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Short Bowel Syndrome: Intestinal Adaptation

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Current Concepts of Intestinal Failure

Abstract

Despite the availability of total parenteral nutrition, advances in resuscitation, availability of potent antibiotics, and modern techniques of organ support, the morbidity of SBS remains strikingly high (Booth and Lander, Bailliere’s Clin Gastroenterol 12:739–772, 1998). The loss of functional small bowel surface area occasionally requires long-term parenteral nutrition. However, the key to survival after massive small bowel resection is the ability of the residual bowel to adapt. Although intestinal transplantation has emerged as a feasible alternative in the treatment of children with short bowel syndrome (SBS) during the last two decades, intestinal adaptation remains the only chance for survival in a subset of these patients. Intestinal adaptation is the term applied to progressive recovery from intestinal failure following a loss of intestinal length. The regulation of intestinal adaptation is maintained through a complex interaction of many different factors. These include nutrients and other luminal constituents, hormones, and peptide growth factors. The current chapter discusses the role of peptide growth factors on intestinal adaptation following massive small bowel resection. This review focuses on the mechanisms of action of peptide growth factors in intestinal cell proliferation. It also summarizes effects of these factors on intestinal regrowth in an animal model of short bowel syndrome.

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Abbreviations

SBS:

Short bowel syndrome

Caspase:

Cysteinyl-aspartate-acid-proteinase

TPN:

Total parenteral nutrition

LCFA:

Long-chain fatty acids

OKG:

Ornithine a-ketoglutarate

GH:

Growth hormone

GLP:

Glucagon-like peptide

EGF:

Epidermal growth factor

TGFβ:

Transforming growth factor β

IGF:

Insulin-like growth factor

FGF:

Fibroblast growth factor

HGF:

Hepatocyte growth factor

PDGF:

Platelet-derived growth factor

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Authors and Affiliations

  1. Department of Pediatric Surgery and Pathology, The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Bnai Zion Medical Center, Haifa, Israel

    I. Sukhotnik

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  1. Children's Hospital, Helsinki University Central Hospital, HUS Helsinki, Finland

    Risto J. Rintala

  2. Children's Hospital, Helsinki University Central Hospital, HUS Helsinki, Finland

    Mikko Pakarinen

  3. Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden

    Tomas Wester

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Sukhotnik, I. (2016). Short Bowel Syndrome: Intestinal Adaptation. In: Rintala, R., Pakarinen, M., Wester, T. (eds) Current Concepts of Intestinal Failure. Springer, Cham. https://doi.org/10.1007/978-3-319-42551-1_2

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