Permanent Intestinal Failure and the Short Bowel Syndrome

Abstract

Intestinal failure can occur through an inactive or obstructed bowel or through loss of intestinal mucosal absorptive surface, most commonly through surgical resection. The management of intestinal failure due to short bowel (SB-IF) is far more complicated than intestinal failure due to obstruction, as it is often associated with high secretory loses, resulting in more pronounced fluid and electrolyte losses from the body. The short bowel syndrome includes a wide spectrum of disorders varying in severity, from a condition where oral supplementation can overcome stool losses to SB-IF where patients would die without regular IV infusions of fluids, electrolytes, and nutrients. Management of SB-IF is complex. This chapter starts out with definitions and then moves on to describe the principles of investigation and management, which include approaches to maximize natural adaptation with the use of dietary modification, anti-motility drugs, antisecretory agents, and the exciting new developments based on the modification of trophic gut peptides, such as GLP-2, to create drugs that can potentiate the natural adaptation process, and thus to reduce reliance of permanent IV infusions.