High-output enterocutaneous fistula or enterostomies can cause intestinal failure.
There is a wide variety of options in medical management of patients with high output.
Dr de Vries and colleagues from the Netherlands systematically reviewed the literature on available pharmacotherapy to reduce output and to propose an algorithm for standard of care.
Relevant databases were systematically reviewed to identify studies on pharmacotherapy for reduction in high-output enterostomies or fistula.
Randomized controlled trials and within subjects controlled prospective trials were included.
|An algorithm for standard of care proposes high-dose proton pump inhibitors combined with high-dose loperamide as the first step|
|Alimentary Pharmacology & Therapeutics|
An algorithm for standard of care was generated based on the outcomes of the systematic review.
The team included 2 studies on proton pump inhibitors, 6 on anti-motility agents, 3 on histamine receptor antagonists, 1 on an α2- receptor agonist, and 8 on somatostatin.
One study examined a proton pump inhibitor, and a histamine receptor antagonist within the same patients.
Overall, the team found evidence for the following medical therapies to be effective: omeprazole, loperamide and codeine, ranitidine and cimetidine.
On the basis of these outcomes and clinical experience, the researchers proposed an algorithm for standard of care which consists of high-dose proton pump inhibitors combined with high-dose loperamide as the first step followed by addition of codeine in case of insufficient output reduction.
So far, there is insufficient evidence for the standard use of somatostatin.
Dr de Vries' team concludes, "The available evidence on the efficacy of medication to reduce enterostomy or enterocutaneous fistula output is hampered by low quality studies."
"We propose an algorithm for standard of care output reduction in these patients."