Short bowel syndrome: Highlights of patient management, quality of life, and survival

Darlene G. Kelly, Kelly A. Tappenden, Marion F. Winkler

Research output: Contribution to journalReview articlepeer-review

Abstract

Short bowel syndrome (SBS) occurs as a result of intestinal resection, and in many patients is associated with complications, such as diarrhea, dehydration, weight loss, and nutrition deficiencies. Many individuals with SBS develop intestinal failure and require parenteral nutrition (PN) and/or intravenous (IV) fluids (PN/IV). Although PN is essential for survival, some patients with SBS who require long-term PN experience significant complications that contribute to morbidity and mortality. Consequently, therapies that decrease reliance on PN are of considerable importance. Intestinal adaptation, which results in morphologic and functional changes that increase performance of the remnant bowel, occurs spontaneously after intestinal resection. These effects can be enhanced with nutrition and pharmaceutical approaches. For example, oral or tube-fed nutrients stimulate growth and adaptation of intestinal tissues. In addition, prebiotics support growth of beneficial intestinal microbiota that produce short-chain fatty acids, which have been shown in preclinical studies to enhance intestinal structure and function. Finally, glucagon-like peptide 2 (GLP-2) is an endogenous peptide that promotes intestinal rehabilitation and improves intestinal absorption. Teduglutide, a recombinant human GLP-2 analog, has recently been approved in the United States for the treatment of adults with SBS who are dependent on PN. In pharmacodynamic and clinical studies, teduglutide has been shown to promote changes in intestinal structure, such as increases in villus height and crypt depth, and to improve intestinal absorption, as indicated by reduced PN/IV dependence. This article presents a brief overview of SBS, including effects on survival and quality of life and current treatment options.

Original languageEnglish (US)
Pages (from-to)427-437
Number of pages11
JournalJournal of Parenteral and Enteral Nutrition
Volume38
Issue number4
DOIs
StatePublished - May 2014

Keywords

  • adults
  • gastroenterology
  • growth factors
  • home nutrition support
  • parenteral nutrition

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

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