Akademik Veri Yönetim Sistemi
2nd International Congress of Health Sciences in the 21st Century, Aydın, Türkiye, 5 - 07 Kasım 2025, ss.851-860, (Tam Metin Bildiri)
A stoma is a surgical opening in
the abdomen where the gastrointestinal tract is brought to the surface to allow
the elimination of waste products. In developed countries, the incidence of
colorectal cancer and inflammatory bowel diseases is increasing, and
consequently, the prevalence of temporary or permanent stomas has risen in
recent years. Proper nutritional
management is crucial in stoma patients, as it can directly influence
postoperative recovery, prevent malnutrition, and reduce complications related
to stoma function. This review evaluates current literature, evidence-based
guidelines, and clinical recommendations regarding nutrition in patients with
intestinal stomas, including considerations for energy, macronutrients,
micronutrients, and fluid management, as well as strategies to prevent
malnutrition and optimize patient outcomes.
The effect of a stoma on fluid and
nutrient balance varies according to its type, with ileostomy patients at
higher risk of dehydration and malnutrition due to high-output stoma and
electrolyte losses, colostomy patients retaining some functional colon allowing
more effective absorption and thus a lower risk, and jejunostomy patients
having only a short segment of the gastrointestinal tract, resulting in
significant fluid and nutrient losses, making accurate dietary information
essential for individualized nutritional support and care planning (Arenas Villafranca et al., 2015; Goodey & Colman, 2016; Mitchell et
al., 2021).
There is no clear literature
regarding increasing or decreasing energy intake in patients with a stoma. Each
patient should be treated individually, and energy intake should be adjusted
according to the risk of malnutrition and the condition of the digestive
system. Carbohydrate intake is generally not restricted, and total daily
calories should include approximately 40–50% from carbohydrates, with attention
to carbohydrate type.The amount of fiber in the diet requires individual
assessment and depends on the type of stoma and the time since surgery (Fulham, 2008; Medlin, 2012). A low-FODMAP diet may
improve gastrointestinal symptoms and hydration in these patients (Barrett et al., 2010). This diet, particularly in
the initial stages, is highly restrictive and should be implemented under the
supervision of a dietitian to ensure adequate and balanced nutrient intake (Barrett et al., 2010; Medlin, 2012). On the other hand, in
colostomy patients, whose gastrointestinal transit is less affected, the
preventive use of higher-fiber foods, such as brown rice or whole wheat bread,
may be beneficial. This can help prevent constipation, which accompanies a significant
proportion of patients with this type of stoma. In patients with a stoma,
nutritional requirements involve consuming smaller and more frequent meals, as
well as increasing fluid intake during main meals (Fulham, 2008).
The distribution of macro and micronutrients largely depends on the underlying
disease and whether the patient is in a flare-up or remission phase (Medlin, 2012).
General guidelines for stoma patients emphasize the importance of regular
meals, adequate fluid intake, and thoroughly chewing food to prevent stagnation
in the gastrointestinal system (Michońska et al., 2023).
Malnutrition is a common and
serious concern in stoma patients, associated with poorer postoperative
outcomes, delayed wound healing, increased infection risk, and higher morbidity
and mortality. The patient’s preoperative nutritional status significantly
affects recovery and should be evaluated before stoma formation (Michońska et al., 2023). Screening for malnutrition
using validated tools is recommended to identify patients at risk and implement
appropriate interventions (Arnott, Zollinger, Haviland, Ng, & Obias, 2022). In 2018, the Global
Leadership Initiative on Malnutrition (GLIM) proposed unified criteria for
diagnosing malnutrition, emphasizing unintended weight loss, low BMI, reduced
muscle mass, decreased food intake or absorption, and presence of disease
burden or inflammation. GLIM recommends the use of the following tools for
diagnosing malnutrition: NRS-2002 (Nutritional Risk Screening 2002), MNA-SF
(Mini Nutritional Assessment – Short Form), MUST (Malnutrition Universal
Screening Tool), SGA (Subjective Global Assessment), and others (Cederholm et al., 2019).
In conclusion, a multidisciplinary
approach is recommended to prevent the development of nutritional disorders in
these patients. Each hospital should establish such a team according to its
specific conditions, including a physician, nurse, dietitian, and pharmacist
trained in clinical nutrition, who should work together in a coordinated
manner. Balanced nutrition and properly conducted nutritional education
play an important role in preventing peristomal complications and deficiencies
that may accompany patients.
Keywords: Colostomy, Dietary
Management, Ileostomy, Stoma