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Management and Complications of Short Bowel Syndrome: an Updated Review

  • Small Intestine (D Sachar, Section Editor)
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Abstract

Short bowel syndrome (SBS) is defined as loss of bowel mass from surgical resection, congenital defects, or disease. Intestinal failure (IF) includes the subset of SBS unable to meet nutrition needs with enteral supplements and requires parenteral nutrition (PN). The parenteral treatment of SBS is now a half-century old. Recent pharmacologic treatment (GLP-2 analogues) has begun to make a significant impact in the care and ultimate management of these patients such that the possibility of reducing PN requirements in formerly PN-dependent patients is a now a real possibility. Finally, newer understanding and possible treatment for some of the complications related to IF have more recently evolved and will be an emphasis of this report. This review will focus on developments over the last 10 years with the goal of updating the reader to new advances in our understanding of the care and feeding of the SBS patient.

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References

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

  1. O’Keefe SJ, Buchman AL, Fishbein TM, Jeejeebhoy KN, Jeppesen PB, Shaffer J. Short bowel syndrome and intestinal failure: consensus definitions and overview. Clin Gastroenterol Hepatol. 2006;4(1):6–10. doi:10.1016/j.cgh.2005.10.002.

    Article  PubMed  Google Scholar 

  2. Dudrick SJ, Wilmore DW, Vars HM, Rhoads JE. Long-term total parenteral nutrition with growth, development, and positive nitrogen balance. Surgery. 1968;64(1):134–42.

    CAS  PubMed  Google Scholar 

  3. Buchman AL, Scolapio J, Fryer J. AGA technical review on short bowel syndrome and intestinal transplantation. Gastroenterology. 2003;124(4):1111–34. doi:10.1053/gast.2003.50139a.

    Article  PubMed  Google Scholar 

  4. Mullady DK, O’Keefe SJ. Treatment of intestinal failure: home parenteral nutrition. Nat Clin Pract Gastroenterol Hepatol. 2006;3(9):492–504. doi:10.1038/ncpgasthep0580.

    Article  PubMed  Google Scholar 

  5. Nightingale J, Woodward JM, Gastroenterology SBaNCotBSo. Guidelines for management of patients with a short bowel. Gut. 2006;55 Suppl 4:iv1–12.

    PubMed  PubMed Central  Google Scholar 

  6. Sinha R, Trivedi D, Murphy PD, Fallis S. Small-intestinal length measurement on MR enterography: comparison with in vivo surgical measurement. AJR Am J Roentgenol. 2014;203(3):W274–9. doi:10.2214/AJR.13.11944.

    Article  PubMed  Google Scholar 

  7. Carbonnel F, Cosnes J, Chevret S, Beaugerie L, Ngô Y, Malafosse M, et al. The role of anatomic factors in nutritional autonomy after extensive small bowel resection. JPEN J Parenter Enteral Nutr. 1996;20(4):275–80.

    Article  CAS  PubMed  Google Scholar 

  8. Kurkchubasche AG, Rowe MI, Smith SD. Adaptation in short-bowel syndrome: reassessing old limits. J Pediatr Surg. 1993;28(8):1069–71.

    Article  CAS  PubMed  Google Scholar 

  9. Crenn P, Messing B, Cynober L. Citrulline as a biomarker of intestinal failure due to enterocyte mass reduction. Clin Nutr. 2008;27(3):328–39. doi:10.1016/j.clnu.2008.02.005.

    Article  CAS  PubMed  Google Scholar 

  10. Sigalet DL, Martin G, Meddings J, Hartman B, Holst JJ. GLP-2 levels in infants with intestinal dysfunction. Pediatr Res. 2004;56(3):371–6. doi:10.1203/01.PDR.0000134250.80492.EC.

    Article  CAS  PubMed  Google Scholar 

  11. Ziv YH, Burrow T, Kocoshis S, Pentiuk S. Encephalopathy in a patient with short bowel syndrome: case report and discussion of the pathophysiology. JPEN J Parenter Enteral Nutr. 2014;38(4):518–20. doi:10.1177/0148607113496819.

    Article  PubMed  Google Scholar 

  12. Weale AR, Edwards AG, Bailey M, Lear PA. Intestinal adaptation after massive intestinal resection. Postgrad Med J. 2005;81(953):178–84. doi:10.1136/pgmj.2004.023846.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Miskowiak J, Andersen B. Bypass revision in unsatisfactory weight loss after jejunoileal bypass for morbid obesity. Scand J Gastroenterol. 1982;17(2):317–9.

    Article  CAS  PubMed  Google Scholar 

  14. Tappenden KA. Intestinal adaptation following resection. JPEN J Parenter Enteral Nutr. 2014;38(1 Suppl):23S–31. doi:10.1177/0148607114525210.

    Article  PubMed  Google Scholar 

  15. Messing B, Crenn P, Beau P, Boutron-Ruault MC, Rambaud JC, Matuchansky C. Long-term survival and parenteral nutrition dependence in adult patients with the short bowel syndrome. Gastroenterology. 1999;117(5):1043–50.

    Article  CAS  PubMed  Google Scholar 

  16. Higuera I, Garcia-Peris P, Camblor M, Bretón I, Velasco C, Romero R, et al. Outcomes of a general hospital-based home parenteral nutrition (HPN) program; report of our experience from a 26-year period. Nutr Hosp. 2014;30(2):359–65. doi:10.3305/nh.2014.30.2.7592.

    PubMed  Google Scholar 

  17. Jeppesen PB, Pertkiewicz M, Messing B, Iyer K, Seidner DL, O’keefe SJ, et al. Teduglutide reduces need for parenteral support among patients with short bowel syndrome with intestinal failure. Gastroenterology. 2012;143(6):1473–81.e3. doi:10.1053/j.gastro.2012.09.007. Teduglutide is the most significant medical advance in the treatment of SBS since the development of PN.

    Article  CAS  PubMed  Google Scholar 

  18. Kelly DG, Tappenden KA, Winkler MF. Short bowel syndrome: highlights of patient management, quality of life, and survival. JPEN J Parenter Enteral Nutr. 2014;38(4):427–37. doi:10.1177/0148607113512678.

    Article  PubMed  Google Scholar 

  19. Vantini I, Benini L, Bonfante F, Talamini G, Sembenini C, Chiarioni G, et al. Survival rate and prognostic factors in patients with intestinal failure. Dig Liver Dis. 2004;36(1):46–55. doi:10.1016/j.dld.2003.09.015.

    Article  CAS  PubMed  Google Scholar 

  20. Lloyd DA, Vega R, Bassett P, Forbes A, Gabe SM. Survival and dependence on home parenteral nutrition: experience over a 25-year period in a UK referral centre. Aliment Pharmacol Ther. 2006;24(8):1231–40. doi:10.1111/j.1365-2036.2006.03106.x.

    Article  CAS  PubMed  Google Scholar 

  21. Crenn P, Rakotoanbinina B, Raynaud JJ, Thuillier F, Messing B, Melchior JC. Hyperphagia contributes to the normal body composition and protein-energy balance in HIV-infected asymptomatic men. J Nutr. 2004;134(9):2301–6.

    CAS  PubMed  Google Scholar 

  22. Nightingale JM. Management of patients with a short bowel. World J Gastroenterol. 2001;7(6):741–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Messing B, Pigot F, Rongier M, Morin MC, Ndeïndoum U, Rambaud JC. Intestinal absorption of free oral hyperalimentation in the very short bowel syndrome. Gastroenterology. 1991;100(6):1502–8.

    CAS  PubMed  Google Scholar 

  24. Qandeel HG, Alonso F, Hernandez DJ, Madhavan S, Duenes JA, Zheng Y, et al. Peptide absorption after massive proximal small bowel resection: mechanisms of ileal adaptation. J Gastrointest Surg. 2011;15(9):1537–47. doi:10.1007/s11605-011-1581-z.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Buyse M, Berlioz F, Guilmeau S, Tsocas A, Voisin T, Péranzi G, et al. PepT1-mediated epithelial transport of dipeptides and cephalexin is enhanced by luminal leptin in the small intestine. J Clin Invest. 2001;108(10):1483–94. doi:10.1172/JCI13219.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Hindlet P, Bado A, Farinotti R, Buyse M. Long-term effect of leptin on H+-coupled peptide cotransporter 1 activity and expression in vivo: evidence in leptin-deficient mice. J Pharmacol Exp Ther. 2007;323(1):192–201. doi:10.1124/jpet.107.125799.

    Article  CAS  PubMed  Google Scholar 

  27. McIntyre PB, Fitchew M, Lennard-Jones JE. Patients with a high jejunostomy do not need a special diet. Gastroenterology. 1986;91(1):25–33.

    Article  CAS  PubMed  Google Scholar 

  28. Cosnes J, Evard D, Beaugerie L, Gendre JP, Le Quintrec Y. Improvement in protein absorption with a small-peptide-based diet in patients with high jejunostomy. Nutrition. 1992;8(6):406–11.

    CAS  PubMed  Google Scholar 

  29. Novak F, Heyland DK, Avenell A, Drover JW, Su X. Glutamine supplementation in serious illness: a systematic review of the evidence. Crit Care Med. 2002;30(9):2022–9. doi:10.1097/01.CCM.0000026106.58241.95.

    Article  CAS  PubMed  Google Scholar 

  30. Byrne TA, Wilmore DW, Iyer K, Dibaise J, Clancy K, Robinson MK, 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(5):655–61.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Wales PW, Nasr A, de Silva N, Yamada J. Human growth hormone and glutamine for patients with short bowel syndrome. Cochrane Database Syst Rev. 2010;6:CD006321. doi:10.1002/14651858.CD006321.pub2.

    PubMed  Google Scholar 

  32. Scolapio JS. Short bowel syndrome: recent clinical outcomes with growth hormone. Gastroenterology. 2006;130(2 Suppl 1):S122–6. doi:10.1053/j.gastro.2005.12.003.

    Article  CAS  PubMed  Google Scholar 

  33. Cardell RR, Badenhausen S, Porter KR. Intestinal triglyceride absorption in the rat. An electron microscopical study. J Cell Biol. 1967;34(1):123–55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Alrefai WA, Gill RK. Bile acid transporters: structure, function, regulation and pathophysiological implications. Pharm Res. 2007;24(10):1803–23. doi:10.1007/s11095-007-9289-1.

    Article  CAS  PubMed  Google Scholar 

  35. Hofmann AF, Hagey LR. Bile acids: chemistry, pathochemistry, biology, pathobiology, and therapeutics. Cell Mol Life Sci. 2008;65(16):2461–83. doi:10.1007/s00018-008-7568-6.

    Article  CAS  PubMed  Google Scholar 

  36. Kapral C, Wewalka F, Praxmarer V, Lenz K, Hofmann AF. Conjugated bile acid replacement therapy in short bowel syndrome patients with a residual colon. Z Gastroenterol. 2004;42(7):583–9. doi:10.1055/s-2004-813059.

    Article  CAS  PubMed  Google Scholar 

  37. Faber J, Goldstein R, Blondheim O, Stankiewicz H, Darwashi A, Bar-Maor JA, et al. Absorption of medium chain triglycerides in the stomach of the human infant. J Pediatr Gastroenterol Nutr. 1988;7(2):189–95.

    Article  CAS  PubMed  Google Scholar 

  38. 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(4):478–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Gray GM. Carbohydrate digestion and absorption. Role of the small intestine. N Engl J Med. 1975;292(23):1225–30. doi:10.1056/NEJM197506052922308.

    Article  CAS  PubMed  Google Scholar 

  40. Cura AJ, Carruthers A. Role of monosaccharide transport proteins in carbohydrate assimilation, distribution, metabolism, and homeostasis. Compr Physiol. 2012;2(2):863–914. doi:10.1002/cphy.c110024.

    PubMed  PubMed Central  Google Scholar 

  41. Hamilton KL, Butt AG. Glucose transport into everted sacs of the small intestine of mice. Adv Physiol Educ. 2013;37(4):415–26. doi:10.1152/advan.00017.2013.

    Article  PubMed  Google Scholar 

  42. Depoortere I. Taste receptors of the gut: emerging roles in health and disease. Gut. 2014;63(1):179–90. doi:10.1136/gutjnl-2013-305112.

    Article  CAS  PubMed  Google Scholar 

  43. 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(2):229–40. doi:10.1177/0148607110378410.

    Article  PubMed  Google Scholar 

  44. Nordgaard I, Hansen BS, Mortensen PB. Colon as a digestive organ in patients with short bowel. Lancet. 1994;343(8894):373–6.

    Article  CAS  PubMed  Google Scholar 

  45. den Besten G, Lange K, Havinga R, van Dijk TH, Gerding A, van Eunen K, et al. Gut-derived short-chain fatty acids are vividly assimilated into host carbohydrates and lipids. Am J Physiol Gastrointest Liver Physiol. 2013;305(12):G900–10. doi:10.1152/ajpgi.00265.2013.

    Article  CAS  Google Scholar 

  46. Schiano TD, Klang MG, Quesada E, Scott F, Tao Y, Shike M. Thiamine status in patients receiving long-term home parenteral nutrition. Am J Gastroenterol. 1996;91(12):2555–9.

    CAS  PubMed  Google Scholar 

  47. Lakhani SV, Shah HN, Alexander K, Finelli FC, Kirkpatrick JR, Koch TR. Small intestinal bacterial overgrowth and thiamine deficiency after Roux-en-Y gastric bypass surgery in obese patients. Nutr Res. 2008;28(5):293–8. doi:10.1016/j.nutres.2008.03.002.

    Article  CAS  PubMed  Google Scholar 

  48. Justino SR, Gonçalves Dias MC, Maculevicius J, Batista de Morais M, Sing TC, Halpern A, et al. Fasting breath hydrogen concentration in short bowel syndrome patients with colon incontinuity before and after antibiotic therapy. Nutrition. 2004;20(2):187–91. doi:10.1016/j.nut.2003.10.009.

    Article  CAS  PubMed  Google Scholar 

  49. Duerksen DR, Fallows G, Bernstein CN. Vitamin B12 malabsorption in patients with limited ileal resection. Nutrition. 2006;22(11-12):1210–3. doi:10.1016/j.nut.2006.08.017.

    Article  CAS  PubMed  Google Scholar 

  50. Pedersen GA, Chakraborty S, Steinhauser AL, Traub LM, Madsen M. AMN directs endocytosis of the intrinsic factor-vitamin B(12) receptor cubam by engaging ARH or Dab2. Traffic. 2010;11(5):706–20. doi:10.1111/j.1600-0854.2010.01042.x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Renner AB, Dietrich-Ntoukas T, Jägle H. Recurrent episodes of night blindness in a patient with short bowel syndrome. Doc Ophthalmol. 2015;131(3):221–30. doi:10.1007/s10633-015-9516-8.

    Article  PubMed  Google Scholar 

  52. Braga CB, Vannucchi H, Freire CM, Marchini JS, Jordão AA, da Cunha SF. Serum vitamins in adult patients with short bowel syndrome receiving intermittent parenteral nutrition. JPEN J Parenter Enteral Nutr. 2011;35(4):493–8. doi:10.1177/0148607110386964.

    Article  CAS  PubMed  Google Scholar 

  53. Touloukian RJ, Gertner JM. Vitamin D deficiency rickets as a late complication of the short gut syndrome during infancy. J Pediatr Surg. 1981;16(3):230–5.

    Article  CAS  PubMed  Google Scholar 

  54. Margulies SL, Kurian D, Elliott MS, Han Z. Vitamin D deficiency in patients with intestinal malabsorption syndromes—think in and outside the gut. J Dig Dis. 2015;16(11):617–33. doi:10.1111/1751-2980.12283.

    Article  CAS  PubMed  Google Scholar 

  55. Jeejeebhoy K. Zinc: an essential trace element for parenteral nutrition. Gastroenterology. 2009;137(5 Suppl):S7–12. doi:10.1053/j.gastro.2009.08.014.

    Article  CAS  PubMed  Google Scholar 

  56. Ishida T, Himeno K, Torigoe Y, Inoue M, Wakisaka O, Tabuki T, et al. Selenium deficiency in a patient with Crohn’s disease receiving long-term total parenteral nutrition. Intern Med. 2003;42(2):154–7.

    Article  PubMed  Google Scholar 

  57. Blaszyk H, Wild PJ, Oliveira A, Kelly DG, Burgart LJ. Hepatic copper in patients receiving long-term total parenteral nutrition. J Clin Gastroenterol. 2005;39(4):318–20.

    Article  PubMed  Google Scholar 

  58. Vanek VW. Review of trace mineral requirements for preterm infants: what are the current recommendations for clinical practice? Nutr Clin Pract. 2015;30(5):720–1. doi:10.1177/0884533615598965. The identification of potential toxicity of parenteral vitamins is of significance for adult and peditric PN population. This review addresses a potential safety problem with the use of these preparations.

    Article  CAS  PubMed  Google Scholar 

  59. Hardy G. Manganese in parenteral nutrition: who, when, and why should we supplement? Gastroenterology. 2009;137(5 Suppl):S29–35. doi:10.1053/j.gastro.2009.08.011.

    Article  CAS  PubMed  Google Scholar 

  60. Moukarzel A. Chromium in parenteral nutrition: too little or too much? Gastroenterology. 2009;137(5 Suppl):S18–28. doi:10.1053/j.gastro.2009.08.048.

    Article  CAS  PubMed  Google Scholar 

  61. Straus E, Yalow RS. Studies on the distribution and degradation of heptadecapeptide, big, and big big gastrin. Gastroenterology. 1974;66(5):936–43.

    CAS  PubMed  Google Scholar 

  62. Buchman AL, Fryer J, Wallin A, Ahn CW, Polensky S, Zaremba K. Clonidine reduces diarrhea and sodium loss in patients with proximal jejunostomy: a controlled study. JPEN J Parenter Enteral Nutr. 2006;30(6):487–91.

    Article  CAS  PubMed  Google Scholar 

  63. Nehra V, Camilleri M, Burton D, Oenning L, Kelly DG. An open trial of octreotide long-acting release in the management of short bowel syndrome. Am J Gastroenterol. 2001;96(5):1494–8. doi:10.1111/j.1572-0241.2001.03803.x.

    Article  CAS  PubMed  Google Scholar 

  64. Gómez-Herrera E, Farías-Llamas OA, Gutiérrez-de la Rosa JL, Hermosillo-Sandoval JM. The role of long-acting release (LAR) depot octreotide as adjuvant management of short bowel disease]. Cir Cir. 2004;72(5):379–86. doi:10.3201/eid1011.040428.

    PubMed  Google Scholar 

  65. Sato D, Morino K, Ohashi N, Ueda E, Ikeda K, Yamamoto H, et al. Octreotide improves early dumping syndrome potentially through incretins: a case report. Endocr J. 2013;60(7):847–53.

    Article  CAS  PubMed  Google Scholar 

  66. Hussaini SH, Pereira SP, Murphy GM, Kennedy C, Wass JA, Besser GM, et al. Composition of gall bladder stones associated with octreotide: response to oral ursodeoxycholic acid. Gut. 1995;36(1):126–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Sukhotnik I, Khateeb K, Krausz MM, Sabo E, Siplovich L, Coran AG, et al. Sandostatin impairs postresection intestinal adaptation in a rat model of short bowel syndrome. Dig Dis Sci. 2002;47(9):2095–102.

    Article  CAS  PubMed  Google Scholar 

  68. Hediger MA, Turk E, Pajor AM, Wright EM. Molecular genetics of the human Na+/glucose cotransporter. Klin Wochenschr. 1989;67(17):843–6.

    Article  CAS  PubMed  Google Scholar 

  69. Wright EM, Loo DD, Hirayama BA, Turk E. Surprising versatility of Na+-glucose cotransporters: SLC5. Physiology (Bethesda). 2004;19:370–6. doi:10.1152/physiol.00026.2004.

    Article  CAS  Google Scholar 

  70. Freedman SB, Cho D, Boutis K, Stephens D, Schuh S. Assessing the palatability of oral rehydration solutions in school-aged children: a randomized crossover trial. Arch Pediatr Adolesc Med. 2010;164(8):696–702. doi:10.1001/archpediatrics.2010.129.

    Article  PubMed  Google Scholar 

  71. Mansmann H. Lab diagnosis of magnesium deficiency. The BartterSite 2008

  72. Anast CS, Winnacker JL, Forte LR, Burns TW. Impaired release of parathyroid hormone in magnesium deficiency. J Clin Endocrinol Metab. 1976;42(4):707–17. doi:10.1210/jcem-42-4-707.

    Article  CAS  PubMed  Google Scholar 

  73. Hahn M, Raithel M, Hagel A, Biermann T, Manger B. Chronic calcium pyrophosphate crystal inflammatory arthritis induced by extreme hypomagnesemia in short bowel syndrome. BMC Gastroenterol. 2012;12:129. doi:10.1186/1471-230X-12-129.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Florentin M, Elisaf MS. Proton pump inhibitor-induced hypomagnesemia: a new challenge. World J Nephrol. 2012;1(6):151–4. doi:10.5527/wjn.v1.i6.151.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Thulesen J. Glucagon-like peptide 2 (GLP-2), an intestinotrophic mediator. Curr Protein Pept Sci. 2004;5(1):51–65.

    Article  CAS  PubMed  Google Scholar 

  76. Drucker DJ, Yusta B. Physiology and pharmacology of the enteroendocrine hormone glucagon-like peptide-2. Annu Rev Physiol. 2014;76:561–83. doi:10.1146/annurev-physiol-021113-170317. Dr. Drucker’s cloning and characterization of GLP-2 and its cognate receptor identified the most important trophic hormone of the small intestine known to date.

    Article  CAS  PubMed  Google Scholar 

  77. Jeppesen PB, Sanguinetti EL, Buchman A, Howard L, Scolapio JS, Ziegler TR, et al. Teduglutide (ALX-0600), a dipeptidyl peptidase IV resistant glucagon-like peptide 2 analogue, improves intestinal function in short bowel syndrome patients. Gut. 2005;54(9):1224–31. doi:10.1136/gut.2004.061440.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. Thulesen J, Hartmann B, Hare KJ, Kissow H, Ørskov C, Holst JJ, et al. Glucagon-like peptide 2 (GLP-2) accelerates the growth of colonic neoplasms in mice. Gut. 2004;53(8):1145–50. doi:10.1136/gut.2003.035212.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  79. Roslyn JJ, Pitt HA, Mann L, Fonkalsrud EW, DenBesten L. Parenteral nutrition-induced gallbladder disease: a reason for early cholecystectomy. Am J Surg. 1984;148(1):58–63.

    Article  CAS  PubMed  Google Scholar 

  80. Thompson JS. The role of prophylactic cholecystectomy in the short-bowel syndrome. Arch Surg. 1996;131(5):556–9. discussion 9-60.

    Article  CAS  PubMed  Google Scholar 

  81. Hutchinson R, Tyrrell PN, Kumar D, Dunn JA, Li JK, Allan RN. Pathogenesis of gall stones in Crohn’s disease: an alternative explanation. Gut. 1994;35(1):94–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  82. Redfern JS, Fortuner WJ. Octreotide-associated biliary tract dysfunction and gallstone formation: pathophysiology and management. Am J Gastroenterol. 1995;90(7):1042–52.

    CAS  PubMed  Google Scholar 

  83. Buchman AL, Moukarzel A. Metabolic bone disease associated with total parenteral nutrition. Clin Nutr. 2000;19(4):217–31. doi:10.1054/clnu.1999.0083.

    Article  CAS  PubMed  Google Scholar 

  84. Pironi L, Labate AM, Pertkiewicz M, Przedlacki J, Tjellesen L, Staun M, et al. Prevalence of bone disease in patients on home parenteral nutrition. Clin Nutr. 2002;21(4):289–96.

    Article  PubMed  Google Scholar 

  85. Braga CB, Bizari L, Suen VM, Marchini JS, Paula FJ, Cunha SF. Bone mineral density in short bowel syndrome: correlation with BMI and serum vitamins C, E and K. Arch Endocrinol Metab. 2015;59(3):252–8. doi:10.1590/2359-3997000000046.

    Article  PubMed  Google Scholar 

  86. Ament ME. Bone mineral content in patients with short bowel syndrome: the impact of parenteral nutrition. J Pediatr. 1998;132(3 Pt 1):386–8.

    Article  CAS  PubMed  Google Scholar 

  87. Tangpricha V, Luo M, Fernández-Estívariz C, Gu LH, Bazargan N, Klapproth JM, et al. Growth hormone favorably affects bone turnover and bone mineral density in patients with short bowel syndrome undergoing intestinal rehabilitation. JPEN J Parenter Enteral Nutr. 2006;30(6):480–6.

    Article  CAS  PubMed  Google Scholar 

  88. Haderslev KV, Jeppesen PB, Hartmann B, Thulesen J, Sorensen HA, Graff J, et al. Short-term administration of glucagon-like peptide-2. Effects on bone mineral density and markers of bone turnover in short-bowel patients with no colon. Scand J Gastroenterol. 2002;37(4):392–8.

    Article  CAS  PubMed  Google Scholar 

  89. Emmett M, Guirl MJ, Santa Ana CA, Porter JL, Neimark S, Hofmann AF, et al. Conjugated bile acid replacement therapy reduces urinary oxalate excretion in short bowel syndrome. Am J Kidney Dis. 2003;41(1):230–7. doi:10.1053/ajkd.2003.50012.

    Article  PubMed  Google Scholar 

  90. Finkielstein VA, Goldfarb DS. Strategies for preventing calcium oxalate stones. CMAJ. 2006;174(10):1407–9. doi:10.1503/cmaj.051517.

    Article  PubMed  PubMed Central  Google Scholar 

  91. Luman W, Shaffer JL. Prevalence, outcome and associated factors of deranged liver function tests in patients on home parenteral nutrition. Clin Nutr. 2002;21(4):337–43.

    Article  CAS  PubMed  Google Scholar 

  92. Kelly DA. Intestinal failure-associated liver disease: what do we know today? Gastroenterology. 2006;130(2 Suppl 1):S70–7. doi:10.1053/j.gastro.2005.10.066.

    Article  CAS  PubMed  Google Scholar 

  93. Fitzgibbons SC, Jones BA, Hull MA, Zurakowski D, Duro D, Duggan C, et al. Relationship between biopsy-proven parenteralnutrition-associated liver fibrosis and biochemical cholestasis in children with short bowel syndrome. J Pediatr Surg. 2010;45(1):95–9. doi:10.1016/j.jpedsurg.2009.10.020. discussion 9.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Fong DG, Nehra V, Lindor KD, Buchman AL. Metabolic and nutritional considerations in nonalcoholic fatty liver. Hepatology. 2000;32(1):3–10. doi:10.1053/jhep.2000.8978.

    Article  CAS  PubMed  Google Scholar 

  95. Rollins MD, Scaife ER, Jackson WD, Meyers RL, Mulroy CW, Book LS. Elimination of soybean lipid emulsion in parenteral nutrition and supplementation with enteral fish oil improve cholestasis in infants with short bowel syndrome. Nutr Clin Pract. 2010;25(2):199–204. doi:10.1177/0884533610361477.

    Article  PubMed  Google Scholar 

  96. Xu Z, Li Y, Wang J, Wu B, Li J. Effect of omega-3 polyunsaturated fatty acids to reverse biopsy-proven parenteral nutrition-associated liver disease in adults. Clin Nutr. 2012;31(2):217–23. doi:10.1016/j.clnu.2011.10.001.

    Article  CAS  PubMed  Google Scholar 

  97. Mercer DF, Hobson BD, Fischer RT, Talmon GA, Perry DA, Gerhardt BK, et al. Hepatic fibrosis persists and progresses despite biochemical improvement in children treated with intravenous fish oil emulsion. J Pediatr Gastroenterol Nutr. 2013;56(4):364–9. doi:10.1097/MPG.0b013e31827e208c.

    Article  CAS  PubMed  Google Scholar 

  98. Matsumoto CS, Kaufman SS, Island ER, Kallakury B, Yazigi NA, Khan KM, et al. Hepatic explant pathology of pediatric intestinal transplant recipients previously treated with omega-3 fatty acid lipid emulsion. J Pediatr. 2014;165(1):59–64. doi:10.1016/j.jpeds.2014.03.034.

    Article  CAS  PubMed  Google Scholar 

  99. Klek S, Chambrier C, Singer P, Rubin M, Bowling T, Staun M, et al. Four-week parenteral nutrition using a third generation lipid emulsion (SMOFlipid)—a double-blind, randomised, multicentre study in adults. Clin Nutr. 2013;32(2):224–31. doi:10.1016/j.clnu.2012.06.011.

    Article  CAS  PubMed  Google Scholar 

  100. Buchman AL, Ament ME, Sohel M, Dubin M, Jenden DJ, Roch M, et al. Choline deficiency causes reversible hepatic abnormalities in patients receiving parenteral nutrition: proof of a human choline requirement: a placebo-controlled trial. JPEN J Parenter Enteral Nutr. 2001;25(5):260–8.

    Article  CAS  PubMed  Google Scholar 

  101. Sentongo TA, Kumar P, Karza K, Keys L, Iyer K, Buchman AL. Whole-blood-free choline and choline metabolites in infants who require chronic parenteral nutrition therapy. J Pediatr Gastroenterol Nutr. 2010;50(2):194–9. doi:10.1097/MPG.0b013e3181a93735.

    Article  PubMed  Google Scholar 

  102. Dunlop RH, Hammond PB. D-lactic acidosis of ruminants. Ann N Y Acad Sci. 1965;119(3):1109–32.

    Article  CAS  PubMed  Google Scholar 

  103. Kowlgi NG, Chhabra L. D-lactic acidosis: an underrecognized complication of short bowel syndrome. Gastroenterol Res Pract. 2015;2015:476215. doi:10.1155/2015/476215.

    Article  PubMed  PubMed Central  Google Scholar 

  104. Ku W, Lau D, Huen KF. Probiotics provoked D-lactic acidosis in short bowel syndrome: case report and literature review. H K J Paediatr. 2006;11:246–54.

    Google Scholar 

  105. Winkler MF, Smith CE. Clinical, social, and economic impacts of home parenteral nutrition dependence in short bowel syndrome. JPEN J Parenter Enteral Nutr. 2014;38(1 Suppl):32S–7. doi:10.1177/0148607113517717.

    Article  PubMed  Google Scholar 

  106. Kalaitzakis E, Carlsson E, Josefsson A, Bosaeus I. Quality of life in short-bowel syndrome: impact of fatigue and gastrointestinal symptoms. Scand J Gastroenterol. 2008;43(9):1057–65. doi:10.1080/00365520802078325.

    Article  PubMed  Google Scholar 

  107. Scolapio JS, Savoy AD, Kaplan J, Burger CD, Lin SC. Sleep patterns of cyclic parenteral nutrition, a pilot study: are there sleepless nights? JPEN J Parenter Enteral Nutr. 2002;26(3):214–7.

    Article  PubMed  Google Scholar 

  108. Feagan BG, Bala M, Yan S, Olson A, Hanauer S. Unemployment and disability in patients with moderately to severely active Crohn’s disease. J Clin Gastroenterol. 2005;39(5):390–5.

    Article  PubMed  Google Scholar 

  109. Marri SR, Buchman AL. The education and employment status of patients with inflammatory bowel diseases. Inflamm Bowel Dis. 2005;11(2):171–7.

    Article  PubMed  Google Scholar 

  110. Jeppesen PB, Pertkiewicz M, Forbes A, Pironi L, Gabe SM, Joly F, et al. Quality of life in patients with short bowel syndrome treated with the new glucagon-like peptide-2 analogue teduglutide—analyses from a randomised, placebo-controlled study. Clin Nutr. 2013;32(5):713–21. doi:10.1016/j.clnu.2013.03.016.

    Article  CAS  PubMed  Google Scholar 

  111. Kunkel D, Basseri B, Low K, Lezcano S, Soffer EE, Conklin JL, et al. Efficacy of the glucagon-like peptide-1 agonist exenatide in the treatment of short bowel syndrome. Neurogastroenterol Motil. 2011;23(8):739–e328. doi:10.1111/j.1365-2982.2011.01723.x.

    Article  CAS  PubMed  Google Scholar 

  112. Madsen KB, Askov-Hansen C, Naimi RM, Brandt CF, Hartmann B, Holst JJ, et al. Acute effects of continuous infusions of glucagon-like peptide (GLP)-1, GLP-2 and the combination (GLP-1+GLP-2) on intestinal absorption in short bowel syndrome (SBS) patients. A placebo-controlled study. Regul Pept. 2013;184:30–9. doi:10.1016/j.regpep.2013.03.025.

    Article  CAS  PubMed  Google Scholar 

  113. Jones BA, Hull MA, Potanos KM, Zurakowski D, Fitzgibbons SC, Ching YA, et al. Report of 111 consecutive patients enrolled in the International Serial Transverse Enteroplasty (STEP) Data Registry: a retrospective observational study. J Am Coll Surg. 2013;216(3):438–46. doi:10.1016/j.jamcollsurg.2012.12.018.

    Article  PubMed  PubMed Central  Google Scholar 

  114. Bianchi A. Intestinal lengthening: an experimental and clinical review. J R Soc Med. 1984;77 Suppl 3:35–41.

    PubMed  PubMed Central  Google Scholar 

  115. Garcia-Roca R, Tzvetanov IG, Jeon H, Hetterman E, Oberholzer J, Benedetti E. Successful living donor intestinal transplantation in cross-match positive recipients: initial experience. World J Gastrointest Surg. 2016;8(1):101–5. doi:10.4240/wjgs.v8.i1.101.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

Hassan Mashbari, MD, and Jonas Staudacher, PhD, provided significant research and technical assistance in the preparation of this manuscript.

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Correspondence to Robert E. Carroll.

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REC, EB, JPS, and ALB declare that they have no conflicts of interest.

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With regard to the authors’ research cited in this paper, all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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This article is part of the Topical Collection on Small Intestine

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Carroll, R.E., Benedetti, E., Schowalter, J.P. et al. Management and Complications of Short Bowel Syndrome: an Updated Review. Curr Gastroenterol Rep 18, 40 (2016). https://doi.org/10.1007/s11894-016-0511-3

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