Redefining "bowel regimen": Pharmacologic strategies and nutritional considerations in the management of small bowel fistulas

Am J Surg. 2018 Aug;216(2):351-358. doi: 10.1016/j.amjsurg.2018.01.040. Epub 2018 Feb 12.


Enterocutaneous fistulae (ECF) and enteroatmospheric fistulae (EAF) are difficult complications that primarily arise after abdominal surgical procedures. Development of an ECF or EAF carries significant mortality and morbidity. Effective management of patients with these disease states requires a multidisciplinary approach, which includes surgical, pharmacotherapeutic, and nutritional interventions. This review focuses on the medical and nutritional management of ECF/EAF, providing background on drug agents and nutritional strategies that may be helpful in reducing effluent volume, optimizing fistula healing, and maintaining nutritional health.

Keywords: Gastrointestinal agents; Intestinal fistula; Nutritional support.

Publication types

  • Review

MeSH terms

  • Clinical Protocols*
  • Gastrointestinal Agents / therapeutic use*
  • Humans
  • Intestinal Fistula / etiology
  • Intestinal Fistula / therapy*
  • Nutrition Assessment*
  • Nutritional Support / methods*
  • Postoperative Complications*
  • Practice Guidelines as Topic*


  • Gastrointestinal Agents