Intestinal adaptation in short bowel syndrome

Abstract

Short bowel syndrome (SBS) either in adults or in children is considered as an indication of small bowel transplantation (SBT). 1,2 Severity and prognosis depend on various factors such as small bowel resection length, patient's age, and intestinal length at the time of resection. In pediatrics, most patients, affected by SBS undergo resection when neonates or anyway in the first months of life (necrotizing enterocolitis, congenital anomalies of gastrointestinal troct, abdominal wall defects); only in few patients pathology begins later on, usually for tumoral, vascular or Crohn's diseases. Intestinal adaptation process, characterized by epithelial hyperplasia, has an early onset, within the first days after resection, with a progressive increase of intestinal absorptive surface; such adapting capacity is greater for ileum rather than for jejunum. 2–5 This intestinal adaptation process with mucosal hyperplasia requires an enteral nutrition which acts both directly by nutrients contact on intestinal epithelium and by stimulating the secretion of trophic factors such as enteroglucagon, epidermal growth factor and insulin-like growth factor-1. From the clinical point of view, the term “adaptation” means the total nutritional autonomy with a satisfying height and weight growth. In patients who initially need parenteral nutrition (PN), total intestinal adaptation is considered as attained when they can stop PN. The aim of the present study is to evaluate retrospectively our series of severe SBS patients, with residual intestine shorter than 100 cm, who consequently required a prolonged PN, verifying the possibility and the time of intestinal adaptation and therefore the existence or not of an indication to intestinal transplantation.