Short bowel syndrome

Short bowel syndrome typically presents as a consequence of extensive bowel resection.

The intestine may adapt over time to be more efficient at nutrient absorption; the extent of adaptation determines the extent of recovery.

Treatment and prognosis are dependent on the length, health, and anatomy of the remaining bowel.

Management includes electrolyte and fluid replacement, provision of adequate macro-nutrients, and prevention and treatment of micro-nutrient deficiencies during intestinal adaptation.

Primary anastomosis of residual small bowel to colon, when possible, is the most important surgical procedure to reduce the need for parenteral nutrition (PN).

Degree of oral medication absorption varies unpredictably between patients; alternative routes of administration should be sought where possible.

Physicians and patients need to watch closely for signs of dehydration, micro-nutrient deficiency, liver disease, and PN-related complications such as catheter infections and occlusions.

Short bowel syndrome (SBS) refers to a condition wherein substantial portions of the small intestine are absent, either congenitally or due to resection.[1]Pironi L, Arends J, Baxter J, et al. ESPEN endorsed recommendations. Definition and classification of intestinal failure in adults. Clin Nutr. 2015 Apr;34(2):171-80. https://www.doi.org/10.1016/j.clnu.2014.08.017 http://www.ncbi.nlm.nih.gov/pubmed/25311444?tool=bestpractice.com [2]Cuerda C, Pironi L, Arends J, et al. ESPEN practical guideline: clinical nutrition in chronic intestinal failure. Clin Nutr. 2021 Sep;40(9):5196-220. https://www.doi.org/10.1016/j.clnu.2021.07.002 http://www.ncbi.nlm.nih.gov/pubmed/34479179?tool=bestpractice.com

Typically, less than 200 cm of residual short bowel is present. This results in a loss of surface area for fluid, nutrient, and medication absorption, causing an inability to maintain protein-energy, fluid, electrolyte, or micro-nutrient balance when ingesting a conventionally accepted, normal diet.[1]Pironi L, Arends J, Baxter J, et al. ESPEN endorsed recommendations. Definition and classification of intestinal failure in adults. Clin Nutr. 2015 Apr;34(2):171-80. https://www.doi.org/10.1016/j.clnu.2014.08.017 http://www.ncbi.nlm.nih.gov/pubmed/25311444?tool=bestpractice.com