Short-bowel syndrome: A clinical update

Short-bowel syndrome (SBS) is a form of intestinal failure following massive intestinal resection; the residual small bowel has inadequate capabilities for the absorption of the required water, macronutrients, and micronutrients to support optimal health, functions, and performance of the body cell mass. Some of these conditions or situations are accompanied by, result in, or result from complex abdominal wall defects. The formidable pathophysiology of SBS is summarized together with its clinical consequences; the principles of the nutritional and metabolic management of SBS, which have withstood the tests of time for a few decades, are discussed in some detail. The more recent efforts to enhance intestinal absorption by incorporating the use of growth hormone, teduglutide, glutamine, and other nutraceuticals, in combination with dietary modifications, in attempts to reduce or obviate the use of long-term parenteral nutrition in selected patients, while promoting maximal adaptation of the intestine, are summarized. Surgical considerations in the adjunctive management of SBS are discussed as potential means of enhancing intestinal absorption. Of all of the surgical approaches to SBS management, intestinal transplantation may well have the greatest promise in terms of restoring gastrointestinal tract function to normal as this field of endeavor continues to advance and improve its long-term outcomes. Finally, parenteral nutrition remains the cornerstone of optimally successful management of SBS, and its judicious use and monitoring by expert, experienced, dedicated nutrition support teams can ensure safe, effective, and maximal gastrointestinal adaptation and nutritional rehabilitation of the patient while maintaining the optimal size, health, and function of the body cell mass.