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Management of the short bowel syndrome in adults

Authors
Jon A Vanderhoof, MD
Rosemary J Pauley-Hunter, NP-C, MS, RN
Section Editor
J Thomas Lamont, MD
Deputy Editor
Shilpa Grover, MD, MPH

INTRODUCTION

Short bowel syndrome is a malabsorptive state that may follow massive resection of the small intestine [1]. It is a functional definition implying a significant amount of malabsorption, which may involve both macronutrients and micronutrients. (See "Pathophysiology of short bowel syndrome".)

Short bowel syndrome in adults usually results from surgical resection for Crohn disease, malignancy, radiation, or vascular insufficiency. In infants and small children, the major causes are necrotizing enterocolitis and congenital intestinal anomalies.

The type and severity of clinical manifestations are variable. In some patients, caloric and protein needs can be adequately met enterally, but vitamin and mineral deficiencies may still occur. In others, fluid and electrolyte losses are the predominant clinical problems while nutrient absorption may be adequate.

In many cases, the process of intestinal adaptation may ultimately permit transition to oral feeding. Intestinal failure is a new term commonly being used to describe the state when gastrointestinal function is inadequate to maintain the nutrient and hydration status of the person without intravenous or enteral supplementation [2]. The process of intestinal adaptation is lengthy but actions taken in the first few months after resection have a significant role in the ultimate outcome. Because quality of life in patients with short bowel syndrome is decreased due to chronic fatigue and ongoing gastrointestinal symptoms special attention to the process of intestinal adaptation is critical [3].

An overview of the management of patients with short bowel syndrome will be provided here. The pathogenesis of this disorder, and the chronic complications that may occur (eg, liver disease, gallstones, bacterial overgrowth, and hyperoxaluria) are presented separately. (See "Pathophysiology of short bowel syndrome" and "Chronic complications of the short bowel syndrome in adults".)

                     

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Literature review current through: Nov 2016. | This topic last updated: Thu Aug 21 00:00:00 GMT 2014.
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