1.0 FORMULATION OF GUIDELINES

1.1 Aim

These guidelines aim to help clinicians manage patients who have had an intestinal resection that leaves a short length (about 2 m or less) of small bowel remaining.

1.2 Development

The preliminary guidelines were compiled from the literature and a first document was drafted by Dr J Nightingale and modified by members of the Small Bowel and Nutrition Committee under the chairmanship of Dr B Jones. A section on “intestinal transplantation” was written by Dr Woodward and added with the approval of the Small Bowel and Nutrition Committee. The resulting document was shown to clinicians at the intestinal units of Hope and St Mark’s Hospitals. Professor A Forbes made recommendations, which have been incorporated. The article was reviewed by the patient organisation PINNT (patients on intravenous or nasogastric nutritional therapy) and modifications made to result in the current document.

The guidelines conform to the North of England evidence based guidelines development project.¹ The grading of each recommendation is dependant on the category of evidence supporting it.

Recommendations based on the level of evidence are presented and graded as:

• A: requires at least one randomised controlled trial of good quality addressing the topic of recommendation (evidence categories Ia and Ib);

• B: requires the availability of clinical studies without randomisation on the topic of recommendation (evidence categories IIa, IIb and III); and

• C: requires evidence from expert committee reports or opinions or clinical experience of respected authorities in the absence of directly applicable clinical studies of good quality (evidence category IV).

1.3 Scheduled review

The content and evidence base for these guidelines should be reviewed within five years of publication. We recommend that these guidelines are audited and request feedback from all users.

1.4 Service delivery

Patients with a short bowel are not common but should be managed by a multidisciplinary team headed by a clinician with expertise in …