Gut instinct: Navigating the landscape of parenteral support in short bowel syndrome.

Depending on the remaining bowel anatomy and the degree of bowel adaptation, patients with short bowel syndrome (SBS) may require parenteral nutrition (PN) and/or intravenous fluid support, sometimes temporarily and sometimes permanently. Although the use of parenteral support in SBS is often lifesaving, it is not without its limitations. Herein, we undertake a focused review of several issues related to use of parenteral support in patients with SBS, including initiation of parenteral support, considerations when formulating PN, select complications, short-term and long-term nutrition monitoring, and weaning strategies.

Hair, Nails, and Skin: Differentiating Cutaneous Manifestations of Micronutrient Deficiency.

Micronutrient deficiencies (MNDs) commonly lead to cutaneous abnormalities involving the skin, hair, and nails, and these cutaneous manifestations often provide clues to the existence of the underlying deficiency. MNDs may be present in at-risk individuals who have impaired absorption or poor dietary intake. The micronutrients that most commonly present with cutaneous findings include the B vitamins riboflavin, niacin, pyridoxine, biotin, and vitamin B12; vitamin C; the fat-soluble vitamins A, E, and K; the minerals zinc, iron, copper, and selenium; and essential fatty acids. This review will highlight the most common clinical hair, skin, and nail presentations associated with MNDs and an approach to their treatment.

Low-residue diet in diverticular disease: putting an end to a myth.

Residue refers to any indigestible food substance that remains in the intestinal tract and contributes to stool bulk. Historically, low-residue diets have been recommended for diverticulosis because of a concern that indigestible nuts, seeds, corn, and popcorn could enter, block, or irritate a diverticulum and result in diverticulitis and possibly increase the risk of perforation. To date, there is no evidence supporting such a practice. In contrast, dietary fiber supplementation has been advocated to prevent diverticula formation and recurrence of symptomatic diverticulosis, although this is based mostly on low-quality observational studies. This report focuses on the evidence that fiber intake may be beneficial in the prevention and recurrence of symptomatic and complicated diverticular disease and provides recommendations regarding fiber supplementation in individuals with diverticulosis.