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Pathophysiology of short bowel syndrome

Author
John K DiBaise, MD
Section Editors
J Thomas Lamont, MD
Kathleen J Motil, MD, PhD
Deputy Editor
Alison G Hoppin, MD

INTRODUCTION

Short bowel syndrome (SBS) is a malabsorptive condition most often caused by massive resection of the small intestine [1]. Clinical disease is only weakly correlated with the amount of intestine that is resected because of the highly variable length of the human small bowel and the remarkable ability of the bowel to compensate for bowel resection. Therefore, the best definition of SBS is based upon intestinal dysfunction, ie, the presence of significant malabsorption of both macronutrients and micronutrients. SBS is the most common cause of intestinal failure, a term that describes the state when an individual's gastrointestinal function is inadequate to maintain his or her nutrient and hydration status without intravenous or enteral supplementation. Other causes of intestinal failure include diseases or congenital defects that cause severe malabsorption, bowel obstruction, and dysmotility (eg, pseudo-obstruction).

SBS in adults usually results from surgical resection of the small intestine for Crohn disease, trauma, malignancy, radiation, or mesenteric ischemia. In addition, SBS caused by postoperative vascular and obstructive catastrophes requiring massive intestinal resection seems to be increasing in incidence. Advances in the treatment of Crohn disease may lead to a reduction in SBS; however, these improvements do not yet appear to have led to a reduction in the number of patients requiring home parenteral nutrition (PN) [2]. In infants and small children, necrotizing enterocolitis and congenital intestinal anomalies, such as mid-gut volvulus, atresias, or gastroschisis, are the most common causes of SBS.

Challenges to estimating the prevalence of SBS include its multifactorial etiology, varying definitions, and difficulty in estimating intestinal length. Therefore, estimates of the incidence and prevalence of SBS are based on data from registries of patients on home PN, for which SBS is the most common indication. One such study reported that the annual prevalence of home PN in the United States is approximately 120 per million population, of whom about 25 percent have SBS; this amounted to about 10,000 individuals in 1992 [3].

The pathogenesis of SBS will be reviewed here. The complications of SBS and the management of this disorder are discussed separately:

(See "Management of short bowel syndrome in children".)

                

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Literature review current through: Nov 2016. | This topic last updated: Tue Jun 14 00:00:00 GMT 2016.
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