UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Chronic complications of the short bowel syndrome in adults

Author
John K DiBaise, MD
Section Editor
J Thomas Lamont, MD
Deputy Editor
Shilpa Grover, MD, MPH

INTRODUCTION

Short bowel syndrome (SBS) is a malabsorptive state that typically occurs following extensive resection of the small intestine. It is a functional definition, implying a significant amount of malabsorption of both macronutrients and micronutrients and is not necessarily dependent on the loss of bowel or a particular length of bowel. Patients with SBS are at risk for several complications. These complications may result from the underlying disease, altered bowel anatomy and physiology, or its treatment, including the need for parenteral nutrition and the use of a central venous catheter. Acute complications that can occur at any time include watery diarrhea, electrolyte disturbances, and catheter-related complications.

This topic will review the chronic complications of SBS in adults. The pathophysiology and management of SBS, including small bowel transplantation, are discussed separately.

ESOPHAGITIS/PEPTIC ULCER DISEASE

Gastric hypersecretion is common after SBS and may last 6 to 12 months postoperatively [1]. In a minority of cases, gastric hypersecretion may lead to esophagitis and/or peptic ulcer disease and patients may present with symptoms of heartburn, regurgitation, dysphagia, or abdominal pain. (See "Pathophysiology of short bowel syndrome", section on 'Ileal versus jejunal adaptation' and "Clinical manifestations and diagnosis of gastroesophageal reflux in adults" and "Peptic ulcer disease: Clinical manifestations and diagnosis".)

Gastric hypersecretion is thought to occur as a result of the loss of inhibitory hormones produced in the proximal gut (eg, gastric inhibitory peptide and vasoactive intestinal peptide). The volume of secretions entering the small bowel increases and the pH of the secretions in the proximal gut is lowered, aggravating fluid losses and leading to peptic complications and impairment in the function of pancreatic exocrine secretions, further contributing to fat maldigestion. (See "Pathophysiology of short bowel syndrome", section on 'Ileal versus jejunal adaptation'.)

Antisecretory medications (eg, proton pump inhibitors or histamine 2-receptor antagonists) used in the early postoperative period in patients with SBS reduce gastric secretions, improve digestion and absorption, and can prevent peptic complications. In patients with gastroesophageal reflux disease or peptic ulcer disease, acid-suppressing medications are used to treat symptoms. However, acid-suppressing medications should be weaned or used at the lowest possible dose in patients with SBS as long-term use is associated with an increased risk of small intestinal bacterial overgrowth and other side effects [2]. (See "Management of the short bowel syndrome in adults" and "Antiulcer medications: Mechanism of action, pharmacology, and side effects" and "Overview and comparison of the proton pump inhibitors for the treatment of acid-related disorders", section on 'Safety'.)

                   

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Mon Nov 30 00:00:00 GMT+00:00 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Williams NS, Evans P, King RF. Gastric acid secretion and gastrin production in the short bowel syndrome. Gut 1985; 26:914.
  2. Cortot A, Fleming CR, Malagelada JR. Improved nutrient absorption after cimetidine in short-bowel syndrome with gastric hypersecretion. N Engl J Med 1979; 300:79.
  3. Dibaise JK, Young RJ, Vanderhoof JA. Enteric microbial flora, bacterial overgrowth, and short-bowel syndrome. Clin Gastroenterol Hepatol 2006; 4:11.
  4. Ziegler TR, Cole CR. Small bowel bacterial overgrowth in adults: a potential contributor to intestinal failure. Curr Gastroenterol Rep 2007; 9:463.
  5. Attar A, Flourié B, Rambaud JC, et al. Antibiotic efficacy in small intestinal bacterial overgrowth-related chronic diarrhea: a crossover, randomized trial. Gastroenterology 1999; 117:794.
  6. Vanderhoof JA, Young RJ, Murray N, Kaufman SS. Treatment strategies for small bowel bacterial overgrowth in short bowel syndrome. J Pediatr Gastroenterol Nutr 1998; 27:155.
  7. Vanderhoof JA, Langnas AN. Short-bowel syndrome in children and adults. Gastroenterology 1997; 113:1767.
  8. Carrion AF, Bhamidimarri KR. Liver transplant for cholestatic liver diseases. Clin Liver Dis 2013; 17:345.
  9. Chung C, Buchman AL. Postoperative jaundice and total parenteral nutrition-associated hepatic dysfunction. Clin Liver Dis 2002; 6:1067.
  10. Kelly DA. Preventing parenteral nutrition liver disease. Early Hum Dev 2010; 86:683.
  11. Cavicchi M, Beau P, Crenn P, et al. Prevalence of liver disease and contributing factors in patients receiving home parenteral nutrition for permanent intestinal failure. Ann Intern Med 2000; 132:525.
  12. Torres C, Sudan D, Vanderhoof J, et al. Role of an intestinal rehabilitation program in the treatment of advanced intestinal failure. J Pediatr Gastroenterol Nutr 2007; 45:204.
  13. Moon J, Iyer K. Intestinal rehabilitation and transplantation for intestinal failure. Mt Sinai J Med 2012; 79:256.
  14. Rudic JS, Poropat G, Krstic MN, et al. Ursodeoxycholic acid for primary biliary cirrhosis. Cochrane Database Syst Rev 2012; 12:CD000551.
  15. San Luis VA, Btaiche IF. Ursodiol in patients with parenteral nutrition-associated cholestasis. Ann Pharmacother 2007; 41:1867.
  16. Pironi L, Agostini F, Guidetti M. Intravenous lipids in home parenteral nutrition. World Rev Nutr Diet 2015; 112:141.
  17. Nandivada P, Cowan E, Carlson SJ, et al. Mechanisms for the effects of fish oil lipid emulsions in the management of parenteral nutrition-associated liver disease. Prostaglandins Leukot Essent Fatty Acids 2013; 89:153.
  18. Mercer DF, Hobson BD, Fischer RT, et al. Hepatic fibrosis persists and progresses despite biochemical improvement in children treated with intravenous fish oil emulsion. J Pediatr Gastroenterol Nutr 2013; 56:364.
  19. Puder M, Valim C, Meisel JA, et al. Parenteral fish oil improves outcomes in patients with parenteral nutrition-associated liver injury. Ann Surg 2009; 250:395.
  20. de Meijer VE, Gura KM, Le HD, et al. Fish oil-based lipid emulsions prevent and reverse parenteral nutrition-associated liver disease: the Boston experience. JPEN J Parenter Enteral Nutr 2009; 33:541.
  21. Burns DL, Gill BM. Reversal of parenteral nutrition-associated liver disease with a fish oil-based lipid emulsion (Omegaven) in an adult dependent on home parenteral nutrition. JPEN J Parenter Enteral Nutr 2013; 37:274.
  22. Nightingale JM, Lennard-Jones JE, Gertner DJ, et al. Colonic preservation reduces need for parenteral therapy, increases incidence of renal stones, but does not change high prevalence of gall stones in patients with a short bowel. Gut 1992; 33:1493.
  23. Roslyn JJ, Pitt HA, Mann LL, et al. Gallbladder disease in patients on long-term parenteral nutrition. Gastroenterology 1983; 84:148.
  24. Dray X, Joly F, Reijasse D, et al. Incidence, risk factors, and complications of cholelithiasis in patients with home parenteral nutrition. J Am Coll Surg 2007; 204:13.
  25. Thompson JS. The role of prophylactic cholecystectomy in the short-bowel syndrome. Arch Surg 1996; 131:556.
  26. Braga CB, Vannucchi H, Freire CM, et al. Serum vitamins in adult patients with short bowel syndrome receiving intermittent parenteral nutrition. JPEN J Parenter Enteral Nutr 2011; 35:493.
  27. DiBaise JK, Matarese LE, Messing B, Steiger E. Strategies for parenteral nutrition weaning in adult patients with short bowel syndrome. J Clin Gastroenterol 2006; 40 Suppl 2:S94.
  28. Anast CS, Winnacker JL, Forte LR, Burns TW. Impaired release of parathyroid hormone in magnesium deficiency. J Clin Endocrinol Metab 1976; 42:707.
  29. Fukumoto S, Matsumoto T, Tanaka Y, et al. Renal magnesium wasting in a patient with short bowel syndrome with magnesium deficiency: effect of 1 alpha-hydroxyvitamin D3 treatment. J Clin Endocrinol Metab 1987; 65:1301.
  30. Acca M, Ragno A, Francucci CM, D'Erasmo E. Metabolic bone diseases during long-term total parenteral nutrition. J Endocrinol Invest 2007; 30:54.
  31. Nightingale JM. Hepatobiliary, renal and bone complications of intestinal failure. Best Pract Res Clin Gastroenterol 2003; 17:907.
  32. Petersen C. D-lactic acidosis. Nutr Clin Pract 2005; 20:634.