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.