caused by chologene diarrhea (diarrhea)

• Vitamin B12 absorption not possible (supply: repeated injections necessary)

Resection of the ileocaecal valve:

• ascending bacterial colonization of the small intestine

• higher susceptibility to diarrhea, flatulence (gas) , food intolerance

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Post-operative effects

1) hypersecretion

• Gut is agitated, active

• large amounts of stool

• 90% of the chyme (chyme) is excreted

2) adaptation (individual)

• Parenteral nutrition (bypassing the bloodstream) + oral nutrition + enteral nutrition (oligopeptide diet)

3) Stabilization in short bowel syndrome

• Parenteral nutrition

• oral nutrition (oligopeptide diet)

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Classification of your weight - definition and classification of weight in relation to height.

Special percentile curves apply to children and adolescents; the BMI cannot simply be used here.

BMI and interpretation: BMI: body mass index. Formula: Body weight in kg : (body height in m) 2

Underweight: <18.5

Normal weight: 18.5 - 24.9

Overweight = pre-obesity: 25-29.9

Obesity grade I: 30 - 34.9

Obesity grade II: 35-39.9

Obesity grade III:> 40 = per magna

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Nutritional therapy

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• Build up to an adapted permanent diet

• Anti-inflammatory nutrition as a basis, individually tailored to you

• Holistic therapy - do you have any comorbidities that need to be taken into account during the consultation?

• Overall fat selection, how should it be designed

• How many animal foods (e.g. meat products, milk and dairy products, cheese, fish products, eggs) are recommended?

• What do I have to look out for when choosing animal foods?

• How can I counteract inflammatory processes through diet?

• Body weight: Weight reduction is recommended if you are overweight / obese.

• Avoid micronutrient deficiencies and mineral deficiencies & possibly counteract them with nutrient preparations

• Prevent protein deficiency

• Which nutrients do I need in which ratio?

• Get enough fiber (> 30 g / day) through natural foods, possibly fiber substitution

• Sufficient fluid: total fluid per day: 30 - 35 ml per kg body weight and day. Attention, this is not just a drinking liquid. The liquid from food (approx. 500 - 800 ml) must still be subtracted from this, so that an amount of approx. 1.3 - 2 l of drinking liquid is created.

• add valuable anti-carcinogenic (anti-cancer) secondary plant substances

• A selection of foods tailored to your needs with cooking and technical information (for breakfast, snacks, lunch, dinner)

• Do you like to eat your warm meal in the evening? I am happy to cater to your individual situation and we will create a plan on how you can implement your wholesome diet into your everyday life.

• which oils are good for me? What should I watch out for in relation to the anti-inflammatory diet?

• How much fat spread (butter / margarine / vegetable fat) can I use and which products are recommended?

• Get enough Omgea-3 fatty acids and essential fatty acids

• How can I boost and support my metabolism with natural foods?

• Coordinate sensible meal frequency for your individual case - meal allocation

• Define the desired weight stabilization / normalization & the estimated period for this

• what should be considered with beverages and alcoholic beverages?

• How does exercise affect your body and thus also your diet?

• Avoid blood sugar fluctuations

• Sweetening foods - sweeteners, glucose, fructose, sugar and sugar substitutes, what can I use and in what quantities? How high is the respective sweetness of the different products?

• what should be considered when baking and cooking?

• what are cheap snacks / main meals

• Eating out - what should you watch out for?

• Vacation, boat trip or hospital stay, what should be considered?

• Flatulence, bloating, diarrhea, constipation, vomiting, heartburn, loss of appetite, pain related to eating, what can I do about it?

• Daily plans as an example for practical implementation in everyday life

• Enjoyment training

• Optimizing your eating situation

• long-term maintenance of a jointly defined weight

• Strengthen the stomach and intestines with natural foods

• Additional therapy options

• Dietetic products in support of nutritional therapy

• Food supplements - under certain circumstances, a supplement can be useful

• and other topics

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Any questions? I look forward to your call or email. To contact form

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Assistance:

• KISS self-help groups

• Self-help network

• German Society for Digestive and Metabolic Diseases e. V.

• German Society for Neurogastroenterology and Motility V.

• German Society for Pediatric Gastroenterology and Nutrition

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