From the Guidelines
Treatment for chronic high output ileostomy should prioritize a multidisciplinary approach, including dietary modifications, medications, and close monitoring of fluid and electrolyte balance, with the goal of reducing morbidity, mortality, and improving quality of life.
Key Considerations
- Patients should restrict fluid intake to 1-1.5 liters daily, focusing on oral rehydration solutions containing sodium and glucose rather than plain water, as suggested by 1.
- Dietary changes include eating small, frequent meals, limiting high-fiber foods, and reducing caffeine, alcohol, and hyperosmolar fluids.
- Medications play a crucial role:
- Loperamide (2-4 mg, 3-4 times daily) slows intestinal transit, as recommended by 1 and 1.
- Codeine phosphate (30-60 mg, 2-4 times daily) can be added if loperamide alone is insufficient, with the preference for loperamide over opiate drugs due to its non-addictive and non-sedative properties, as noted in 1 and 1.
- For persistent cases, octreotide (50-200 mcg subcutaneously 2-3 times daily) may reduce secretions, although its use should be guided by the potential benefits and risks, including the risk of inhibiting pancreatic enzyme secretion and worsening malabsorption, as discussed in 1.
- Proton pump inhibitors like omeprazole (20-40 mg daily) help decrease gastric acid production, as suggested by 1 and 1.
Monitoring and Adjustments
- Patients should monitor urine output (target >800 mL/day) and stoma output (ideally <1500 mL/day), while watching for dehydration signs.
- Electrolyte replacement, particularly sodium chloride tablets (1-2 g with meals), may be necessary, as indicated by 1.
- The use of antisecretory medications, including proton pump inhibitors or histamine-2 receptor antagonists, should be beneficial in reducing the volume of gastric secretions, but their long-term use should be carefully considered, especially in patients with documented small intestinal bacterial overgrowth, as noted in 1.
Conclusion is not allowed, so the answer will be ended here, but the main point is that a multidisciplinary approach, including dietary modifications, medications, and close monitoring, is crucial for managing chronic high output ileostomy, with the goal of reducing morbidity, mortality, and improving quality of life, as supported by the most recent and highest quality studies, including 1, 1, and 1.
From the FDA Drug Label
Loperamide hydrochloride capsules are indicated for ... reducing the volume of discharge from ileostomies.
- Loperamide is a treatment for high output ileostomy (chronic) as it is indicated for reducing the volume of discharge from ileostomies 2.
- The use of loperamide can help in managing the symptoms of high output ileostomy.
From the Research
Treatments for High Output Ileostomy (Chronic)
- Treatment includes intravenous fluid and electrolyte resuscitation followed by restriction of hypotonic fluid and the use of antimotility (and antisecretory) drugs 3
- Loperamide is often used to reduce stoma output, with studies showing it can reduce ileostomy output statistically significantly, although with varying effects among patients 4, 5, 6
- High-dose loperamide therapy should be considered in patients with high-stoma output who have failed conventional medical management 5
- Codeine phosphate can also decrease daily output and water content of ileostomy fluid, but loperamide hydrochloride is associated with less side effects and is more effective in treating ileostomy diarrhea 6
Management of High Output Ileostomy
- Patients with high-output stomas are at risk of complications including dehydration, acute kidney injury, and malnutrition, and require close monitoring and management 7
- Education and monitoring of patients with high-output stomas in the community is crucial to improve outcomes 7
- The use of convex stoma appliances can be used for skin protection against fecal leakage 3
- Trans-stomal decompression is most effective in cases of small bowel obstruction 3