Short Bowel Syndrome: Management and Treatment

Abstract

Intestinal failure is defined as the critical reduction of functional gut mass below the amount that is minimally necessary for adequate digestion and absorption to satisfy nutrient and fluid requirements for growth in children [1]. Therefore the use of parenteral nutrition (PN) is required. Intestinal failure may result from intestinal obstruction, dysmotility, surgical resection, congenital defects, or disease-associated loss of absorption [2]. Intestinal failure may be caused by short bowel syndrome (SBS), mucosal enteropathy, or dysmotility syndromes [3]. SBS is a subcategory of intestinal failure, which may result from surgical resection, congenital defect, or disease-associated loss of absorption. This condition is characterized by the inability to maintain protein–energy, fluid, electrolyte, or micronutrient balances when on a conventionally accepted, normal diet [2]. Numerous definitions of SBS have been proposed, such as the American definition by O’Keefe et al. [2], but regrettably there is no worldwide consensus on a generally applicable clinical definition [3, 4]. Essentially, authors disagree on whether the diagnosis should solely refer to either remaining bowel length or to duration of postoperative PN, or to a combination of both. Establishing the remaining bowel length is hampered by practical problems, and thus it seems tentative to base the definition of SBS on its clinical presentation solely, rather than on anatomical aspects.