Version May 2024
| Indications | Comments | |
| Antisecretory agents | ||
| Acid suppression (PPIs, H2RAs) | For all children in early phases after intestinal resection. | Resection induces gastric acid hypersecretion, which contributes to fluid losses and interferes with fat digestion. |
| For long-term acid suppression in selected children, if clinically useful. | Prolonged use of acid suppression should be used with caution because it may predispose to SIBO or vitamin B12 deficiency. | |
| Bile acid sequestrants (cholestyramine, colesevelam) | For patients with bile acid diarrhea (which occasionally occurs in patients who lack terminal ileum). | Bile acids entering the colon trigger secretory diarrhea. Confirm with empiric trial. Use with caution because bile acid sequestrants may impair fat-soluble vitamin absorption and cause gastrointestinal irritation. |
| Octreotide | Second- or third-line option for watery diarrhea that does not respond to other measures, including dietary changes and acid suppression. | May hinder intestinal adaptation and increases the risk of cholelithiasis (because it reduces gallbladder contractility). |
| Clonidine | Third-line option for watery diarrhea, after optimizing other antisecretory and antidiarrheal therapies. | Limited data; mostly in adults. Do not use in infants. |
| Antimotility agents | ||
| Loperamide | Infants and children with high stool output (eg, >10 stools/day or nighttime stools). | Use tablet or capsule form (liquid formulation may have carbohydrates). May predispose to SIBO; avoid in patients with acute gastrointestinal infection. |
| Absorptive agents | ||
| Pancreatic enzymes | Rare patients with apparent pancreatic insufficiency, as suggested by steatorrhea and response to empiric trial of enzymes. | Traditional testing for pancreatic insufficiency is often inaccurate because fecal elastase can be falsely low in SBS. Steatorrhea in SBS is more often caused by mucosal malabsorption. |
| Adaptive agents* | ||
| Teduglutide | Selected patients who are slow to achieve enteral autonomy. | GLP-2 analog. May enhance intestinal adaptation. Patient selection criteria in children are not well established. |
| Promotility agents | ||
| Cisapride | Patients with dysmotility, suggested by underlying gastroschisis, bowel dilatation, frequent vomiting, or delayed gastric emptying. | Caution due to concerns about cardiac arrhythmias; limited availability in the United States. |
| Erythromycin | Limited data for efficacy in dysmotility related to gastroschisis. | |
| Appetite stimulants | ||
| Cyproheptadine | Selected patients with poor appetite during transition to oral feeding; possibly patients with delayed gastric emptying. | Appetite-stimulating effects; improves gastric accommodation. |
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