The non-surgical treatment of adult patients with short bowel syndrome

Abstract

Introduction: This review focuses on the practical, non-surgical, management and treatment of adult short bowel syndrome (SBS) patients. The heterogeneous pathophysiological characteristics of patients highlight the importance of current strategies to diminish the human distress and health care burden associated with this rare, orphan condition.Areas covered: Over the past decades, it has become increasingly clear, that the malassimilation seen in SBS patients relates not only to the diminished absorptive surface-area of the remnant bowel but also to changes in gastrointestinal motility, secretion, blood flow, immunological and barrier functions, mucosal replacement, repair and adaptation. It is now evident that mucosal nerve endings and endocrine cells within the gastrointestinal tract convey information through the enteric nervous system in response to the passing of luminal contents, thereby regulating the highly coordinated processes of nutrient assimilation. This neuro-endocrine communication is disrupted by mucosal disease and intestinal resections. It may be possible to identify key hormonal modulators and utilize them in conjunction with dietary management and conventional medical treatments to enhance structural and functional adaptation.Expert opinion: Objective measurements of intestinal function are a prerequisite for defining effects of treatments; therefore, centres taking care of SBS patients should have the facilities to make such assessments, thereby providing the best individualized treatment for each SBS patient.