Advances in the management of short bowel syndrome

Abstract

Short bowel syndrome (SBS) is the predominant cause of intestinal failure and is thus associated with a high degree of morbidity and mortality. One of the reasons this occurs is the dramatic reduction in nutrient absorptive capacity. Of the many causes of SBS, the most common cause is extensive surgical resection. The impressive ability of the bowel to adapt functionally and morphologically is critical for decreasing morbidity and mortality in these patients. The degree of adaptation is vital in decreasing the dependence on parenteral nutrition (PN) and for improving patient quality of life and long-term outcome. Provision of appropriate and sufficient nutritional and fluid support is essential for the management of these patients. The primary goal is to prevent or eliminate the need for PN. Recent developments have promoted a greater understanding of the process of intestinal adaptation. Various intestinal trophic factors have been recognized. These efforts have led to the early development of hormonal therapy to stimulate intestinal adaptation and enhance intestinal absorption. Intestinal transplantation remains an option for those who have developed life-threatening complications from PN and cannot be managed using more conservative techniques.

Peptide absorption after massive proximal small bowel resection: Mechanisms of ileal adaptation

“…Despite several treatment options, such as long-term parenteral nutrition, intestinal rehabilitation, various intestinal lengthening procedures, and, more recently, small bowel transplantation, the outcomes with current therapies are still not optimal for patients with SBS [1][2][3][4]. Preserving the distal ileum with the ileocecal junction in patients undergoing massive small bowel resection is associated with better surgical outcomes; however, the adaptive mechanisms occurring in the distal ileum for improving nutrient absorption, and especially for proteins as peptides, has not been characterized.…”

“…A similar state can follow traumatic loss of intestinal surface area, also leading to SBS. Despite recent advances in treatment options for patients with short bowel, current therapies still carry substantial risk of morbidity and mortality [3][4][5][6].…”

Effects of microalgae chlorella species crude extracts on intestinal adaptation in experimental short bowel syndrome

“…Searching for new treatment methods for increasing bowel adaptation mechanisms in order to reduce complications of SBS is an area which many recent studies concentrated on. The hormones; bombesin, growth factors, insulin like growth factors, ghrelin, leptin, and EN products; glutamine, fish oil (omega-3 fatty acids), immune nutrients and fibers, have been investigated, and found to have beneficial effects on bowel adaptation mechanism in SBS [8][9][10]18] . We designed our research on the use of species of chlorella algae for healing effects because of its high protein, nucleic acid, antioxidant and fiber content [11,12] .…”

“…The most important therapeutic objectives in the management of SBS are maintenance of the patient's calorie intake and nutritional status. Optimal intestinal rehabilitation should enhance the intestinal adaptation and shorten the period of intestinal recovery [7,8] ; Yet, today no such optimal therapy exists. However, some enteral nutrition (EN) products are used for energy supports in order to reduce demand for total parenteral nutrition (TPN).…”

Growth faltering: setting the scene

“…The administration of feeding, as well as the composition (elemental, semi-elemental or polymeric) and mode of delivery (gastric tube feeding or oral feeding; Jackson and Buchman, 2004), varies among different groups. Long-term follow-up of growth after parenteral nutrition weaning is mandatory, leading in some cases with growth failure to a restart of nutritional support (Goulet et al, 2005).…”