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Nutrition and Gastrointestinal Disease pp 177–203Cite as

Management of the Short Bowel Syndrome

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Part of the book series: Clinical Gastroenterology ((CG))

Summary

Short bowel syndrome (SBS) results from extensive intestinal resection. It is associated with significant morbidity and mortality, a reduced quality of life and a high rate of health care resource utilization. The management of patients with SBS requires a multidisciplinary approach that includes dietary, fluid and pharmacological management, co-morbid disease management and, occasionally, surgery. An understanding of the physiological alterations that occur in SBS patients is useful to understand the therapeutic strategies employed. In the pages that follow, these physiological alterations are discussed as are the roles of diet and fluids, specialized nutrition support, medications including trophic factors and surgery in the care of these complex patients.

Short bowel syndrome (SBS) is a malabsorption syndrome resulting from extensive intestinal resection [1, 2]. In infants, necrotizing enterocolitis and congenital intestinal anomalies are frequently responsible. In older children and adults, multiple resections for Crohn’s disease and massive resections due to catastrophic mesenteric vascular events, radiation enteritis, adhesive obstruction and trauma represent the more common causes of SBS [3]. These patients frequently experience chronic diarrhea, dehydration, and macro- and micronutrient deficiencies often requiring enteral or parenteral nutrition support at home. It has been demonstrated, using nutrient absorption studies, that patients who absorb > 1.4, kg/day of wet weight or > 84 % of their calculated energy needs will likely require parenteral fluid and/or nutrition support [4]. This typically translates into a patient with > 50–70 cm of small bowel when the colon is intact, or > 100–150 cm of small bowel when the colon is absent [5]. For practical purposes, in adults, SBS can be defined as the presence of > 200 cm of the remaining small intestine. In infants, the diagnosis of SBS relies less on an anatomical definition and more on a functional definition. The amount of resection required to produce malabsorption in infants varies with factors such as age, the presence or absence of an ileocecal valve and length of residual colon [6].

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References

  1. AGA technical review on short bowel syndrome and intestinal transplantation. Gastroenterology 2003;124:1111–1134.

    Google Scholar 

  2. Vanderhoof JA, Langnas AN. Short-bowel syndrome in children and adults. Gastroenterology 1997;113:1767–1778.

    PubMed  CAS  Google Scholar 

  3. Dabney A, Thompson J, DiBaise J, et al. Short bowel syndrome after trauma. Am J Surg 2004;188:792–5.

    PubMed  Google Scholar 

  4. Jeppesen PB, Mortensen PB. Intestinal failure defined by measurements of intestinal energy and wet weight absorption. Gut 2000;46:701–706.

    PubMed  CAS  Google Scholar 

  5. Messing B, Crenn P, Beau P, et al. Long-term survival and parenteral nutrition dependence in adult patients with the short bowel syndrome. Gastroenterology 1999;117:1043–50.

    PubMed  CAS  Google Scholar 

  6. Vanderhoof JA, Young RJ, Thompson JS. New and emerging therapies for short bowel syndrome in children. Paediatr Drugs 2003;5(8):525.

    PubMed  Google Scholar 

  7. Van Gossum A, Bakker H, Bozetti F, et al. Home parenteral nutrition in adults: a European multicenter study in 1997. Clin Nutr 1999;18:135–140.

    Google Scholar 

  8. Howard L, Ament M, Fleming CR, et al. Current use and clinical outcome of home parenteral and enteral nutrition therapies in the United States. Gastroenterology 1995;109:355–365.

    PubMed  CAS  Google Scholar 

  9. Jeppesen PB, Langholz, Mortensen PB. Quality of life in patients receiving home parenteral nutrition. Gut 1999;44:844–852.

    PubMed  CAS  Google Scholar 

  10. Howard L, Ashley C. Management of complications in patients receiving home parenteral nutrition. Gastroenterology 2003;124:1651–1661.

    PubMed  Google Scholar 

  11. Scolapio JS, Fleming CR, Kelly DG, et al. Survival of home parenteral nutrition-treated patients: 20 years of experience at the Mayo Clinic. Mayo Clin Proc 1999;74:217–222.

    PubMed  CAS  Google Scholar 

  12. Messing B, Lemann M, Landais P, et al. Prognosis of patients with nonmalignant chronic intestinal failure receiving long-term home parenteral nutrition. Gastroenterology 1995;108:1005–1010.

    PubMed  CAS  Google Scholar 

  13. Carbonnel F, Cosnes J, Chevret S, et al. The role of anatomic factors in nutritional autonomy after extensive small bowel resection. J Parenter Enteral Nutr 1996;20:275–80.

    CAS  Google Scholar 

  14. Borgstrom B, Daalq A, Lundh G, Sjovall J. Studies of intestinal digestion and absorption in the human. J Clin Invest 1957;36:1521–1536.

    PubMed  CAS  Google Scholar 

  15. Fordtran JS, Rector FC Jr., Carter NW. The mechanisms of sodium absorption in the human small intestine. J Clin Invest 1968;47:884–900.

    PubMed  CAS  Google Scholar 

  16. Nightingale JM, Kamm MA, van der Sijp JR, et al. Gastrointestinal hormones in short bowel syndrome. Peptide YY may be the ‘colonic brake’ to gastric emptying. Gut 1996;39:267–272.

    PubMed  CAS  Google Scholar 

  17. Fich A, Steadman CJ, Phillips SF, et al. Ileocolonic transit does not change after right hemicolectomy. Gastroenterology 1992;103:794–799.

    PubMed  CAS  Google Scholar 

  18. Singleton AO, Redmond DC, McMurray JE. Ileocecal resection and small bowel transit and absorption. Ann Surg 1964;159:690–694.

    Google Scholar 

  19. Debongnie JC, Phillips SF. Capacity of the colon to absorb fluid. Gastroenterology. 1978;74:698–703.

    PubMed  CAS  Google Scholar 

  20. Pironi L, Stanghellini V, Miglioli, et al. Fat-induced ileal brake in humans: a dose-dependent phenomenon correlated to plasma levels of peptide YY. Gastroenterology 1993;105:733–739.

    PubMed  CAS  Google Scholar 

  21. Jorgensen JR, Fitch MD, Mortensen PB, Fleming SE. In vivo absorption of medium-chain fatty acids by the rat colon exceeds that of short-chain fatty acids. Gastroenterology 2001;120:1152–61.

    PubMed  CAS  Google Scholar 

  22. Nordgaard I, Hansen BS, Mortensen PB. Importance of colonic support for energy absorption as small bowel failure proceeds. Am J Clin Nutr 1996;64:222–231.

    PubMed  CAS  Google Scholar 

  23. Nightingale JM, Bartram CI, Lennard-Jones JE. Length of residual small bowel after partial resection: correlation between radiographic and surgical measurements. Gastrointest Radiol 1991;16:305–306.

    PubMed  CAS  Google Scholar 

  24. Siebert JR. Small-intestine length in infants and children. Am J Dis Child 1980;134(6):593.

    PubMed  CAS  Google Scholar 

  25. Dowling RH, Booth CC. Structural and functional changes following small intestinal resection in the rat. Clin Sci 1967;32:139–149.

    PubMed  CAS  Google Scholar 

  26. Thompson JS, Ferguson DC. Effect of the distal remnant on ileal adaptation. J Gastrointest Surg 2000;4:430–434.

    PubMed  CAS  Google Scholar 

  27. Nightingale JMD, Lennard-Jones JE, Gertner DJ, et al. Colonic preservation reduces the need for parenteral therapy, increases the incidence of renal stones but does not change the high prevalence of gallstones in patients with a short bowel. Gut 1992;33:1493–1497.

    PubMed  CAS  Google Scholar 

  28. Pullan JM. Massive intestinal resection. Proc R Soc Med 1959;52:31–37.

    PubMed  CAS  Google Scholar 

  29. Williamson RCN, Chir M. Intestinal adaptation: mechanisms of control. N Engl J Med 1978;298:1444–1450.

    PubMed  CAS  Google Scholar 

  30. Williamson RCN, Chir M. Intestinal adaptation: structural, functional and cytokinetic changes. N Engl J Med 1978;298:1393–1402.

    PubMed  CAS  Google Scholar 

  31. Thiesen A, Drozdowski L, Iordache C, et al. Adaptation following intestinal resection: mechanisms and signals. Best Pract Res Clin Gastroenterol 2003;17:981–995.

    PubMed  CAS  Google Scholar 

  32. Dowling FH, Booth CC. Functional compensation after small bowel resection in man: demonstration by direct measurement. Lancet 1966;2:146–147.

    PubMed  CAS  Google Scholar 

  33. Crenn P, Coudray-Lucas C, Thuillier F, et al. Postabsorptive plasma citrulline concentration is a marker of absorptive enterocyte mass and intestinal failure in humans. Gastroenterology. 2000 Dec;119:1496–1505.

    CAS  Google Scholar 

  34. Seguy D, Vahedi K, Kapel N, et al. Low-dose growth hormone in adult home parenteral nutrition-dependent short bowel syndrome patients: a positive study. Gastroenterology 2003;124:293–302.

    PubMed  CAS  Google Scholar 

  35. Brown CR, DiBaise JK. Intestinal rehabilitation: a management program for short-bowel syndrome. Prog Transplant 2004;14:290–6; quiz 297–8.

    PubMed  Google Scholar 

  36. McIntyre PB, Fitchew M, Lennard-Jones JE. Patients with a high jejunostomy do not need a special diet. Gastroenterology 1986;91:25–33.

    PubMed  CAS  Google Scholar 

  37. Norgaard I, Hansen BS, Mortensen PB. Colon as a digestive organ in patients with short bowel. Lancet 1994;343:373–376.

    Google Scholar 

  38. Woolf GM, Miller C, Kurian R, Jeejeebhoy KN. Nutritional absorption in short bowel syndrome. Evaluation of fluid, calorie, and divalent cation requirements. Dig Dis Sci 1987;32:8–15.

    PubMed  CAS  Google Scholar 

  39. Byrne TA, Veglia L, Camelio M, et al. Beyond the prescription: optimizing the diet of patients with short bowel syndrome. Nutr Clin Pract 2000;15:306–311.

    Google Scholar 

  40. Weiming Z, Ning L, Jieshou L. Effect of recombinant human growth hormone and enteral nutrition on short bowel syndrome. J Parenter Enter Nutr 2004;28: 377–281.

    Google Scholar 

  41. Sladen GE, Dawson AM. Inter-relationships between the absorptions of glucose, sodium and water by the normal human jejunum. Clin Sci 1969;36:119–132.

    PubMed  CAS  Google Scholar 

  42. Rodrigues Ca, Lennard-Jones JE, Thompson DG, Farthing MJG. What is the ideal sodium concentration of oral rehydration solutions for short bowel patients. Clin Sci 1988;74:69.

    Google Scholar 

  43. Nightingale JM, Lennard-Jones JE, Walker ER, Farthing MJ. Oral salt supplements to compensate for jejunostomy losses: comparison of sodium chloride capsules, glucose electrolyte solution, and glucose polymer electrolyte solution. Gut 1992;33:759–761.

    PubMed  CAS  Google Scholar 

  44. Marteau P, Messing B, Arrigoni E, et al. Do short bowel patients need a lactose-free diet? Nutrition 1997;13:13–16.

    PubMed  CAS  Google Scholar 

  45. Jeppesen PB, Mortensen PB. The influence of a preserved colon on the absorption of medium chain fat in patients with small bowel resection. Gut 1998;43:478–483.

    PubMed  CAS  Google Scholar 

  46. Jeppesen PB, Howy CE, Mortensen PB. Deficiencies of essential fatty acids, vitamin A and E and changes in plasma lipoproteins in patients with reduced fat absorption or intestinal failure. Eur J Clin Nutr 2000;54:632–642.

    PubMed  CAS  Google Scholar 

  47. Nordgaard I, Hansen BS, Mortensen PB. Importance of colonic support for energy absorption as small-bowel failure proceeds. Am J Clin Nutr 1996;64:222–231.

    PubMed  CAS  Google Scholar 

  48. Finkel Y, Brown G, Smith HL, et al. The effects of a pectin-supplemented elemental diet in a boy with short gut syndrome. Acta Paediatr Scan 1990;79: 983–986.

    CAS  Google Scholar 

  49. Byrne TA, Morrisey TB, Nattakom TV, et al. Growth hormone, glutamine and a modified diet enhance nutrient absorption in patients with severe short bowel syndrome. J Parenter Enter Nutr 1995;222:296–302.

    Google Scholar 

  50. Fuse K, Bamba T, Hosoda S. Effects of pectin on fatty acid and glucose absorption and on the thickness of the unstirred water layer in rat and human intestine. Dig Dis Sci 1989;34:1109–1116.

    PubMed  CAS  Google Scholar 

  51. Williams NS, Evans P, King RFGJ. Gastric acid secretion and gastrin production in the short bowel syndrome. Gut 1985;26:914–919.

    PubMed  CAS  Google Scholar 

  52. Cortot A, Fleming CR, Malagelada JR. Improved nutrient absorption after cimetidine in short-bowel syndrome with gastric hypersecretion. N Engl J Med. 1979 11;300:79–80.

    Google Scholar 

  53. Fried M, Siegrist H, Frei R, et al. Duodenal bacterial overgrowth during treatment in outpatients with omeprazole. Gut 1994;35:23–26.

    PubMed  CAS  Google Scholar 

  54. Cooper JC, Williams NS, King RF, et al. Effects of a long-acting somatostatin analogue in patients with severe ileostomy diarrhea. Br J Surg 1986;73:128–131.

    PubMed  CAS  Google Scholar 

  55. Ladefofed K, Christensen KC, Hegnhoj J, Jarnum S. Effect of a long-acting somatostatin analogue SMS 201–995 on jejunostomy effluents in patients with severe short bowel syndrome. Gut 1989;30:943–949.

    Google Scholar 

  56. Nehra V, Camilleri M, Burton D, et al. An open trial of octreotide long-acting release in the management of short bowel syndrome. Am J Gastroenterol 2001;96:1494–1498.

    PubMed  CAS  Google Scholar 

  57. O’Keefe SJD, Haymond MW, Bennet WM, et al. Long-acting somatostatin analogue therapy and protein metabolism in patients with jejunostomies. Gastroenterology 1994;107:379–388.

    PubMed  CAS  Google Scholar 

  58. Sukhotnik I, Khateeb K, Krausz MM, et al. Sandostatin impairs postresection intestinal adaptation in a rat model of short bowel syndrome. Dig Dis Sci 2002;47:2095–2102.

    PubMed  CAS  Google Scholar 

  59. Vanderhoof JA, Kollman KA. Lack of inhibitory effect of octreotide on intestinal adaptation in short bowel syndrome in the rat. J Pediatr Gastroenterol Nutr 1998;26:241–244.

    PubMed  CAS  Google Scholar 

  60. King RFGJ, Norton T, Hill GL. A double-blind crossover study of the effect of loperamide hydrochloride and codeine phosphate on ileostomy output. Aust N Z J Surg 1982;52:121–124.

    PubMed  CAS  Google Scholar 

  61. Rovera G, Furukawa H, Reyes J, et al. The use of clonidine for the treatment of high intestinal output following small bowel transplantation. Transplant Proceed 1997;29:1853–1854.

    CAS  Google Scholar 

  62. Buchman AL, Wallin A, Fryer J, Polensky S. Clonidine reduces fecal weight and sodium losses modestly in some patients with proximal jejunostomy. Gastroenterology 2005;128:A399 (abstract).

    Google Scholar 

  63. Little KH, Schiller LR, Bilhartz LE, Fordtran JS. Treatment of severe steatorrhea with ox bile in an ileectomy patient with residual colon. Dig Dis Sci 1992;37: 929–933.

    PubMed  CAS  Google Scholar 

  64. Heydorn S, Jeppesen PB, Mortensen PB. Bile acid replacement therapy with cholylsarcosine for short-bowel syndrome. Scand J Gastroenterol 1999;34: 818–823.

    PubMed  CAS  Google Scholar 

  65. Hoffman AF, Poley R. Role of bile acid malabsorption in pathogenesis of diarrhea and steatorrhea in patients with ileal resection. Gastroenterology 1972;62: 918–934.

    Google Scholar 

  66. Kotler DP, Levine GM. Reversible gastric and pancreatic hyposecretion after long-term total parenteral nutrition. N Engl J Med 1979;300:241–242.

    PubMed  CAS  Google Scholar 

  67. DiBaise JK, Young RJ, Vanderhoof JA. Enteric microbial flora, bacterial overgrowth and short bowel syndrome. Clin Gastroenterol Hepatol 2006;4: 11–20.

    PubMed  Google Scholar 

  68. Toskes PP, Giannella RA, Jervis HR, et al. Small intestinal mucosal injury in the experimental blind loop syndrome. Light- and electron-microscopic and histochemical studies. Gastroenterology 1975;68:193–203.

    Google Scholar 

  69. Giannella RA, Rout WR, Toskes PP. Jejunal brush border injury and impaired sugar and amino acid uptake in the blind loop syndrome. Gastroenterology 1974;67:965–974.

    PubMed  CAS  Google Scholar 

  70. Lin HC. Small intestinal bacterial overgrowth: a framework for understanding irritable bowel syndrome. JAMA 2004;292:852–8.

    PubMed  CAS  Google Scholar 

  71. Byrne TA, Persinger RL, Young LS, et al. A new treatment for patients with short-bowel syndrome: growth hormone, glutamine, and a modified diet. Ann Surg 1995;222:243–254.

    PubMed  CAS  Google Scholar 

  72. Wilmore DW, Lacey JM, Soultanakis RP, et al. Factors predicting a successful outcome after pharmacologic bowel compensation. Ann Surg 1997;226: 288–293.

    PubMed  CAS  Google Scholar 

  73. Byrne TA, Cox S, Karimbakas M, et al. Bowel rehabilitation: an alternative to long-term parenteral nutrition and intestinal transplantation for some patients with short bowel syndrome. Transplant Proc 2002;34:887–890.

    PubMed  CAS  Google Scholar 

  74. Zhu W, Li N, Ren J, et al. Rehabilitation therapy for short bowel syndrome. Chin Med J 2002;115:776–778.

    PubMed  Google Scholar 

  75. Scolapio JS, Camilleri M, Fleming CR, et al. Effect of growth hormone, glutamine, and diet on adaptation in short bowel syndrome: a randomized, controlled study. Gastroenterology 1997;113:1074–1081.

    PubMed  CAS  Google Scholar 

  76. Szkudlarek J, Jeppesen PB, Mortensen PB. Effect of high dose growth hormone with glutamine and no change in diet on intestinal absorption in short bowel patients: a randomized, double-blind, crossover, placebo-controlled study. Gut 2000;47:199–205.

    PubMed  CAS  Google Scholar 

  77. Jeppesen PB, Mortensen PB. Experimental approaches: dietary and hormone therapy. Best Pract Res Clin Gastroenterol 2003;17:1041–1054.

    PubMed  CAS  Google Scholar 

  78. Scolapio JS. Tales from the crypt. Gastroenterology. 2003;124:561–564.

    PubMed  Google Scholar 

  79. Byrne TA, Wilmore DW, Iyer K, et al. Growth hormone, glutamine and an optimal diet reduces parenteral nutrition in patients with short bowel syndrome. A prospective, randomized, placebo-controlled, double-blind clinical trial. Ann Surg 2005;242:655–661.

    PubMed  Google Scholar 

  80. DiBaise JK, Somatropin in short bowel syndrome: opening the door to trophic factor use. Therapy 2006;3:55–67

    CAS  Google Scholar 

  81. Litvak DA, Hellmich MR, Evers BM, et al. Glucagon-like peptide 2 is a potent growth factor for small intestine and colon. J Gastrointest Surg 1998;2:146–150.

    PubMed  CAS  Google Scholar 

  82. Drucker DJ, Erlich P, Asa SL, Brubaker PL. Induction of intestinal epithelial proliferation by glucagon-like peptide 2. Proc Natl Acad Sci U S A 1996;93:7911–7916.

    PubMed  CAS  Google Scholar 

  83. Ghatei MA, Goodlad RA, Taheri S, et al. Proglucagon-derived peptides in intestinal epithelial proliferation. Glucagon-like peptide-2 is a major mediator of intestinal epithelial proliferation in rats. Dig Dis Sci 2001;46: 1255–1263.

    PubMed  CAS  Google Scholar 

  84. Scott RB, Kirk D, MacNaughton WK, Meddings JB. GLP-2 augments the adaptive response to massive intestinal resection in rat. Am J Physiol 1998;275:G911–G921.

    PubMed  CAS  Google Scholar 

  85. Wojdemann M, Wettergren A, Hartmann B, Holst JJ. Glucagon-like peptide-2 inhibits centrally induced antral motility in pigs. Scand J Gastroenterol 1998;33:828–832.

    PubMed  CAS  Google Scholar 

  86. Wojdemann M, Wettergren A, Hartmann B, et al. Inhibition of sham feeding-stimulated human gastric acid secretion by glucagon-like peptide-2. J Clin Endocrinol Metab 1999;84:2513–2517.

    PubMed  CAS  Google Scholar 

  87. Jeppesen PB, Hartmann B, Thulesen J, et al. Glucagon-like peptide 2 improves nutrient absorption and nutritional status in short-bowel patients with no colon. Gastroenterology 2001;120:806–815.

    PubMed  CAS  Google Scholar 

  88. Jeppesen PB, Sanguinetti EL, Buchman A, et al. Teduglutide (ALX-0600), a dipeptidyl peptidase IV resistant glucagon-like peptide analogue, improves intestinal function in short bowel syndrome patients. Gut 2005;54:1224–1231.

    PubMed  CAS  Google Scholar 

  89. Andrews NJ, Irving MH. Human gut hormone profiles in patients with short-bowel syndrome. Dig Dis Sci 1992;37:729–732.

    PubMed  CAS  Google Scholar 

  90. Litvak DA, Iseki H, Evers M, et al. Characterization of two novel proabsorptive polypeptide YY analogs, BIM-43073D and BIM-43004C. Dig Dis Sci 1999;44:643–648.

    PubMed  CAS  Google Scholar 

  91. van der Hulst RR, van Kreel BK, von Meyenfeldt MF, et al. Glutamine and the preservation of gut integrity. Lancet 1993;341:1363–1365.

    PubMed  Google Scholar 

  92. Beaugererie L, Carbonnel F, Hecketsweiler B, et al. Effects of an isotonic oral rehydration solution, enriched with glutamine, on fluid and sodium absorption in patients with a short bowel. Aliment Pharmacol Ther 1997;11:741–747.

    Google Scholar 

  93. Scolapio JS, McGreevy K, Tennyson GS, Burnett OL. Effect of glutamine in short-bowel syndrome. Clin Nutr 2001;20:319–323.

    PubMed  CAS  Google Scholar 

  94. Zhou X, Li YX, Li N, Li JS. Glutamine enhances the gut trophic effect of growth hormone in rat after massive small bowel resection. J Surg Res 2001;99:47–52.

    PubMed  CAS  Google Scholar 

  95. Biolo G, Iscra F, Bosutti A, et al. Growth hormone decreases muscle glutamine production and stimulates protein syntheses in hypercatabolic patients. Am J Physiol 2000;279:E323–E332.

    CAS  Google Scholar 

  96. Thompson JS. Reoperation in patients with the short bowel syndrome. Am J Surg 1992;164:453–457.

    PubMed  CAS  Google Scholar 

  97. Thompson JS. Strategies for preserving intestinal length in the short bowel syndrome. Dis Col Rectum 1987;30:208–213.

    CAS  Google Scholar 

  98. Sudan D, DiBaise J, Torres C, et al. A multidisciplinary approach to the treatment of intestinal failure. J Gastrointest Surg. 2005;9:165–76; discussion 176–7.

    PubMed  Google Scholar 

  99. Fishbein TM, Gondolesi GE, Kaufman SS. Intestinal transplantation for gut failure. Gastroenterology 2003;124:1615–1628.

    PubMed  Google Scholar 

  100. Grant D, Abu-Elmagd K, Reyes J, et al., on behalf of the Intestine Transplant Registry. 2003 report of the intestine transplant registry: a new era has dawned. Ann Surg. 2005;241:607–13.

    PubMed  Google Scholar 

  101. Rovera GM, Schoen RE, Goldbach B, et al. Intestinal and multivisceral transplantation: dynamics of nutritional management and functional autonomy. J Parenter Enter Nutr 2003;27:252–259.

    Google Scholar 

  102. DiBaise JK, Young RJ, Vanderhoof JA. Intestinal rehabilitation and the short bowel syndrome: part 2. Am J Gastroenterol 2004;99:1823–1832.

    PubMed  Google Scholar 

  103. Crenn P, Coudray-Lucas C, Thuillier F, et al. Postabsorptive plasma citrulline concentration is a marker of absorptive enterocyte mass and intestinal failure in humans. Gastroenterology 2000;119:1496–1505.

    PubMed  CAS  Google Scholar 

  104. Weseman R, DiBaise JK, Sudan D, et al. Successful restoration of nutritional autonomy in short bowel syndrome (SBS) patients with very low plasma citrulline concentration. Nutr Clin Prac 2004;19:86–87 (abstract).

    Google Scholar 

  105. DiBaise JK, Matarese LE, Messing B, Steiger E. Strategies for weaning parenteral nutrition in adult patients with short bowel syndrome. J Clin Gastroenterol 2006;40(suppl):S94–98.

    PubMed  Google Scholar 

  106. Booth CC. The effects of intestinal resection in man. Postgrad Med J 1961;37:725–739.

    PubMed  CAS  Google Scholar 

  107. Fleming CR, George L, Stoner GL, et al. The importance of urinary magnesium values in patients with gut failure. Mayo Clin Proc 1996;71:21–24.

    PubMed  CAS  Google Scholar 

  108. Anast CS, Winnacker JL, Forte LR, Burns TW. Impaired release of parathyroid hormone in magnesium deficiency. Clin Endocrinol Metab 1976;42:707–717.

    CAS  Google Scholar 

  109. Fukumoto S, Matsumoto T, Tanaka Y, et al. Renal magnesium wasting in a patient with short bowel syndrome with magnesium deficiency: effect of 1 alpha-hydroxyvitamin D3 treatment. J Clin Endocrinol Metab 1987;65: 1201–1204.

    Google Scholar 

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DiBaise, J.K. (2008). Management of the Short Bowel Syndrome. In: Nutrition and Gastrointestinal Disease. Clinical Gastroenterology. Humana Press. https://doi.org/10.1007/978-1-59745-320-2_8

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