Short Bowel Syndrome

Abstract

Objectives and Study: Intestinal failure (IF) is a state of severe intestinal malabsorption requiring parenteral nutrition (PN) for survival. The leading cause of IF is short bowel syndrome (SBS). This study aims to show whether the presence of the colon makes a difference in children with SBS, and to find correlations between intestinal absorption rate, citrulline level, anatomy of the remnant bowel and parenteral nutrition dependency. Methods: Twenty-three SBS children were included in this study and divided into two groups according to the presence or absence of the colon. Bowel length, citrulline plasma levels, intestinal absorption rate [by using three days stool balance analysis] and PN dependency index [by using the index Non Protein Energy Intake (NPEI)/Resting Energy Expenditure (REE) by Schofield formula], were assessed. Regression analysis and student t tests comparing variables were performed. Results: Patients with colon (n=14) had significantly shorter remnant small bowel as compared with those without colon (n=9) (29.25 ± 25.64 vs. 60.88 ± 22.54 cm; P < 0.003) and lower fecal sodium losses (48.5 ± 28.07 vs. 85.88 ± 18.98 mmol/l; P < 0.002). No difference was found between the groups for the percentage energy absorption (63.4 ± 19.0 vs 66.4 ± 15.4% respectively), while citrulline plasma levels showed only a tendency to be higher in SBS without colon (19.1 ± 12.17 vs. 14.4 ± 9.72 μmol/l; P = 0.17). PN dependency was not significantly different between neither groups, nor the total energy intake from oral or enteral nutrition. No correlation was found between the different parameters, although the citrulline level correlates with the small bowel length in the group with colon (r2 = 0.57). Conclusion: By using three days’ stool balance analysis, this study demonstrates for the first time in SBS children, the role of the colon in energy salvage in addition to water- electrolytes absorption. It emphasizes the importance of early restoration of intestinal continuity and preservation of intestinal microbiota.