Short Bowel Syndrome: A Paradigm for Intestinal Adaptation to Nutrition?

2020 ◽  
Vol 40 (1) ◽  
pp. 299-321 ◽  
Author(s):  
Johanne Le Beyec ◽  
Lore Billiauws ◽  
André Bado ◽  
Francisca Joly ◽  
Maude Le Gall
Keyword(s):  
Parenteral Nutrition ◽  
Short Bowel Syndrome ◽  
Metabolic Diseases ◽  
Current Knowledge ◽  
Intestinal Adaptation ◽  
Intestinal Failure ◽  
Extensive Resection ◽  
Oral Nutrition ◽  
Short Bowel ◽  
Gut Hormone

Short bowel syndrome (SBS) is a rare disease that results from extensive resection of the intestine. When the remaining absorption surface of the intestine cannot absorb enough macronutrients, micronutrients, and water, SBS results in intestinal failure (IF). Patients with SBS who suffer from IF require parenteral nutrition for survival, but long-term parenteral nutrition may lead to complications such as catheter sepsis and metabolic diseases. Spontaneous intestinal adaptation occurs weeks to months after resection, resulting in hyperplasia of the remnant gut, modification of gut hormone levels, dysbiosis, and hyperphagia. Oral nutrition and presence of the colon are two major positive drivers for this adaptation. This review aims to summarize the current knowledge of the mechanisms underlying spontaneous intestinal adaptation, particularly in response to modifications of luminal content, including nutrients. In the future, dietary manipulations could be used to treat SBS.

scholarly journals Short bowel syndrome in infancy: recent advances and practical management

2020 ◽  
pp. flgastro-2020-101457
Author(s):  
Elena Cernat ◽  
Chloe Corlett ◽  
Natalia Iglesias ◽  
Nkem Onyeador ◽  
Julie Steele ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Short Bowel Syndrome ◽  
Intestinal Adaptation ◽  
Intestinal Failure ◽  
Rare Condition ◽  
Oral Feeding ◽  
Short Bowel ◽  
Intestinal Continuity ◽  
Gastrointestinal Reconstruction ◽  
Lipid Reduction

Short bowel syndrome (SBS) is a rare condition characterised by extensive loss of intestinal mass secondary to congenital or acquired disease. The outcomes are determined by dependency on parenteral nutrition (PN), its possible complications and factors that influence intestinal adaptation. In order to achieve the best results, patients should be managed by a specialised multidisciplinary team with the aims of promoting growth and development, stimulating intestinal adaptation and preventing possible complications. This involves timely surgical management aimed at rescuing maximum bowel length and eventually re-establishing intestinal continuity where appropriate. A combination of enteral and parenteral nutrition needs to be targeted towards maintaining a balance between fulfilling the nutritional and metabolic needs of the child while preventing or at least minimising potential complications. Enteral nutrition and establishment of oral feeding play a fundamental role in stimulating bowel adaptation and promoting enteral autonomy. Other measures to promote enteral autonomy include the chyme recycling in patients where bowel is not in continuity, autologous gastrointestinal reconstruction and pharmacological treatments, including promising new therapies like teduglutide. Strategies such as lipid reduction, changing the type of lipid emulsion and cycling PN are associated with a reduction in the rates of intestinal failure–associated liver disease. Even though vast improvements have been made in the surgical and medical management of SBS, there is still lack of consensus in many aspects and collaboration is essential.

scholarly journals RARE CASE OF SHORT BOWEL SYNDROME

2019 ◽  
Vol 49 ◽  
pp. 6-8
Author(s):  
Azmaiparashvili G. აზმაიფარაშვილი გ. ◽  
Tomadze G. თომაძე გ. ◽  
Megreladze A. მეგრელაძე ა.
Keyword(s):  
Small Intestine ◽  
Small Bowel ◽  
Parenteral Nutrition ◽  
Short Bowel Syndrome ◽  
Rare Case ◽  
Postoperative Management ◽  
Hepatic Flexure ◽  
Postoperative Treatment ◽  
Extensive Resection ◽  
Short Bowel

Short bowel syndrome is characterized by malabsorption following extensive resection of the small bowel. It may occur after resection of more than 50% and is certain after resection of more than 70% of the small intestine, or if less than 100 cm of small bowel remains.  Successful postoperative management of short bowel syndrome has been discussed. Patient was operated because of cancer of hepatic flexure of large bowel with invasion in stomach, pancreas, retroperitoneal space, mesentery of small bowel. Right sided colectomy and excessive resection of small bowel with limphodissection was performed and only 80 cm of small bowel was left together with the left part of the colon. Ileotransversoanastomosis was performed. After the adequate course of chemotherapy and partial parenteral nutrition patient’s general condition became satisfactory. Patient started to gain weight. Adequate postoperative treatment determined postoperative period without surgical and nutritional complication.

scholarly journals Congenital Short Bowel Syndrome: A Case Report and Review of the Literature

2008 ◽  
Vol 22 (1) ◽  
pp. 71-74 ◽  
Author(s):  
Mohammed Hasosah ◽  
Daniel A Lemberg ◽  
Eric Skarsgard ◽  
Richard Schreiber
Keyword(s):  
Small Bowel ◽  
Parenteral Nutrition ◽  
Short Bowel Syndrome ◽  
Intestinal Adaptation ◽  
Rare Condition ◽  
Normal Growth ◽  
Upper Gastrointestinal Endoscopy ◽  
Term Survival ◽  
Short Bowel ◽  
Upper Gastrointestinal

Congenital short bowel syndrome (SBS) is a rare condition of the newborn, with several reports demonstrating high mortality. A six-week-old boy presented with chronic diarrhea and failure to thrive. An upper gastrointestinal endoscopy showed a straight duodenum, and multiple small bowel biopsies were histologically normal. An upper gastrointestinal series showed malrotation. At laparotomy, the small bowel was 50 cm in length, confirming the diagnosis of congenital SBS. Parenteral nutrition was initiated and enteral feeding with an amino acid-based formula containing long-chain fatty acids was introduced early and gradually advanced. At the last follow-up examination at 24 months, he was thriving on a regular diet, with normal growth and development. Long-term survival of children with congenital SBS is now possible if enteral feeds are introduced early to promote intestinal adaptation, with subsequent weaning off parenteral nutrition.

scholarly journals Early effectivity of teduglutide for the treatment of short bowel sydrome – our first clinical experience

2021 ◽  
pp. 230
Author(s):  
◽  
◽  
Keyword(s):  
Parenteral Nutrition ◽  
Short Bowel Syndrome ◽  
Treatment Effectiveness ◽  
Intestinal Adaptation ◽  
Standard Of Care ◽  
Home Parenteral Nutrition ◽  
Short Bowel ◽  
Post Surgery ◽  
Advanced Therapy ◽  
New Treatment

Background Short bowel syndrome is an uncommon malabsorptive condition most frequently caused by massive surgical resection of the small intestine. Standard of care is home parenteral nutrition. Teduglutide, glucagon like peptide 2 analog, was approved to treat patients with short bowel syndrome, who are stable following a period of post-surgery intestinal adaptation. Case presentation We report two cases of patients with short bowel syndrome on home parenteral nutrition, treated with teduglutide, novel advanced therapy. We monitored the effectiveness and tolerance of the new treatment. Conclusion Teduglutide increases intestinal absorption, causes cryptal hyperplasia, villous hypertrophy, angiogenesis, and allows weaning from parenteral nutrition. We confirmed the early onset of treatment effectiveness in the 4th month. Early effectiveness of treatment allowed a reduction in the volume of home parenteral nutrition with an improvement in quality of life.

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