Pharmacological Strategies for High-Output Ileostomies in Children: A Narrative Review

Aim

Nutritional measures often suffice for managing high-output ileostomy (HOI) in paediatric patients, but pharmacological treatment may be required to control ostomy output. This paper reviews the literature on the pharmacological management of paediatric HOI and provides recommendations.

Methods

PubMed and Embase were searched for relevant articles up to 22 May 2024. Relevant articles were reviewed and recommendations were formulated.

Results

No pharmacological studies involving paediatric ileostomy patients were identified, apart from two case reports on octreotide. The formulated recommendations are therefore based on data from adults or other intestinal failure conditions. The primary treatment suggestions are proton pump inhibitors and loperamide. Subcutaneous octreotide can be administered when complications persist. Codeine may be used in rare cases in children over 12 years old, but addiction risk and side effects limit its use. There is no or insufficient evidence for smectite, racecadotril, probiotics or prophylactic cycled antibiotics or clonidine. Bile acid sequestrants are not indicated in patients without a colon in continuity.

Conclusion

Pharmacological options for the treatment of HOI in children are limited and evidence for their use is lacking. Research in paediatric HOI patients is needed to validate the use of pharmacotherapy in this patient group.