Management of the short bowel syndrome after extensive small bowel resection

Abstract

Short bowel syndrome (SBS) is a global malabsorption syndrome that results from extensive intestinal resections. It used to be a typical complication of repetitive bowel resections in patients with Crohn's disease. However, due to improved medical and surgical therapies for these patients it currently occurs more frequently as a consequence of vascular disorders in adults (intestinal infarction) and congenital aberrations in children, respectively. Adequate therapy depends on the degree of (small) bowel losses and on resulting functional disturbances. Moreover, it must be adjusted to the postoperative adaptation process, which consists of three phases: The immediate acute phase lasts less than 4 weeks and serves to stabilise the patient. The subsequent year should be used to induce maximal adaptation by gradually increasing nutrient exposure. When maximal stimulation of nutrient absorption has been achieved, permanent maintenance nutrition treatment should be defined individually, dependent on extent and quality of nutritive deficits. In patients with Crohn's disease, optimal treatment of the underlying disease is of pivotal importance in order to avoid a further reduction of absorptive capacity or other complications. Current investigations aim at improving the adaptation process by administration of specific diets and growth hormones. With these, it appears possible to treat even some patients with very short bowel, i.e. less than 50 cm of small intestine left, with oral nutrition, only. Still, a considerable proportion of patients will need long-term parenteral nutrition. If young patients experience intolerable complications of parenteral nutrition, intestinal transplantation may be considered as a high risk therapy of last choice.

Bone mineral density in short bowel syndrome: correlation with BMI and serum vitamins C, E and K

“…Recently, we showed that SBS patients present deficien cies in vitamins E, D (3,4) and K (3), regardless of venous infusion. Within this context, efforts are primarily devo ted to intestinal adaptation to oral route nutrition (5). Pa tients with severe malabsorption need home PN (5), but it is not a therapeutic option provided by the Brazilian public health system.…”

Long-Term Outcome of Living Related Renal Transplantation in a Patient with Short Bowel Syndrome

“…The major problems following SBS are chronic diarrhea, dehydration, electrolyte abnormalities, and malnutrition, as a result of severe maldigestion and malabsorption (Keller et al 2004;Duro et al 2008). As regarding renal complication, it is well documented that hyperoxaluria related to malabsorption leads to urolithiasis, oxalate nephropathy, and ultimately development of ESRF (Chadwick et al 1973;Earnest et al 1974;Barilla et al 1978;Das et al 1979;Mole et al 2001).…”

“…In patients with SBS, oral administration of drugs usually becomes difficult because the severity of intestinal failure and absorption capacity vary widely among individuals. This is a significant issue in patients under immunosuppressive therapy to prevent allograft rejection after organ transplantation (Keller et al 2004;Severijnen et al 2004;Duro et al 2008).…”

Short Bowel Syndrome: Amelioration of Diarrhea after Vagotomy and Pyloroplasty for Peptic Hemorrhage

“…Thus, a signifi cant number of patients with small intestinal remnants become progressively independent of parenteral nutrition and require diet rich in energy supply (Allard and Jeejeebhoy 1989), which should be distributed over multiple small meals including proper supplementation of vitamins and trace elements (maintenance phase) (Keller et al 2004). However, steatorrhea and diarrhea remain principal manifestations of SBS.…”