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Short-Bowel Syndrome: A Clinical Update

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Surgery of Complex Abdominal Wall Defects

Abstract

Short-bowel syndrome (SBS) is a form of intestinal failure following massive intestinal resection; the residual small bowel has inadequate capabilities for the absorption of the required water, macronutrients, and micronutrients to support optimal health, functions, and performance of the body cell mass. Some of these conditions or situations are accompanied by, result in, or result from complex abdominal wall defects. The formidable pathophysiology of SBS is summarized together with its clinical consequences; the principles of the nutritional and metabolic management of SBS, which have withstood the tests of time for a few decades, are discussed in some detail. The more recent efforts to enhance intestinal absorption by incorporating the use of growth hormone, teduglutide, glutamine, and other nutraceuticals, in combination with dietary modifications, in attempts to reduce or obviate the use of long-term parenteral nutrition in selected patients, while promoting maximal adaptation of the intestine, are summarized. Surgical considerations in the adjunctive management of SBS are discussed as potential means of enhancing intestinal absorption. Of all of the surgical approaches to SBS management, intestinal transplantation may well have the greatest promise in terms of restoring gastrointestinal tract function to normal as this field of endeavor continues to advance and improve its long-term outcomes. Finally, parenteral nutrition remains the cornerstone of optimally successful management of SBS, and its judicious use and monitoring by expert, experienced, dedicated nutrition support teams can ensure safe, effective, and maximal gastrointestinal adaptation and nutritional rehabilitation of the patient while maintaining the optimal size, health, and function of the body cell mass.

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References

  1. Dudrick SJ. Foreword. In: Langas A, Goulet E, Tappenden K, editors. Intestinal failure: diagnosis, management and transplantation. Oxford: Blackwell; 2008.

    Google Scholar 

  2. Allard J, Jeejeebhoy K. Nutritional support and therapy in the short bowel syndrome. Gastroenterol Clin North Am. 1989;18:589–601.

    PubMed  CAS  Google Scholar 

  3. Deitel M, Wong KH. Short bowel syndrome. In: Deitel M, editor. Nutrition in clinical surgery. 2nd ed. Baltimore: Williams & Wilkins; 1985. p. 255–75.

    Google Scholar 

  4. Dudrick SJ, Jackson D. The short bowel syndrome and total parenteral nutrition. Heart Lung. 1983;12:195–201.

    PubMed  CAS  Google Scholar 

  5. Goutrebel M, Saint-Aubert B, Astre C, et al. Total parenteral nutrition needs in different types of short bowel syndrome. Dig Dis Sci. 1986;31:713–23.

    Google Scholar 

  6. Weser B. Nutritional aspects of malabsorption. Short gut adaptation. Clin Gastroenterol. 1983;12:443–61.

    PubMed  CAS  Google Scholar 

  7. Dudrick SJ, Abdullah F, Latifi R. Nutrition and metabolic management of short bowel syndrome. In: Lafiti R, Dudrick S, editors. The biology and practice of current nutritional support. 2nd ed. Georgetown: Landes Bioscience; 2003. p. 261–74.

    Google Scholar 

  8. Tilson MD. Pathophysiology and treatment of short bowel syndrome. Surg Clin North Am. 1980;60:1273–84.

    PubMed  CAS  Google Scholar 

  9. Dudrick SJ, Englert DM. Management of the short bowel syndrome. In: Miller TA, Dudrick SJ, editors. The management of difficult surgical problems. Austin: University of Texas Press; 1981. p. 225–35.

    Google Scholar 

  10. Dudrick SJ, O’Donnell JJ, Englert DM. Ambulatory home parenteral nutrition for short bowel syndrome and other diseases. In: Deitel M, editor. Nutrition in clinical surgery. 2nd ed. Baltimore: Williams & Wilkins; 1985. p. 276–87.

    Google Scholar 

  11. Trier JS, Lipsky M. The short bowel syndrome. In: Sleidenger MH, Fordtran JS, editors. Gastrointestinal disease: pathophysiology, diagnosis, management. 4th ed. Philadelphia: WB Saunders; 1989. p. 1106–12.

    Google Scholar 

  12. Weser B, Fletcher JT, Urban E. Short bowel syndrome. Gastro­enterology. 1979;77:572–9.

    Google Scholar 

  13. Wilmore DW, Dudrick SJ. Effects of nutrition on intestinal adaptation following massive small bowel resection. Surg Forum. 1969;20:398–400.

    PubMed  CAS  Google Scholar 

  14. Wilmore DW, Holtzapple PG, Dudrick SJ, et al. Transport studies, morphological and histological findings in intestinal epithelial cells following massive bowel resection. Surg Forum. 1971;22:361–3.

    PubMed  CAS  Google Scholar 

  15. Conn HJ, Chavez CM, Fain WR. The short bowel syndrome. Ann Surg. 1972;175:803–14.

    Article  PubMed  CAS  Google Scholar 

  16. Dudrick SJ. A clinical review of nutritional support of the patients. Am J Clin Nutr. 1981;34:1191–8.

    PubMed  CAS  Google Scholar 

  17. Sheldon DF. Role of parenteral nutrition in patients with short-bowel syndrome. Med J Aust. 1979;67:1021–9.

    CAS  Google Scholar 

  18. Stewart GR. Home parenteral nutrition for short-bowel syndrome. Med J Aust. 1989;2:317–9.

    Google Scholar 

  19. Wilmore DW, Johnson DJ. Metabolic effects of short bowel reversal in treatment of short bowel syndrome. Arch Surg. 1968;97:784–91.

    Article  PubMed  CAS  Google Scholar 

  20. Wilmore DW, Dudrick SJ, Daly JM, et al. The role of nutrition in the adaptation of small intestine after massive resection. Surg Gynecol Obstet. 1971;132:673–80.

    PubMed  CAS  Google Scholar 

  21. Dudrick SJ, Latifi R, Fosnocht D. Management of the short bowel syndrome. Surg Clin North Am. 1991;71:625–43.

    PubMed  CAS  Google Scholar 

  22. Garcia VF, Templeton JM, Eichelberger MR, et al. Colon interposition for the short bowel syndrome. J Pediatr Surg. 1981;16:994–5.

    Article  PubMed  CAS  Google Scholar 

  23. Levine GM. Short gut syndrome and intestinal adaptation. In: Kurtz RD, editor. Nutrition in gastrointestinal disease. New York: Churchill Livingstone; 1981. p. 101–11.

    Google Scholar 

  24. Thompson JS, Rikkers LF. Surgical alternatives for the short bowel syndrome. Am J Gastroenterol. 1987;22:97–105.

    Google Scholar 

  25. Schecter WP, Hirshberg A, Chang DS, Harris HW, Napolitano LM, Wexner SD, et al. Enteric fistulas: principles of management. J Am Coll Surg. 2009;209(4):484–91.

    Article  PubMed  Google Scholar 

  26. Schecter WP. Management of entercutaneous fistulas. Surg Clin North Am. 2011;91(3):481–91.

    Article  PubMed  Google Scholar 

  27. Borgstrom B, Dahlquist A, Lundh G, et al. Studies of intestinal digestion and absorption in the human. J Clin Invest. 1957;36:1521–36.

    Article  PubMed  CAS  Google Scholar 

  28. Debongnie J, Philips S. Capacity of the human colon to absorb fluid. Gastroenterology. 1978;74:698–703.

    PubMed  CAS  Google Scholar 

  29. Ricotta J, Zuidema FD, Gadacz RT, et al. Construction of an ileocecal valve and its role in massive resection of the small intestine. Surg Gynecol Obstet. 1981;152:310–4.

    PubMed  CAS  Google Scholar 

  30. Wright HK, Tilson MD. Short gut syndrome: pathophysiology and treatment. Curr Probl Surg. 1971;8:1–51.

    Article  Google Scholar 

  31. Strause E, Gerson E, Yalow RS. Hypersecretion of gastrin associated with the short bowel syndrome. Gastroenterology. 1974;66:175–80.

    Google Scholar 

  32. Philips SF, Giller J. The contribution of the colon to electrolyte and water conservation in man. J Lab Clin Med. 1973;81:733–46.

    Google Scholar 

  33. Bond JH, Currier BE, Buchwald H, et al. Colonic conservation of malabsorbed carbohydrates. Gastroenterology. 1980;78:444–7.

    PubMed  CAS  Google Scholar 

  34. Bond JH, Levitt MD. Fate of soluble carbohydrate in the colon of rats and humans. J Clin Invest. 1976;57:1158–64.

    Article  PubMed  CAS  Google Scholar 

  35. Haverstad T. Studies of short-chain fatty acid absorption in man. Scand J Gastroenterol. 1980;21:257–60.

    Article  Google Scholar 

  36. Pomare EW, Branch WJ, Cummings JH. Carbohydrate fermentation in the human colon and its relation to blood acetate concentration in venous blood. J Clin Invest. 1985;75:1148–54.

    Article  Google Scholar 

  37. Capton JP, Gineston JL, Herve MA, et al. Metronidazole in prevention of cholestasis associated with parenteral nutrition. Lancet. 1983;1:446–7.

    Google Scholar 

  38. Dudrick SJ, Latifi R. Management of patients with short-bowel syndrome. In: Kirby DF, Dudrick SJ, editors. Practical handbook of nutrition in clinical practice. Boca Raton: CRC Press; 1994. p. 215–25.

    Google Scholar 

  39. Barnett WO, Oliver RI, Elliot RL. Elimination of the lethal properties of gangrenous bowel segments. Ann Surg. 1968;167:912–9.

    Article  PubMed  CAS  Google Scholar 

  40. Bounous G, McArdle AH. Release of intestinal enzymes in acute mesenteric ischemia. J Surg Res. 1968;9:343–8.

    Google Scholar 

  41. Ratych RE, Smith GW. Anatomy and physiology of the liver. In: Zuidema GD, editor. Shackleford’s surgery of the alimentary tract. 3rd ed. Philadelphia: WB Saunders; 1991. p. 273–86.

    Google Scholar 

  42. Sarr WG, Tito WA. Intestinal obstruction. In: Zuidema GD, editor. Shackleford’s surgery of the alimentary tract. 3rd ed. Philadelphia: WB Saunders; 1991. p. 372–413.

    Google Scholar 

  43. Woolf GM, Miller C, Kurian R, et al. Nutritional absorption in short bowel syndrome: evaluation of fluid, calorie and divalent cation requirements. Dig Dis Sci. 1987;32:8–15.

    Article  PubMed  CAS  Google Scholar 

  44. Cortot A, Fleming CR, Malagelada JR. Improved nutrient absorption after cimetidine in short bowel syndrome with gastric hypersecretion. N Engl J Med. 1979;300:79–80.

    Article  PubMed  CAS  Google Scholar 

  45. Ladefoged K, Christensen K, Hegnhoi J, et al. Effect of long-acting somatostatin analog SMS 201-995 on jejunostomy effluents in patients with severe short bowel syndrome. Gut. 1989;30:943–9.

    Article  PubMed  CAS  Google Scholar 

  46. Nightingale J, Walker E, Burnham W et al. Short bowel syndrome. Digestion. 1990;45(Suppl 1):77–83.

    Google Scholar 

  47. Levy E, Frileux P, Sandrucci S, et al. Continuous enteral nutrition during the early adaptive stage of the short bowel syndrome. Br J Surg. 1988;75:549–53.

    Article  PubMed  CAS  Google Scholar 

  48. Ovesen L, Chu R, Howard L. The influence of dietary fat on jejunostomy output in patients with severe short bowel syndrome. Am J Clin Nutr. 1983;38:270–7.

    PubMed  CAS  Google Scholar 

  49. Woolf GM, Miller C, Kurian R, et al. Diet for patients with short bowel: high fat or high carbohydrate? Gastroenterology. 1983;84:823–8.

    PubMed  CAS  Google Scholar 

  50. McIntyre P. The short bowel. Br J Surg. 1985;72:893–9.

    Article  Google Scholar 

  51. McIntyre P, Fitchew M, Lennard-Jones J. Patients with a high jejunostomy do not need a special diet. Gastroenterology. 1986;91:25–33.

    PubMed  CAS  Google Scholar 

  52. Ladefoged K. Intestinal and renal loss of infused minerals in patients with severe short bowel syndrome. Am J Clin Nutr. 1982;36:59–67.

    PubMed  CAS  Google Scholar 

  53. Thompson JS. Surgical considerations in the short bowel syndrome. Surg Gynecol Obstet. 1993;36:59–67.

    Google Scholar 

  54. Byrne TA, Persinger RL, Young LS, et al. A new treatment for patients with short-bowel syndrome. Ann Surg. 1995;222:243–55.

    Article  PubMed  CAS  Google Scholar 

  55. Byrne TA, Morrissey TB, Nattakorn TV, et al. Growth hormone, glutamine and a modified diet enhance nutrient absorption in patients with severe short bowel syndrome. J Parenter Enteral Nutr. 1995;19:296–302.

    Article  CAS  Google Scholar 

  56. Wilmore DW, Byrne TA, Persinger RL. Short bowel syndrome: new therapeutic approaches. Curr Probl Surg. 1997;34:389–444.

    Article  PubMed  CAS  Google Scholar 

  57. Wilmore DW. Growth factors and nutrients in the short bowel syndrome. J Parenter Enteral Nutr. 1999;23:S117–20.

    Article  CAS  Google Scholar 

  58. Thompson JS, Weseman R, Rochling FA, Mercer DF. Current management of the short bowel syndrome. Surg Clin North Am. 2011;91(3):493–510.

    Article  PubMed  Google Scholar 

  59. Scolapio JS, Camilleri M, Fleming CR, et al. Effect of growth ­hormone, glutamine, and diet on adaptation in short bowel syndrome: a randomized controlled trial. Gastroenterology. 1997;115:1075–81.

    Google Scholar 

  60. Szkudlarek J, Jeppesen PB, Mortensen PB. Effect of high dose growth hormone with glutamine and no change in diet on intestinal absorption in short bowel patient: a randomized double blind, crossover, placebo controlled study. Gut. 2000;47:199–205.

    Article  PubMed  CAS  Google Scholar 

  61. Platell CFE, Coster J, McCauley RD, Hall JC. The management of patients with the short bowel syndrome. World J Gastroenterol. 2002;8(1):13–20.

    PubMed  Google Scholar 

  62. Wales PW, Nasr A, de Silvea N et al. Human growth hormone and glutamine for patients with short bowel syndrome. Cochrane Database of Syst Rev. 2010;issue 6. Art No. CD006321, doi: 10.1002/14651858.CD006321.pub2

  63. Seetharam P, Rodrigues G. Short bowel syndrome: a review of management options. Saudi J Gastroenterol. 2011;17:229–35.

    Article  PubMed  Google Scholar 

  64. Ferone M, Scolapio JS. Teduglutide for the treatment of short bowel syndrome. Ann Pharmacother. 2006;40:1105–9.

    Article  Google Scholar 

  65. Mardini HE, de Villiers WJ. Teduglutide in intestinal adaptation and repair: light at the end of the tunnel. Expert Opin Investig Drugs. 2008;17(6):945–51.

    Article  PubMed  CAS  Google Scholar 

  66. Jeppesen PB, Gilroy R, Pertkiewicz M, et al. Randomized placebo-controlled trial of teduglutide in reducing parenteral nutrition and/or intravenous fluid requirements in patients with short bowel syndrome. Gut. 2011;60(7):902–14.

    Article  PubMed  CAS  Google Scholar 

  67. Mouksassi MS, Marier JF, Cyran J, Vinks AA. Clinical trial simulations in pediatric patients using realistic covariates: application to teduglutide, a glucagon-like peptide-2 analog in neonates and infants with short bowel syndrome. Clin Pharmacol Ther. 2009;86(6):667–71.

    Article  PubMed  CAS  Google Scholar 

  68. Wallis K, Walters JR, Gabe S. Short bowel syndrome: the role of GLP-2 on improving outcome. Curr Opin Clin Nutr Metab Care. 2009;12(5):526–32.

    Article  PubMed  CAS  Google Scholar 

  69. Yazbeck R. Teduglutide, a glucagon-like peptide-2 analog for the treatment of gastrointestinal diseases, including short bowel syndrome. Curr Opin Mol Ther. 2010;12(6):798–809.

    PubMed  CAS  Google Scholar 

  70. Thompson JS, Langnas AN. Surgical approaches to improving intestinal function in short bowel syndrome. Arch Surg. 1999;134:706–71.

    Article  PubMed  CAS  Google Scholar 

  71. Thompson JS, Sudan DA. Intestinal lengthening in the short bowel syndrome. Adv Surg. 2008;42:49–61.

    Article  PubMed  Google Scholar 

  72. Bianchi A. Experience with longitudinal intestinal lengthening and tailoring. Eur J Pediatr Surg. 1999;9:256–9.

    Article  PubMed  CAS  Google Scholar 

  73. Sudan D, Thompson JS, Botha J, et al. Comparisons of intestinal lengthening procedures for patients with short bowel syndrome. Ann Surg. 2007;246:593–604.

    Article  PubMed  Google Scholar 

  74. Kim H, Fauza D, Garza J, et al. Serial transverse enteroplasty (STEP): a novel bowel lengthening procedure. J Pediatr Surg. 2003;38:425–9.

    Article  PubMed  Google Scholar 

  75. Yannam G, Sudan D, Grant W, et al. Intestinal lengthening in adults with short bowel syndrome. J Gastrointest Surg. 2010;14:1931–6.

    Article  PubMed  Google Scholar 

  76. Thompson JS, Sudan DA, Gilroy R. Predicting outcome of procedures to slow intestinal transit. Transplant Proc. 2006;38:1838–9.

    Article  PubMed  CAS  Google Scholar 

  77. Mazariegos GV, Steffick DE, Horslen S, et al. Intestinal transplantation in the United States 1999–2008. Am J Transplant. 2010;10:1020–34.

    Article  PubMed  CAS  Google Scholar 

  78. Grant D, Abu-Elmagd K, et al. 2003 report of the Intestine Transplant Registry. Ann Surg. 2005;241:607–13.

    Article  PubMed  Google Scholar 

  79. Abu-Elmagd K, Costa G, Bond GJ, et al. Five hundred intestinal and multivisceral transplantations at a single center. Ann Surg. 2009;250:567–81.

    PubMed  Google Scholar 

  80. O’Keefe SID, Emerling M, Kovitsky D, et al. Nutrition and quality of life following small intestinal transplantation. Am J Gastroenterol. 2007;102:1093–100.

    Article  PubMed  Google Scholar 

  81. Sudan D. Long term outcomes and quality of life after intestinal transplantation. Curr Opin Organ Transplant. 2010;15:357–60.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Yale University School of Medicine, 40 Beecher Street, Naugatuck, CT, 06770, USA

    Stanley J. Dudrick MD, FACS

  2. Department of Surgery, Michigan State College of Human Medicine Lacks Cancer Center/Saint Mary’s Health Care, 250 Cherry Street SE, Grand Rapids, MI, 49503, USA

    Jose M. Pimiento MD

  3. Department of Surgery, University of Arizona, 1501 N. Campbell Ave., 245063, Tucson, AZ, 85724, USA

    Rifat Latifi MD, FACS

  4. Department of Surgery, Weill-Cornell University, Doha, Qatar

    Rifat Latifi MD, FACS

  5. Department of Surgery, Hamad Medical Corporation, Doha, Qatar

    Rifat Latifi MD, FACS

Authors
  1. Stanley J. Dudrick MD, FACS
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  2. Jose M. Pimiento MD
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  3. Rifat Latifi MD, FACS
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Correspondence to Stanley J. Dudrick MD, FACS .

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Editors and Affiliations

  1. Department of Surgery, University of Arizona, Tucson, 85719, Arizona, USA

    Rifat Latifi

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Dudrick, S.J., Pimiento, J.M., Latifi, R. (2013). Short-Bowel Syndrome: A Clinical Update. In: Latifi, R. (eds) Surgery of Complex Abdominal Wall Defects. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6354-2_22

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  • DOI: https://doi.org/10.1007/978-1-4614-6354-2_22

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