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Management of the Short Bowel Syndrome

  • John K. DiBaise
Part of the Clinical Gastroenterology book series (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].

Keywords

Short Bowel Syndrome Multidisciplinary Treatment Parenteral Nutrition Intestinal Transplantation 

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  • John K. DiBaise

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