Principles of management of patients with short bowel syndrome

Abstract

Short bowel syndrome (SBS) is a rare disease accompanied by the phenomena of malabsorption (impaired absorption of food) and maldigestion (phenomena of creato-, steato-and amilorrhea), as a result of resection of most of the small intestine (usually with a residual part of the intestine less than 200 cm) from – due to various etiological factors. One of the severe complications of this syndrome is the development of intestinal failure, which can be manifested by the occurrence of water, electrolyte and white matter disturbances, hypovitaminosis, and deficiency of micro-and macronutrients. It is possible to suspect the development of intestinal failure if the patient continues to have repeated diarrhea 2–3 months after surgery and a progressive decrease in body weight by 5% or more of the initial weight within a month. Therefore, an important aspect in the treatment of SBS is the correction of electrolyte disturbances and maintenance of nutritional status. However, the severity of the patient’s condition is often determined not only by the course of the disease itself, but also by the long-term use of parenteral nutrition after surgery. Therefore, an important aspect in the management of patients with SBS is the cessation of parenteral nutrition as early as possible and the transition to a physiological nature of food intake. This can be achieved both by choosing certain surgical treatment techniques and by using drug therapy – an analogue of glucagon-like peptide-2 – Teduglutide, which increases the functional ability of enterocytes to absorb. SBS is a significant social problem due to the high mortality rate in childhood and a significant percentage of disability in people of working age, which makes it highly relevant to discuss the management strategy for this category of patients.