Abstract
Extensive resection of small bowel often leads to short bowel syndrome (SBS). SBS patients develop clinical mal-absorption and dehydration relative to the reduction of absorptive area, acceleration of gastrointestinal transit time and modifications of the gastrointestinal intra-luminal environment. As a consequence of severe mal-absorption, patients require parenteral nutrition (PN). In adults, the overall adaptation following intestinal resection includes spontaneous and complex compensatory processes such as hyperphagia, mucosal remodeling of the remaining part of the intestine and major modifications of the microbiota. SBS patients, with colon in continuity, harbor a specific fecal microbiota that we called “lactobiota” because it is enriched in the Lactobacillus/Leuconostoc group and depleted in anaerobic micro-organisms (especially Clostridium and Bacteroides). In some patients, the lactobiota-driven fermentative activities lead to an accumulation of fecal d/l-lactates and an increased risk of d-encephalopathy. Better knowledge of clinical parameters and lactobiota characteristics has made it possible to stratify patients and define group at risk for d-encephalopathy crises.
Highlights
Short bowel syndrome (SBS) is a well-known cause of intestinal failure (IF) [1]
SBS occurs in patients who have an extensive resection of the small bowel (RSB) that leaves less than 150/200 cm
We mainly report the post-surgery adaptations occuring in the remnant colon, because preservation of at least a part of the colon is a determining factor in reducing the need for parenteral nutrition (PN) and contributes to the clinical outcomes of SBS in adults
Summary
Short bowel syndrome (SBS) is a well-known cause of intestinal failure (IF) [1]. SBS occurs in patients who have an extensive resection of the small bowel (RSB) that leaves less than 150/200 cm. A complete understanding of the physiopathology of SBS and post-surgery adaptations may reveal the spontaneous processes that compensate for the reduction of the absorptive surface. In SBS adults, hyperphagia is reflected by an increase in nutritional intake after surgery. The composition and metabolic functions of intestinal microbiota are mostly altered by age, nutrition, environment and health status [12,13,14]. We mainly report the post-surgery adaptations occuring in the remnant colon, because preservation of at least a part of the colon is a determining factor in reducing the need for PN and contributes to the clinical outcomes of SBS in adults. In the context of increasing knowledge on the role of microbiota, we emphasize our results describing the activities and composition of microbiota after surgery in SBS adults. Studies of the physiopathology of SBS may reveal mechanistic clues for the adaptive process following the loss, or the exclusion, of a part of intestine
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