Managing short bowel syndrome: making the most of what the patient still has.

Abstract

Short bowel syndrome (severe malabsorption after resection of the small bowel) is characterized clinically by chronic diarrhea, dehydration, electrolyte abnormalities, and malnutrition. The severity and management depend on the site and extent of the intestinal resection, whether the ileocecal valve remains, whether there is disease in the residual bowel, and the degree of adaptation of the remaining bowel.

Mesenteric Infarction

“…Cessation or reducing dependence on PN improved survival in this and other studies. 15,24,25 PN does have its own associated risks of morbidity and mortality. 26,27 The 5-year survival rate for patients on home PN is between 60% and 83% 26,28 -31 though quality of life may be impaired.…”

Screening for Celiac Disease in Short Bowel Syndrome

“…This finding underscores the importance of the ileocecal valve in maintaining sufficient intestinal transit time for absorption. 22 Screening for celiac disease was performed using serum IgA TTG level. Total IgA was also examined to evaluate for IgA deficiency.…”

Short Bowel Syndrome: Current Medical and Surgical Trends

“…Among these factors, GLP-2 seems to have a potent trophic effect on the intestine, as it stimulates enterocyte proliferation, whereas at the same time it reduces the rate of enterocyte apoptosis. 27 …”

“…The ability of the small bowel to maintain nutrition after a massive intestinal resection depends on the extent and site of resection, the presence of the ileocecal valve and the colon, the adaptation of the intestinal remnant, and nature and complications of the underline disease. 16,27 The patients with SBS initially adapt to the reduced energy absorption through hyperphagia. A diet that provides 120% to 200% of the usual energy and protein requirements generally compensates for the malabsorption that occurs.…”