Cath Lab Digest

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Index: Ostomy Wound Manage. 2008;54(6):36-47.

  A survey of the Fort Worth Ostomy Association found the majority of the members are > 65 years of age. Many have had their ostomies for more than two decades.¹ Thus, people who have had significant bowel resections such as ileostomies, ileoanal pull-throughs, continent diversions, and colectomies are living long enough to have to deal with some of the same degenerative diseases and conditions commonly encountered by all older adults. Of particular concern: Does living with an incomplete intestine increase risk for age-related disabilities such as osteoporosis?²

  The intestine seems to adapt to surgery and resections. Generally, the physiology of vitamin and minerals (absorption from the resected intestine and subsequent use by the body) requires adequate nutritional intake, including enzymes and specific hormones in amounts sufficient to process the nutrients. Even with as little as one third of the small intestine present, the body continues to maintain adequate vitamin and mineral stores as long as the patient maintains a healthy diet.³

However, loss of the distal ileum and colon can affect bile salt production. Changes in nutritional absorption have been found to cause higher numbers of gallstones among patients who have short bowel syndrome than among the normal population.⁴ Calcium-related renal stones also are more common among persons with significant reductions in bowel length secondary to increased transit time of effluent, which results in dehydration and concentrated urine output.⁵

  Clinicians, caregivers, and patients need to know whether significant changes resulting from bowel resection increase the risk of osteoporosis, gallstones, and renal stones in persons with a stoma. Because mineral absorption in people with ostomies was a concern of the members of the Fort Worth Chapter of the United Ostomy Association (UOA), a literature search was conducted to determine if intestinal resection with loss of significant portions of the intestine can affect absorption of vital nutritional elements. The most productive searches resulted from using the word calcium in combination with Crohn’s or inflammatory bowel and yielded English-language articles published between 1989 and 2007; most involved retrospective research. The literature search focused on the anatomy of the intestine, the physiology that affects mineral and bile salt absorption, and whether intestinal resection can result in latent deficiencies of essential vitamins and minerals. The results of the literature search, first presented to the UOA Fort Worth chapter members, are summarized to help clinicians optimize care of all persons with a stoma.

Anatomy and Function

  The intestinal tract comprises the stomach, the small intestine, and the large intestine or colon. Alcohol, some medications, and simple carbohydrates are absorbed directly from the stomach. Each section of the intestine is responsible for the absorption of a particular nutritional element.

  Small intestine. The small intestine in the adult is approximately 22 feet long and consists of the duodenum, the jejunum, and the ileum. The small intestine wall is arranged in folds of absorptive cells and villi. Most nutrient absorption occurs in the small intestine,⁶ including minerals, vitamins, proteins, and fats. Iron, calcium, magnesium, and zinc are absorbed almost immediately after leaving the stomach – ie, in the 8 feet of the duodenum and the jejunum.