Skip to main content

Advertisement

SpringerLink
Log in

Dietary Strategies for Managing Short Bowel Syndrome

  • Nutrition and Obesity (O Pickett-Blakely, Section Editor)
  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Abstract

Purpose of review

Short bowel syndrome (SBS) is an uncommon but important disease entity. Apart from parenteral support, dietary strategies are crucial for all SBS patients. Despite publication of recent guidelines, a pragmatic approach in dietary management is still lacking. This review aims to provide a practical dietary guidance for SBS patients based on updated and available data.

Recent findings

Recommendations and goal of dietary management are based on anatomical types and phases of SBS. Hyperphagia with appropriate diet and fluid composition are key factors in managing the diet of SBS patients. There are potential benefits of several dietary strategies including fermentable, oligo-, di-, monosaccharides, and polyols (FODMAPs) restriction, soluble fiber, and nutrient supplements in selected patients.

Summary

Oral diet plays a major role in intestinal adaptation. It can improve nutritional status, reduce parenteral support, and improve quality of life. The management for SBS patients should be done on a case-by-case basis. The main factor for determining dietary strategies is bowel anatomy, especially the presence or absence of colon-in-continuity. Further studies are needed for several aspects of dietary strategies for SBS patients such as the role of FODMAPs restriction, soluble fiber, and citrulline supplementation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Underhill BML. Intestinal length in man. BMJ. 1955;2:1243–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Buchman AL, Scolapio J, Fryer J. AGA technical review on short bowel syndrome and intestinal transplantation. Gastroenterology. 2003;124:1111–34.

    Article  PubMed  Google Scholar 

  3. Nightingale J. Guidelines for management of patients with a short bowel. Gut. 2006;55:iv1-12.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Jeppesen PB. Spectrum of short bowel syndrome in adults: intestinal insufficiency to intestinal failure. JPEN J Parenter Enteral Nutr. 2014;38:8S-13S.

    Article  PubMed  Google Scholar 

  5. Pironi L, Hébuterne X, Van Gossum A, Messing B, Lyszkowska M, Colomb V, et al. Candidates for intestinal transplantation: a multicenter survey in Europe. Am J Gastroenterol. 2006;101:1633–43; quiz 1679.

    Article  PubMed  Google Scholar 

  6. ESPEN-Home Artificial Nutrition Working Group, Van Gossum A, Bakker H, De Francesco A, Ladefoged K, Leon-Sanz M, et al. Home parenteral nutrition in adults: a multicentre survey in Europe in 1993. Clin Nutr. 1996;15:53–9.

    Google Scholar 

  7. Baxter JP, Gillanders L, Angstmann K, Staun M, O’Hanlon C, Smith T, et al. Home parenteral nutrition: an international benchmarking exercise. E-SPEN J. 2012;7:e211–4.

    Article  Google Scholar 

  8. Noelting J, Gramlich L, Whittaker S, Armstrong D, Marliss E, Jurewitsch B, et al. Survival of patients with short-bowel syndrome on home parenteral nutrition: a prospective cohort study. JPEN J Parenter Enteral Nutr. 2021;45:1083–8.

    Article  CAS  PubMed  Google Scholar 

  9. Nordsten CB, Molsted S, Bangsgaard L, Fuglsang KA, Brandt CF, Niemann MJ, et al. High parenteral support volume is associated with reduced quality of life determined by the short-bowel syndrome quality of life scale in nonmalignant intestinal failure patients. JPEN J Parenter Enteral Nutr. 2021;45:926–32.

    Article  PubMed  Google Scholar 

  10. Pironi L, Goulet O, Buchman A, Messing B, Gabe S, Candusso M, et al. Outcome on home parenteral nutrition for benign intestinal failure: a review of the literature and benchmarking with the European prospective survey of ESPEN. Clin Nutr. 2012;31:831–45.

    Article  PubMed  Google Scholar 

  11. Canovai E, Ceulemans LJ, Peers G, De Pourcq L, Pijpops M, De Hertogh G, et al. Cost analysis of chronic intestinal failure. Clin Nutr. 2019;38:1729–36.

    Article  PubMed  Google Scholar 

  12. Pironi L, Arends J, Baxter J, Bozzetti F, Peláez RB, Cuerda C, et al. ESPEN endorsed recommendations. Definition and classification of intestinal failure in adults. Clin Nutr. 2015;34:171–80.

    Article  PubMed  Google Scholar 

  13. Cuerda C, Pironi L, Arends J, Bozzetti F, Gillanders L, Jeppesen PB, et al. ESPEN practical guideline: clinical nutrition in chronic intestinal failure. Clin Nutr. 2021;40:5196–220. The latest guidelines that address several strategies for dietary management in SBS.

    Article  PubMed  Google Scholar 

  14. Neelis EG, Olieman JF, Hulst JM, de Koning BAE, Wijnen RMH, Rings EHHM. Promoting intestinal adaptation by nutrition and medication. Best Pract Res Clin Gastroenterol. 2016;30:249–61. A recent review that demonstrates several factors for promoting intestinal adaptation including dietary factors.

    Article  CAS  PubMed  Google Scholar 

  15. Tappenden KA. Intestinal adaptation following resection. JPEN J Parenter Enteral Nutr. 2014;38:23S-31S. A thorough review that shows several factors for intestinal adaptation following massive bowel resection.

    Article  PubMed  Google Scholar 

  16. Cooper H, Levitan R, Fordtran JS, Ingelfinger FJ. A method for studying absorption of water and solute from the human small intestine. Gastroenterology. 1966;50:1–7.

    Article  CAS  PubMed  Google Scholar 

  17. Barrett KE, Barman SM, Boitano S, Reckelhoff JF. Overview of gastrointestinal function & regulation. Ganongs Med Physiol Exam Board Rev. New York: McGraw-Hill Education; 2017 [cited 2022 Feb 14]. Available from: accessmedicine.mhmedical.com/content.aspx?aid=1142555909.

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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Hofmann AF, Poley JR. Role of bile acid malabsorption in pathogenesis of diarrhea and steatorrhea in patients with ileal resection. I. Response to cholestyramine or replacement of dietary long chain triglyceride by medium chain triglyceride. Gastroenterology. 1972;62:918–34.

    Article  CAS  PubMed  Google Scholar 

  20. Tappenden KA. Pathophysiology of short bowel syndrome: considerations of resected and residual anatomy. JPEN J Parenter Enteral Nutr. 2014;38:14S-22S. A comprehensive review regarding pathophysiology of SBS according to residual anatomy.

    Article  CAS  PubMed  Google Scholar 

  21. Lakananurak N. Risk factors for parenteral nutrition-dependence and mortality with the short bowel syndrome: a 10-year retrospective study in Thailand. Asia Pac J Clin Nutr. 2018;27:770–6.

    PubMed  Google Scholar 

  22. Sundaram A, Koutkia P, Apovian CM. Nutritional management of short bowel syndrome in adults. J Clin Gastroenterol. 2002;34:207–20.

    Article  CAS  PubMed  Google Scholar 

  23. Nordgaard I, Hansen BS, Mortensen PB. Importance of colonic support for energy absorption as small-bowel failure proceeds. Am J Clin Nutr. 1996;64:222–31.

    Article  CAS  PubMed  Google Scholar 

  24. Nightingale JM, Kamm MA, van der Sijp JR, Ghatei MA, Bloom SR, Lennard-Jones JE. Gastrointestinal hormones in short bowel syndrome Peptide. YY may be the “colonic brake” to gastric emptying. Gut. 1996;39:267–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Pironi L, Stanghellini V, Miglioli M, Corinaldesi R, De Giorgio R, Ruggeri E, et al. Fat-induced heal brake in humans: a dose-dependent phenomenon correlated to the plasma levels of peptide YY. Gastroenterology. 1993;105:733–9.

    Article  CAS  PubMed  Google Scholar 

  26. Chander Roland B, Mullin GE, Passi M, Zheng X, Salem A, Yolken R, et al. A prospective evaluation of ileocecal valve dysfunction and intestinal motility derangements in small intestinal bacterial overgrowth. Dig Dis Sci. 2017;62:3525–35.

    Article  PubMed  Google Scholar 

  27. Sun H, Eliasson J, Fuglsang KA, Hvistendahl M, Naimi RM, Jeppesen PB. Repeated metabolic balance studies in patients with short bowel syndrome. JPEN J Parenter Enteral Nutr. 2020;44:677–87.

    Article  PubMed  Google Scholar 

  28. Baker ML, Williams RN, Nightingale JMD. Causes and management of a high-output stoma: causes and management of a high-output stoma. Colorectal Dis. 2011;13:191–7.

    Article  CAS  PubMed  Google Scholar 

  29. Austin K, Bonnes S, Daniel H. Controversy in nutrition recommendations for short bowel syndrome: how type of SBS impacts response. Curr Gastroenterol Rep. 2019;21:64. A current review that demonstrates dietary strategies according to anatomical type of SBS.

    Article  PubMed  Google Scholar 

  30. Parrish CR, DiBaise JK. Short bowel syndrome in adults—Part 2 Nutrition therapy for short bowel syndrome in the adult patient. Pract Gastroenterol. 2014;9:40–51.

  31. Berkeley N. Limketkai short bowel syndrome. In: Mueller CM, editor. The ASPEN adult nutrition support core curriculum. 3rd ed. Silver Spring: American Society of Parenteral and Enteral Nutrition; 2017. p. 587–602.

  32. Fassini PG, Das SK, Pfrimer K, Suen VMM, SérgioMarchini J, Ferriolli E. Energy intake in short bowel syndrome: assessment by 24-h dietary recalls compared with the doubly labelled water method. Br J Nutr. 2018;119:196–201. An important and recent study showing energy intake in SBS patients.

    Article  CAS  PubMed  Google Scholar 

  33. Crenn P. Net digestive absorption and adaptive hyperphagia in adult short bowel patients. Gut. 2004;53:1279–86.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Schaart MW, de Bruijn ACJM, Tibboel D, Renes IB, van Goudoever JB. Dietary protein absorption of the small intestine in human neonates. JPEN J Parenter Enteral Nutr. 2007;31:482–6.

    Article  CAS  PubMed  Google Scholar 

  35. Joly F, Mayeur C, Bruneau A, Noordine M-L, Meylheuc T, Langella P, et al. Drastic changes in fecal and mucosa-associated microbiota in adult patients with short bowel syndrome. Biochimie. 2010;92:753–61.

    Article  CAS  PubMed  Google Scholar 

  36. Sun RC, Choi PM, Diaz-Miron J, Sommovilla J, Guo J, Erwin CR, et al. High-protein diet improves postoperative weight gain after massive small-bowel resection. J Gastrointest Surg. 2015;19:451–7.

    Article  PubMed  Google Scholar 

  37. Ksiazyk J, Piena M, Kierkus J, Lyszkowska M. Hydrolyzed versus nonhydrolyzed protein diet in short bowel syndrome in children. J Pediatr Gastroenterol Nutr. 2002;35:615–8.

    Article  CAS  PubMed  Google Scholar 

  38. Arrigoni E, Marteau P, Briet F, Pochart P, Rambaud JC, Messing B. Tolerance and absorption of lactose from milk and yogurt during short-bowel syndrome in humans. Am J Clin Nutr. 1994;60:926–9.

    Article  CAS  PubMed  Google Scholar 

  39. Hamilton K, Crowe T, Testro A. High amylase resistant starch to decrease stool output in people with short bowel syndrome: a pilot trial. Clin Nutr ESPEN. 2019;29:242–4.

    Article  PubMed  Google Scholar 

  40. Atia A, Girard-Pipau F, Hébuterne X, Spies WG, Guardiola A, Ahn CW, et al. Macronutrient absorption characteristics in humans with short bowel syndrome and jejunocolonic anastomosis: starch is the most important carbohydrate substrate, although pectin supplementation may modestly enhance short chain fatty acid production and fluid absorption. JPEN J Parenter Enteral Nutr. 2011;35:229–40.

    Article  PubMed  Google Scholar 

  41. Vílchez-López FJ, Larrán-Escandón L, García Almeida JM, Arraiza Irigoyen C, IrlesRocamora JA, Molina-Puerta MJ, et al. Evidence-based recommendations of the Andalusian Group for Nutrition Reflection and Investigation (GARIN) for the management of adult patients with short bowel syndrome. Nutr Hosp. 2021;38:1287–303.

    PubMed  Google Scholar 

  42. Hall JE, Guyton AC. Guyton and Hall textbook of medical physiology. 12th ed. Philadelphia: Saunders/Elsevier; 2011.

    Google Scholar 

  43. 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;43:478–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. 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.

    Article  CAS  PubMed  Google Scholar 

  45. Filippi J, Rubio A, Lasserre V, Maccario J, Walrand S, Neveux N, et al. Dose-dependent beneficial effects of citrulline supplementation in short bowel syndrome in rats. Nutr Burbank Los Angel Cty Calif. 2021;85:111118.

    Article  CAS  Google Scholar 

  46. Scolapio JS, McGreevy K, Tennyson GS, Burnett OL. Effect of glutamine in short-bowel syndrome. Clin Nutr. 2001;20:319–23.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Leah Gramlich MD for comments that greatly improved the manuscript.

Author information

Authors and Affiliations

  1. Division of Clinical Nutrition, Department of Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Rama IV Road, Pathumwan, Bangkok, 10330, Thailand

    Natcha Limtrakun RD & Narisorn Lakananurak MD, MSc

  2. Division of Clinical Nutrition, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Narisorn Lakananurak MD, MSc

Authors
  1. Natcha Limtrakun RD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Narisorn Lakananurak MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Narisorn Lakananurak MD, MSc.

Ethics declarations

Conflict of Interest

Natcha Limtrakun declares that she has no conflict of interest. Narisorn Lakananurak declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Obesity and Nutrition

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Limtrakun, N., Lakananurak, N. Dietary Strategies for Managing Short Bowel Syndrome. Curr Treat Options Gastro 20, 376–391 (2022). https://doi.org/10.1007/s11938-022-00385-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11938-022-00385-y

Keywords

Search

Navigation