Materiały źródłowe

• #1 Concise review on short bowel syndrome: Etiology, pathophysiology, and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9649563/

  Adults have approximately 20 feet of small intestine, which is the primary site for absorbing essential nutrients and water. Resection of the intestine for any medical reason may result in short bowel syndrome (SBS), leading to loss of major absorptive surface area and resulting in various malabsorption and motility disorders. […] The condition may present clinically depending mainly upon the remaining anatomical portion of the intestine and its related function, which makes the clinical representation of the disease variable. […] Since the length and function of the intestine are compromised, it leads to loss of nutrients, fluid, and weight loss due to malabsorption. Symptoms of electrolyte disturbances and deficiencies of micronutrients and vitamins occur clinically. […] SBS occurs in about 15% of patients with intestinal resection. About three-quarters of these patients have a massive intestinal resection, and one-quarter have multiple sequential resections. Overall, the prevalence of SBS is 3-4 per million.

• #1 Concise review on short bowel syndrome: Etiology, pathophysiology, and management

  https://www.wjgnet.com/2307-8960/full/v10/i31/11273.htm

  Adults have approximately 20 feet of small intestine, which is the primary site for absorbing essential nutrients and water. Resection of the intestine for any medical reason may result in short bowel syndrome (SBS), leading to loss of major absorptive surface area and resulting in various malabsorption and motility disorders. The mainstay of treatment is personalized close dietary management. […] The condition may present clinically depending mainly upon the remaining anatomical portion of the intestine and its related function, which makes the clinical representation of the disease variable. Since the length and function of the intestine are compromised, it leads to loss of nutrients, fluid, and weight loss due to malabsorption. […] SBS occurs in about 15% of patients with intestinal resection. About three-quarters of these patients have a massive intestinal resection, and one-quarter have multiple sequential resections. Overall, the prevalence of SBS is 3-4 per million.

• #1 Short Bowel Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/28983

  Short bowel syndrome (SBS) can result from extensive surgical resection or congenital intestinal diseases. The most common pathologies that lead to SBS in adults are Crohn disease, mesenteric ischemia, radiation enteritis, post-surgical adhesions, and post-operative complications. In children, the most common pathologies include volvulus, intestinal malformations, and necrotizing enterocolitis. […] SBS can be classified by anatomical, pathophysiological, and postoperative criteria. Anatomically, there are three types of SBS: end-jejunostomy, jejunocolonic anastomosis where the jejunum is in continuity, most commonly, with the left colon, and jejunoileal anastomosis. The pathophysiological criteria can also be subdivided into categories where the colon is in continuity and those where it is not.

• #1 Short Bowel Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/28983

  The primary pathophysiological mechanism of chronic intestinal failure secondary to SBS is intestinal malabsorption due to the loss of intestinal absorptive surface and more rapid intestinal transit. The successful rehabilitation of a patient with SBS depends upon the management of the three phases of SBS: acute phase, adaptation phase, and maintenance phase. […] The acute phase of SBS lasts 3 to 4 weeks and involves metabolic derangement and significant intestinal losses as well as gastric hypersecretion due to the lack of inhibitory hormones that are normally released from the terminal ileum. […] The adaptation phase of SBS lasts 1 to 2 years and involves adaptive changes of remaining small bowel to increase the area of bowel available for nutrient absorption, slow down intestinal transit to maximize the time available for absorption, and adaptive hyperphagia. […] The third and final phase of SBS is the maintenance phase. This phase is managed with special diets, oral or intramuscular supplementation of nutrients, and pharmacological treatments.

• #1 Concise review on short bowel syndrome: Etiology, pathophysiology, and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9649563/

  Several aspects determine the severity of this case and its manifestation. These include the loss of absorptive surface area, loss of site-specific transport processes, loss of endocrine cells and GI hormones, rapid intestinal transit time, colon removal, small intestinal dysbiosis because of altered motility, and the loss of ileocecal valve. […] An individual becomes malnourished and requires supplemental dietary intervention to support his health. […] The nutritional deficits depend on the anatomically resected portions of the intestine. […] Furthermore, the most common types of SBS are type 3, which include jejunoileal anastomosis (where parts of the jejunum or ileum are resected with an intact colon), jejunal-colic anastomosis (where the ileum is resected), and terminal jejunostomy (where a stoma in the abdomen is formed following the complete resection of the ileum and colon while preserving part of the jejunum).

• #1 Short bowel syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Short_bowel_syndrome

  Short bowel syndrome usually develops when there is less than 2 meters (6.6 feet) of the small intestine left to absorb sufficient nutrients. […] The resection of specific areas of the small bowel can lead to distinct symptoms in short bowel syndrome. The resection of the ileum leads to a malabsorption of vitamin B12, bile acids and the fat soluble vitamins A, D, E and K. […] Loss of the distal ileum also leads to loss of inhibitory hormones; leading to gastric hypersecretion, intestinal hypermotility (decreases in the intestinal transit time) leading to secretory diarrhea and macronutrient, micronutrient, vitamin and mineral deficiencies. […] Loss of the ileocecal valve leads to small intestinal bacterial overgrowth (SIBO) as bacterial flora normally found in the large intestines migrate proximally and colonize the small intestines leading to further malabsorption.

• #1 Short bowel syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Short_bowel_syndrome

  SIBO leads to malabsorption as the bacteria colonizing the small intestine metabolize nutrients, directly competing with the intestinal absorption of nutrients. The bacteria colonizing the small intestines in SIBO may also cause bile acid deconjugation leading to malabsorption of lipids. […] In a process called intestinal adaptation, physiological changes to the remaining portion of the small intestine occur to increase its absorptive capacity. These changes usually take place over 12 years. […] Osteoporosis is a very common comorbidity in people with short bowel syndrome who are on parenteral nutrition, with an estimated prevalence of 57-67%. The contributing factors to the osteoporosis include malnutrition, vitamin D deficiency due to malabsorption and vitamin D deficiency due to scarce sunlight exposure due to chronic disability.

• #1 Short Bowel Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK536935/

  Short bowel syndrome (SBS) in adults is defined as less than 180 to 200 centimeters of remaining small bowel leading to the need for nutritional and fluid supplements. […] The primary pathophysiological mechanism of chronic intestinal failure secondary to SBS is intestinal malabsorption due to the loss of intestinal absorptive surface and more rapid intestinal transit. […] The successful rehabilitation of a patient with SBS depends upon the management of the three phases of SBS: acute phase, adaptation phase, and maintenance phase. […] The acute phase of SBS lasts 3 to 4 weeks and involves metabolic derangement and significant intestinal losses as well as gastric hypersecretion due to the lack of inhibitory hormones that are normally released from the terminal ileum. […] The adaptation phase of SBS lasts 1 to 2 years and involves adaptive changes of remaining small bowel to increase the area of bowel available for nutrient absorption, slow down intestinal transit to maximize the time available for absorption, and adaptive hyperphagia. […] The third and final phase of SBS is the maintenance phase. This phase is managed with special diets, oral or intramuscular supplementation of nutrients, and pharmacological treatments.

• #1 An Overview of Short-Bowel Syndrome in Pediatric Patients: Focus on Clinical Management and Prevention of Complications

  https://www.mdpi.com/2072-6643/15/10/2341

  In the following months, the remaining bowel gradual modifications are seen. […] Already in the initial stages, epithelial hyperplasia occurs, which includes the lengthening of residual villi and deepening of the crypts; furthermore, microvilli proliferation is observed. […] A more adaptive capacity of the ileum compared to the jejunum is well-documented. […] Structural and functional changes are more prominent in the ileum than in the jejunum. […] The preservation of the continuity of the gastrointestinal tract is important to potentiate the mucosal absorptive and digestive capacity, the early closure of stomas promotes the weaning from the PN. […] The pathogenesis of IFALD is multifactorial. […] Risk factors for the development of IFALD include prematurity, interruption of enterohepatic circulation of bile acids, intestinal stasis with bacterial proliferation and translocation, reduced portal venous return, leading to ischemia or decreased blood flow resulting in inflammation and intestinal necrosis, recurrent sepsis related to the central venous catheter, excessive glucose intake, which causes hyperinsulinism and subsequent steatosis, and long-term parenteral nutrition. […] Significant research has improved our understanding of the pathophysiology and the way we care for these patients, in order to promote enteral autonomy and improve patient outcomes.

• #1 Concise review on short bowel syndrome: Etiology, pathophysiology, and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9649563/

  These surgeries will create changes in the normal anatomy of the gastrointestinal tract and will furtherly affect its absorptive function. […] The process of intestinal adaptation begins after surgical resection to increase the absorptive function and continues for about 2 years. […] This indicates the importance of supplementing the patient with a complex diet as soon as possible to aid this process. […] Nutritional management during different SBS phases requires considering the physiological changes during adaptation. […] The early phase of SBS is characterized by gastric hypersecretion due to loss of inhibitory hormonal feedback signals due to resection; this is attributed to a deficiency in hormones usually produced by the endocrine cells of the proximal GI tract, such as glucagon-like peptide(GLP) -1 and GLP-2, neurotensin, and peptide YY.

• #1 Short-Bowel Syndrome: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/193391-overview

  Macronutrients and micronutrients are absorbed along the length of the small intestine. However, the jejunum has taller villi, deeper crypts, and greater enzyme activity than the ileum. […] The adaptation phase generally begins 2-4 days after bowel resection and may last up to 12-18 months. During this second phase, as much as 90% of the bowel adaptation may take place. Villous hyperplasia, increased crypt depth, and intestinal dilatation occur. […] In contrast, maintenance of the colon increases the incidence of urinary calcium oxalate stone formation. […] The physiologic changes and adaptation of patients with SBS can be viewed in three phases. […] The acute phase occurs immediately after massive bowel resection and may last up to 3-4 months. it is associated with malnutrition and fluid and electrolyte loss through the GI tract. […] The maintenance phase has the following characteristics: The absorptive capacity of the intestine is at its maximum. Nutritional and metabolic homeostasis can be achieved by oral feeding, or patients are committed to receiving supplemental or complete nutritional support for life.

• #1 Short Bowel Syndrome: A Paradigm for Intestinal Adaptation to Nutrition? – CRI

  https://cri1149.fr/en/publications/short-bowel-syndrome-a-paradigm-for-intestinal-adaptation-to-nutrition/

  Short bowel syndrome (SBS) is a rare disease that results from extensive resection of the intestine. When the remaining absorption surface of the intestine cannot absorb enough macronutrients, micronutrients, and water, SBS results in intestinal failure. Patients with SBS who suffer from intestinal failure require parenteral nutrition for survival, but long-term parenteral nutrition may also lead to complications such as catheter sepsis or thrombosis and metabolic liver diseases, renal failure and oxalic lithiasis. […] Spontaneous intestinal adaptation occurs weeks to months after resection, resulting in hyperplasia of the remnant gut, modification of gut hormone levels, dysbiosis (i.e;. modification of the intestinal microbiota), and hyperphagia. Oral nutrition and presence of the colon are two major positive drivers for this adaptation. […] This review aims to summarize the current knowledge of the mechanisms underlying spontaneous intestinal adaptation, particularly in response to modifications of luminal content, including nutrients. In the future, dietary manipulations could be used to treat SBS.

• #1 Intestinal Failure | Pediatric Surgery NaT

  https://www.pedsurglibrary.com/apsa/view/Pediatric-Surgery-NaT/829019/all/Intestinal_Failure

  Following massive small bowel resection there are significant fluid and electrolyte losses and alterations in the microbiome. […] While genetic factors undoubtedly play a role in the pathogenesis of many of these diagnoses, there does not appear to be any common genetic or molecular mechanism to account for intestinal failure. […] Following massive small bowel resection (SBR), there is a compensatory response in the remnant bowel termed adaptation. Adaptation after SBR provokes alterations which affect intestinal morphology, the kinetics of cell turnover and overall intestinal function. […] The significance of adaptation is illustrated clinically in patients who were previously unable to tolerate full enteral feeding but are ultimately able to wean completely from parenteral nutrition (PN) over time.

• #1 SciELO Brazil – Short bowel syndrome: treatment options Short bowel syndrome: treatment options

  https://www.scielo.br/j/jcol/a/bQSzfX9kHHDvFXvWWQxwJmJ/

  The success of this adaptation depends on both the length and the portion of resected bowel, and will determine whether the patient will require a permanent or non-permanent total parenteral nutrition (TPN), a fact with great impact on quality of life (QoL) and prognosis. […] Adaptation is an individualized process that depends on factors related to the intestine and to the patient. This phenomenon takes place in a period of about 2 years, and is divided into three phases: acute, adaptive, and maintenance phases, during which the remaining intestine compensates for the loss incurred through structural and motility changes. […] The established treatment occurs at a nutritional, pharmacological or, if necessary, surgical level. […] In patients with SBS, surgery plays an important role in preventing, mitigating or even reversing intestinal failure, and one should always choose the most conservative approach possible.

• #1 A potential anatomic subtype of short bowel syndrome: a matched case-control study | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-016-0425-4

  Short bowel syndrome (SBS) is a disabling malabsorptive disease usually following massive resection of the small intestine and characterized by the inability to maintain their nutritional status through normal oral intake alone. […] Our results indicated that ileum presents greater adaptive potential than the jejunum in nutrition and fluid absorption. […] Interestingly, it seems that ileum presents greater adaptive potential than the jejunum. […] The existing evidence and indications suggested ileum has greater adaptive potential than the jejunum in nutrition and fluid absorption. […] Further research need to be conducted to more fully understand the adaptive potential of ileum besides nutrition and fluid absorption.

• #1 Intestinal Failure | Pediatric Surgery NaT

  https://www.pedsurglibrary.com/apsa/view/Pediatric-Surgery-NaT/829019/all/Intestinal_Failure

  Multiple mechanisms and mediators have been proposed for the initiation and maintenance of the postresection adaptation response. […] After massive SBR, there is an initial period of significant fluid and electrolyte loss. The subsequent initiation of enteral feeding leads to a period of dynamic intestinal adaptation. […] The clinical response to massive intestinal loss is dependent upon several key features including the length and site of intestinal resection and possibly the presence of an ileocecal valve. […] Small bowel bacterial overgrowth (SBBO) and catheter-related bloodstream infections are two of the most common complications experienced by patients with intestinal failure and directly impact morbidity and mortality. […] Recent advances in high throughput sequencing of the 16S ribosomal rRNA gene of luminal gut bacteria have established a significant association between the intestinal microbiome and various intestinal epithelial and metabolic responses from a wide spectrum of diseases and conditions.

• #1 Short bowel syndrome pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Short_bowel_syndrome_pathophysiology

  Short bowel syndrome is the result of bowel resection following Crohn’s disease, malignancies, ischemia, and trauma. […] The small intestine has a very good adaptation following bowel resection of up to half of the small bowel length. However, a small intestine length less than 2 meters is considered as short bowel syndrome and requires nutritional therapy to prevent malnutrition. […] Adaptation is the specific ability of the intestine to increase its capacity to absorb nutrients following loss of its surface area and length. […] There will be structural, motility and functional changes in the remaining intestine to compensate its loss. […] Changes usually starts in the first 24 hours following bowel resection. […] Successful adaptation depends on the length of remaining intestine, portion of the resected intestine, early introduction of nutrition therapy. Total intestinal adaptation defines as when patient is weaned from parenteral nutrition.

• #1 Concise review on short bowel syndrome: Etiology, pathophysiology, and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9649563/

  Malabsorption is the physiologic consequence of SBS, resulting in nutrient deficiencies. […] Patients who undergo terminal ileal resections suffer from a deficiency in the absorption of vitamin B12-intrinsic factor and thus would require supplementation if they have 60 cm resection. […] The necessity of home parenteral nutrition home PN or IV fluids depends on the enterocyte function and colon preservation, which role lies in the absorption of water, electrolytes, and fatty acids. […] Different patients with SBS require PN for varying periods, depending on the remaining bowel length and the type of SBS resulting after resection. […] The metabolic bone disease may result in osteoporosis or osteomalacia. […] Intestinal transplantation has long been an exciting aspect of gastroenterology that has faced several challenges until professionals could finally carry it out successfully.

• #1 Short bowel syndrome pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Short_bowel_syndrome_pathophysiology

  Following the bowel resection, adaptation occurs in three phases including acute, adaptive, and maintenance phases. […] The main reasons for malabsorption following bowel resection include: Reduced absorption capacity of the small intestine due to loss of surface area, leading to: Loss of fluid and dehydration, Electrolyte imbalance, Loss of Macronutrients including carbohydrates, lipids and proteins. […] Disturbance in production of enzymes and hormones, leading to: Diarrhea, Steatorrhea, Loss of vitamins. […] Resection of specific sites, leading to: Loss of absorption of vitamin B12 and bile salts, Reduced capacity of fluid retention. […] Loss of ileocecal valve, leading to: Small bowel bacterial overgrowth, Increased gastric and intestinal transit. […] Compromised production of gastrointestinal regulators including cholecystokinin, secretin, gastric inhibitory polypeptide and peptide YY, leading to: Increased gastric and intestinal transit, Hypergastrinemia.

• #1 Gut Microbiota Modulation of Short Bowel Syndrome and the Gut–Brain Axis

  https://www.mdpi.com/2072-6643/15/11/2581

  Short bowel syndrome (SBS) is a condition that results from a reduction in the length of the intestine or its functional capacity. SBS patients can have significant side effects and complications, the etiology of which remains ill-defined. Thus, facilitating intestinal adaptation in SBS remains a major research focus. Emerging data supports the role of the gut microbiome in modulating disease progression. […] In SBS, it has also been found that microbial shifts are highly variable and dependent on many factors, including the anatomical location of bowel resection, length, and structure of the remnant bowel, as well as associated small intestinal bacterial overgrowth (SIBO). Recent data also notes a bidirectional communication that occurs between enteric and central nervous systems called the gut–brain axis (GBA), which is regulated by the gut microbes. Ultimately, the role of the microbiome in disease states such as SBS have many clinical implications and warrant further investigation.

• #1 Gut Microbiota Modulation of Short Bowel Syndrome and the Gut–Brain Axis

  https://www.mdpi.com/2072-6643/15/11/2581

  The focus of this review is to characterize the role of the gut microbiota in both positively and negatively modulating short bowel syndrome, and if altering the microbiome with factors such as pre-, pro-, or symbiotics has therapeutic potential. […] When dysbiosis occurs in SBS, it typically results in small intestinal bacterial overgrowth (SIBO). […] It has also been hypothesized that alterations in the gut microbiota enable bacterial flux across the intestinal mucosa which results in cytokine mediated hepatocellular injury. […] Additionally, there is emerging evidence that the gut microbiome communicates with the central nervous system vagally via the gut–brain axis, which then modulates brain and behavioral development. […] The gut–brain axis (GBA) is made up of bidirectional communication between the enteric and central nervous systems (CNS).

• #1 Gut Microbiota Modulation of Short Bowel Syndrome and the Gut–Brain Axis

  https://www.mdpi.com/2072-6643/15/11/2581

  What seems apparent is that the link between the gut–brain axis and the role it plays in gastrointestinal orders such as SBS remains an area ripe for research. […] As previously noted, changes in microbiota can be adaptive and respond positively to assist in disease states such as SBS and lack of luminal nutrition or can be pathologic as a result of maladaptive change. […] Overall, evidence in the literature points to microbial dysregulation as a consequence rather than cause of SBS, with an emphasis on the concurrent state of nutrition, i.e., TPN vs. EN. […] SBS can present in several variants based on anatomical location and length of resection or missing tissue. Additionally, SBS can result in an altered microbiome, resulting in SIBO or dysbiosis. […] Probiotics are used to add healthy bacteria to the gut and could theoretically be used to restore the alterations in gut microbiome that are the consequence of SBS.

• #1 Short Bowel Syndrome: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/14725-short-bowel-syndrome-in-children

  Treatment for short bowel syndrome in children focuses on helping your child get the nutrients they need and relieving symptoms they experience. […] Changes to your childs food intake and nutrition can help treat short bowel syndrome. […] Newer treatments like teduglutide, an injection given on a regular basis, can improve adaptation and help children come off IV nutrition and improve absorption. […] Short bowel syndrome can be a lifelong condition or a short-term condition for your child. Your childs body may improve its ability to absorb nutrients over time.

• #1 Management of short bowel syndrome in adult patients – Mayo Clinic

  https://www.mayoclinic.org/medical-professionals/digestive-diseases/news/management-of-short-bowel-syndrome-in-adult-patients/mac-20536579

  According to Drs. Bering and DiBaise, management of this condition can be complex, requiring nutritional support, fluid and electrolyte management, and pharmacologic therapies. As such, a multidisciplinary approach to management is recommended to provide optimal care. […] There has been intense interest in the development of intestinal growth factors and other agents to slow intestinal transit and thereby enhance intestinal absorption. The recent availability of a safe and effective glucagon-like peptide (GLP)-2 analogue has enhanced the treatment options described previously. This medication, administered via daily subcutaneous injections, can improve intestinal absorption and help wean parenteral support. Other longer acting GLP-2 and GLP-1 agents that are currently in development may result in less frequent administration and improved efficacy.

• #1 Concise review on short bowel syndrome: Etiology, pathophysiology, and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9649563/

  SBS has been the most common reason for the need for a transplant, accounting for 60%-65% of all transplant cases. […] Home PN is considered the primary treatment for patients with SBS. However, when it fails by contributing to liver disease, central venous catheter thrombosis of at least two central veins, frequent central line sepsis, or severe dehydration despite receiving fluids, the choice of undergoing intestinal transplantation is supported. […] Teduglutide increases absorptive capacity and inhibits gut motility, stimulating crypt cell proliferation and inhibiting enterocyte apoptosis.

• #2 Concise review on short bowel syndrome: Etiology, pathophysiology, and management

  https://www.wjgnet.com/2307-8960/full/v10/i31/11273.htm

  Adults have approximately 20 feet of small intestine, which is the primary site for absorbing essential nutrients and water. Resection of the intestine for any medical reason may result in short bowel syndrome (SBS), leading to loss of major absorptive surface area and resulting in various malabsorption and motility disorders. The mainstay of treatment is personalized close dietary management. […] The condition may present clinically depending mainly upon the remaining anatomical portion of the intestine and its related function, which makes the clinical representation of the disease variable. Since the length and function of the intestine are compromised, it leads to loss of nutrients, fluid, and weight loss due to malabsorption. […] SBS occurs in about 15% of patients with intestinal resection. About three-quarters of these patients have a massive intestinal resection, and one-quarter have multiple sequential resections. Overall, the prevalence of SBS is 3-4 per million.

• #2 Short bowel syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Short_bowel_syndrome

  Short bowel syndrome usually develops when there is less than 2 meters (6.6 feet) of the small intestine left to absorb sufficient nutrients. […] The resection of specific areas of the small bowel can lead to distinct symptoms in short bowel syndrome. The resection of the ileum leads to a malabsorption of vitamin B12, bile acids and the fat soluble vitamins A, D, E and K. […] Loss of the distal ileum also leads to loss of inhibitory hormones; leading to gastric hypersecretion, intestinal hypermotility (decreases in the intestinal transit time) leading to secretory diarrhea and macronutrient, micronutrient, vitamin and mineral deficiencies. […] Loss of the ileocecal valve leads to small intestinal bacterial overgrowth (SIBO) as bacterial flora normally found in the large intestines migrate proximally and colonize the small intestines leading to further malabsorption.

• #2 Management of short bowel syndrome in adult patients – Mayo Clinic

  https://www.mayoclinic.org/medical-professionals/digestive-diseases/news/management-of-short-bowel-syndrome-in-adult-patients/mac-20536579

  Short bowel syndrome (SBS) is a rare condition in which severe intestinal dysfunction prevents absorption of macronutrients and micronutrients. Adults typically develop SBS after massive surgical resection or significant damage to the small intestines. […] Although the condition is rare, researchers have identified several risk factors and disorders associated with SBS. These include mesenteric ischemia, abdominal trauma, Crohn’s disease, malignancy, radiation enteritis, postoperative obstructive or vascular catastrophes, and repeated abdominal surgeries. Prior abdominal surgery is a leading cause of SBS, accounting for up to 50% of cases. […] A variety of clinical complications can occur in patients with SBS, including chronic diarrhea, malabsorption-related weight loss, fluid and electrolyte disturbances, micronutrient deficiencies, nephrolithiasis, and liver and kidney diseases. These complications are often associated with a loss of intestinal absorptive surface and rapid intestinal transit triggered by underlying disease, altered bowel anatomy and physiology, or treatments such as parenteral nutrition (PN) and the central venous catheter through which it is administered.

• #2 Short bowel syndrome pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Short_bowel_syndrome_pathophysiology

  Following the bowel resection, adaptation occurs in three phases including acute, adaptive, and maintenance phases. […] The main reasons for malabsorption following bowel resection include: Reduced absorption capacity of the small intestine due to loss of surface area, leading to: Loss of fluid and dehydration, Electrolyte imbalance, Loss of Macronutrients including carbohydrates, lipids and proteins. […] Disturbance in production of enzymes and hormones, leading to: Diarrhea, Steatorrhea, Loss of vitamins. […] Resection of specific sites, leading to: Loss of absorption of vitamin B12 and bile salts, Reduced capacity of fluid retention. […] Loss of ileocecal valve, leading to: Small bowel bacterial overgrowth, Increased gastric and intestinal transit. […] Compromised production of gastrointestinal regulators including cholecystokinin, secretin, gastric inhibitory polypeptide and peptide YY, leading to: Increased gastric and intestinal transit, Hypergastrinemia.

• #2 Concise review on short bowel syndrome: Etiology, pathophysiology, and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9649563/

  These surgeries will create changes in the normal anatomy of the gastrointestinal tract and will furtherly affect its absorptive function. […] The process of intestinal adaptation begins after surgical resection to increase the absorptive function and continues for about 2 years. […] This indicates the importance of supplementing the patient with a complex diet as soon as possible to aid this process. […] Nutritional management during different SBS phases requires considering the physiological changes during adaptation. […] The early phase of SBS is characterized by gastric hypersecretion due to loss of inhibitory hormonal feedback signals due to resection; this is attributed to a deficiency in hormones usually produced by the endocrine cells of the proximal GI tract, such as glucagon-like peptide(GLP) -1 and GLP-2, neurotensin, and peptide YY.

• #2 Gut Microbiota Modulation of Short Bowel Syndrome and the Gut–Brain Axis

  https://www.mdpi.com/2072-6643/15/11/2581

  Short bowel syndrome (SBS) is a condition that results from a reduction in the length of the intestine or its functional capacity. SBS patients can have significant side effects and complications, the etiology of which remains ill-defined. Thus, facilitating intestinal adaptation in SBS remains a major research focus. Emerging data supports the role of the gut microbiome in modulating disease progression. […] In SBS, it has also been found that microbial shifts are highly variable and dependent on many factors, including the anatomical location of bowel resection, length, and structure of the remnant bowel, as well as associated small intestinal bacterial overgrowth (SIBO). Recent data also notes a bidirectional communication that occurs between enteric and central nervous systems called the gut–brain axis (GBA), which is regulated by the gut microbes. Ultimately, the role of the microbiome in disease states such as SBS have many clinical implications and warrant further investigation.

• #2 Short Bowel Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/28983

  The primary pathophysiological mechanism of chronic intestinal failure secondary to SBS is intestinal malabsorption due to the loss of intestinal absorptive surface and more rapid intestinal transit. The successful rehabilitation of a patient with SBS depends upon the management of the three phases of SBS: acute phase, adaptation phase, and maintenance phase. […] The acute phase of SBS lasts 3 to 4 weeks and involves metabolic derangement and significant intestinal losses as well as gastric hypersecretion due to the lack of inhibitory hormones that are normally released from the terminal ileum. […] The adaptation phase of SBS lasts 1 to 2 years and involves adaptive changes of remaining small bowel to increase the area of bowel available for nutrient absorption, slow down intestinal transit to maximize the time available for absorption, and adaptive hyperphagia. […] The third and final phase of SBS is the maintenance phase. This phase is managed with special diets, oral or intramuscular supplementation of nutrients, and pharmacological treatments.

• #2 Short-Bowel Syndrome: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/193391-overview

  Macronutrients and micronutrients are absorbed along the length of the small intestine. However, the jejunum has taller villi, deeper crypts, and greater enzyme activity than the ileum. […] The adaptation phase generally begins 2-4 days after bowel resection and may last up to 12-18 months. During this second phase, as much as 90% of the bowel adaptation may take place. Villous hyperplasia, increased crypt depth, and intestinal dilatation occur. […] In contrast, maintenance of the colon increases the incidence of urinary calcium oxalate stone formation. […] The physiologic changes and adaptation of patients with SBS can be viewed in three phases. […] The acute phase occurs immediately after massive bowel resection and may last up to 3-4 months. it is associated with malnutrition and fluid and electrolyte loss through the GI tract. […] The maintenance phase has the following characteristics: The absorptive capacity of the intestine is at its maximum. Nutritional and metabolic homeostasis can be achieved by oral feeding, or patients are committed to receiving supplemental or complete nutritional support for life.

• #2 Short Bowel Syndrome | Doctor

  https://patient.info/doctor/short-bowel-syndrome

  The age of the patient at the time the bowel was lost. […] The remaining length of small and large intestine. […] Whether the ileocaecal valve is present or absent. […] Three physiological changes may be identified. […] Acute phase – immediately after bowel resection. It is associated with malnutrition and fluid and electrolyte loss. […] Adaptation phase – 2-4 days after bowel resection, histological changes result in improved absorption and may influence the amount of parenteral nutrition required. […] Maintenance phase – the absorptive capacity of the bowel recovers to a greater or lesser extent. The degree of recovery will dictate the management of the patient in terms of the need for parenteral nutrition and nutritional supplements.

• #2 An Overview of Short-Bowel Syndrome in Pediatric Patients: Focus on Clinical Management and Prevention of Complications

  https://www.mdpi.com/2072-6643/15/10/2341

  In the following months, the remaining bowel gradual modifications are seen. […] Already in the initial stages, epithelial hyperplasia occurs, which includes the lengthening of residual villi and deepening of the crypts; furthermore, microvilli proliferation is observed. […] A more adaptive capacity of the ileum compared to the jejunum is well-documented. […] Structural and functional changes are more prominent in the ileum than in the jejunum. […] The preservation of the continuity of the gastrointestinal tract is important to potentiate the mucosal absorptive and digestive capacity, the early closure of stomas promotes the weaning from the PN. […] The pathogenesis of IFALD is multifactorial. […] Risk factors for the development of IFALD include prematurity, interruption of enterohepatic circulation of bile acids, intestinal stasis with bacterial proliferation and translocation, reduced portal venous return, leading to ischemia or decreased blood flow resulting in inflammation and intestinal necrosis, recurrent sepsis related to the central venous catheter, excessive glucose intake, which causes hyperinsulinism and subsequent steatosis, and long-term parenteral nutrition. […] Significant research has improved our understanding of the pathophysiology and the way we care for these patients, in order to promote enteral autonomy and improve patient outcomes.

• #2 Short bowel syndrome pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Short_bowel_syndrome_pathophysiology

  Short bowel syndrome is the result of bowel resection following Crohn’s disease, malignancies, ischemia, and trauma. […] The small intestine has a very good adaptation following bowel resection of up to half of the small bowel length. However, a small intestine length less than 2 meters is considered as short bowel syndrome and requires nutritional therapy to prevent malnutrition. […] Adaptation is the specific ability of the intestine to increase its capacity to absorb nutrients following loss of its surface area and length. […] There will be structural, motility and functional changes in the remaining intestine to compensate its loss. […] Changes usually starts in the first 24 hours following bowel resection. […] Successful adaptation depends on the length of remaining intestine, portion of the resected intestine, early introduction of nutrition therapy. Total intestinal adaptation defines as when patient is weaned from parenteral nutrition.

• #2 Short Bowel Syndrome: A Paradigm for Intestinal Adaptation to Nutrition? – CRI

  https://cri1149.fr/en/publications/short-bowel-syndrome-a-paradigm-for-intestinal-adaptation-to-nutrition/

  Short bowel syndrome (SBS) is a rare disease that results from extensive resection of the intestine. When the remaining absorption surface of the intestine cannot absorb enough macronutrients, micronutrients, and water, SBS results in intestinal failure. Patients with SBS who suffer from intestinal failure require parenteral nutrition for survival, but long-term parenteral nutrition may also lead to complications such as catheter sepsis or thrombosis and metabolic liver diseases, renal failure and oxalic lithiasis. […] Spontaneous intestinal adaptation occurs weeks to months after resection, resulting in hyperplasia of the remnant gut, modification of gut hormone levels, dysbiosis (i.e;. modification of the intestinal microbiota), and hyperphagia. Oral nutrition and presence of the colon are two major positive drivers for this adaptation. […] This review aims to summarize the current knowledge of the mechanisms underlying spontaneous intestinal adaptation, particularly in response to modifications of luminal content, including nutrients. In the future, dietary manipulations could be used to treat SBS.

• #2 Short bowel syndrome | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/short-bowel-syndrome

  Short bowel syndrome refers to the malabsorption of food nutrients due to failure of the small intestine. […] The most common causes of short bowel syndrome include: Small intestine malfunction severe abnormality in the way the small intestine functions. This may be caused by a condition or disease such as intestinal pseudo-obstruction, in which the intestine fails to move food and fluid along its length normally and absorption of food is compromised. […] Bowel surgery may be required to remove a significant proportion of the small bowel due to disease or malformation. […] If the small intestine is affected, absorption of food nutrients will be impaired. […] A person can lose more than half of their small intestine before they experience problems such as malnutrition. This shows the remarkable ability of the small intestine to recover and function after disease or extensive surgery, particularly in children. This is called intestinal adaptation. […] The mechanisms behind this adaptation are not well understood. Researchers have discovered that the amino acid glutamine is important in cell regeneration after bowel resection surgery.

• #2 SciELO Brazil – Short bowel syndrome: treatment options Short bowel syndrome: treatment options

  https://www.scielo.br/j/jcol/a/bQSzfX9kHHDvFXvWWQxwJmJ/

  The loss of nutrient and fluid absorption capacities heralds the onset of malnutrition and electrolyte imbalances; absorption of macro-nutrients, mainly carbohydrates and lipids, are the most affected. […] The presence of a large amount of unabsorbed solutes in the intestinal lumen results in an increased osmotic pressure and in the onset of one of the major symptoms of SBS, diarrhea, usually more intense at an initial stages. […] The loss of intestinal absorption surface; the loss of specific sites of absorption; a decrease in production of intestinal hormones; the loss of the ileocecal valve. […] Most SBS cases occur after extensive resections, and the length of the remaining intestine is the major determinant of prognosis and of clinical consequences. […] Likewise, intestinal resection will compromise the endocrine capacity of the gut, taking into account that important regulators of the digestive process, e.g. cholecystokinin (CCK), secretin, gastric inhibitory polypeptide (GIP) and peptide YY, are produced in the intestinal mucosa and are critical for the neurohormonal control of the digestive process.

• #2 Gut Microbiota Modulation of Short Bowel Syndrome and the Gut–Brain Axis

  https://www.mdpi.com/2072-6643/15/11/2581

  What seems apparent is that the link between the gut–brain axis and the role it plays in gastrointestinal orders such as SBS remains an area ripe for research. […] As previously noted, changes in microbiota can be adaptive and respond positively to assist in disease states such as SBS and lack of luminal nutrition or can be pathologic as a result of maladaptive change. […] Overall, evidence in the literature points to microbial dysregulation as a consequence rather than cause of SBS, with an emphasis on the concurrent state of nutrition, i.e., TPN vs. EN. […] SBS can present in several variants based on anatomical location and length of resection or missing tissue. Additionally, SBS can result in an altered microbiome, resulting in SIBO or dysbiosis. […] Probiotics are used to add healthy bacteria to the gut and could theoretically be used to restore the alterations in gut microbiome that are the consequence of SBS.

• #2 Short Bowel Syndrome: What It Is, Who Gets It, and More

  https://www.webmd.com/ibd-crohns-disease/crohns-disease/short-bowel-syndrome

  This is another complication that’s more likely to happen in people who are on long-term IV nutrition. It’s caused by nutritional deficiencies. Metabolic bone disease refers to a group of diseases that weaken your bones. […] If, once your gut has stopped adapting, it still can’t absorb enough nutrients to keep you healthy, you have what’s called chronic intestinal failure. In this case, you might need long-term IV nutrition or surgery. […] With treatment and time, some people with short bowel syndrome get better. Their remaining intestine adapts and they’re once again able to absorb all the nutrients they need from regular food. Other people may never get back to a fully functioning digestive tract.

• #2 Understanding Short Bowel Syndrome & Treatment Options

  https://gastrohealth.com/news/patient-care/what-is-short-bowel-syndrome

  Enteral feeding: Should be introduced as soon as possible to promote intestinal adaptation since it stimulates release of digestive juices, hormonal secretions and maintains the integrity of the gut barrier and its immunoregulatory mechanisms. The goal is to taper parenteral nutrition and slowly start oral feedings. […] Growth Factors: agents that promote and enhance adaptation beyond normal limits, increasing intestinal absorptive capacity and decreasing the need for parenteral nutrition support. E.1 Glucagon like peptide-2 (GLP-2): Teduglutide (GattexR), approved by the FDA recently for the treatment of SBS. […] If none of the treatments or options explained before work in a patient, the consequences of SMB are in a short term and can include dehydration, and electrolyte imbalances (loss of potassium, calcium and magnesium), as well as disequilibrium of the pH of the body (alkalosis or acidosis). For mid and long term, osteoporosis due to calcium and Vitamin D malabsorption, kidney stones, increase of acid production in the stomach and decrease in gastric time leads to ulcers formation.

• #3 Short Bowel Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/28983

  Short bowel syndrome (SBS) can result from extensive surgical resection or congenital intestinal diseases. The most common pathologies that lead to SBS in adults are Crohn disease, mesenteric ischemia, radiation enteritis, post-surgical adhesions, and post-operative complications. In children, the most common pathologies include volvulus, intestinal malformations, and necrotizing enterocolitis. […] SBS can be classified by anatomical, pathophysiological, and postoperative criteria. Anatomically, there are three types of SBS: end-jejunostomy, jejunocolonic anastomosis where the jejunum is in continuity, most commonly, with the left colon, and jejunoileal anastomosis. The pathophysiological criteria can also be subdivided into categories where the colon is in continuity and those where it is not.

• #3 Short-Bowel Syndrome: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/193391-overview

  Physiologic derangements in SBS are the result of the loss of large amounts of intestinal absorptive surface area. The sequelae of this loss include malabsorption of water, electrolytes, macronutrients (ie, proteins, carbohydrates, fats), and micronutrients (ie, vitamins, minerals, trace elements). […] Disturbances in the major determinants of intestinal fluid absorption negatively impact the ability to reabsorb this large fluid load. The major determinants include intestinal mucosal surface area, the health or integrity of the mucosa, the status of small-bowel motility, and the osmolarity of solutes in the intestinal lumen. […] Clinically, these disturbances can manifest as major components of SBS, namely diarrhea, dehydration, and electrolyte imbalance. Thus, SBS can be produced by clinical entities that result in critical loss of mucosal surface area (eg, massive small-bowel resection) or degrade mucosal integrity (eg, radiation enteritis).

• #3 Short Bowel Syndrome | Doctor

  https://patient.info/doctor/short-bowel-syndrome

  Loss of absorptive surface area. […] Loss of site-specific transport processes. […] Loss of site-specific endocrine cells and gastrointestinal hormones. […] Loss of ileocaecal valve. […] Loss of large amounts of small intestinal absorptive mucosa results in malabsorption of water, electrolytes and nutrients. […] It also results in failure of resorption of the liquid produced by the gastrointestinal tract itself. […] This scenario is being increasingly referred to as 'intestinal failure’. […] Loss of significant lengths of ileum results in reduction of bile salt reabsorption, resulting in steatorrhoea. […] SBS is not an inevitable consequence of loss of a significant amount of bowel. […] Other factors which come into play include: The length of premorbid bowel. […] Which segment of bowel is lost.

• #3 Short Bowel Syndrome – Intestinal Diseases – Gastrointestinal Diseases – Gastroenterology – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.4.11.

  Short bowel syndrome (SBS) develops after surgical resection or bypass of the small intestine, leading to reduced absorption of nutrients and water; in some SBS patients severe malabsorption can lead to intestinal failure such that the patients well-being cannot be maintained by oral or enteral nutrition alone. […] SBS is the most common cause of intestinal failure; the other 4 major pathophysiologic causes, which may be due to a variety of benign or malignant conditions, are intestinal fistula, intestinal dysmotility, mechanical obstruction, and extensive small bowel mucosal disease. […] Glucagon-like peptide-2 (GLP-2), produced by enteroendocrine L cells in the ileum and colon, plays a key role in maintaining small bowel mucosal mass and function.

• #3 An Overview of Short-Bowel Syndrome in Pediatric Patients: Focus on Clinical Management and Prevention of Complications

  https://www.mdpi.com/2072-6643/15/10/2341

  However, the long-term use of PN is associated with the incidence of many complications, including liver disease and catheter-associated malfunction and bloodstream infections. […] The key is complication mitigation, which involves focusing on avoiding catheter complications, infections, nutrient deficiencies, metabolic disorders and cholestatic liver disease. […] After massive bowel loss, the gastrointestinal tract responds with a process called intestinal adaptation, which consists of physiologic changes by the remaining bowel, in intestinal morphology and function, occurring in order to gradually improve the absorption of adequate nutrients and fluid and recover part of the residual functionality. […] The first period is characterized by diarrhea and a massive loss of fluids and electrolytes; the use of total PN is often suggested.

• #3 Concise review on short bowel syndrome: Etiology, pathophysiology, and management

  https://www.wjgnet.com/2307-8960/full/v10/i31/11273.htm

  The nutritional deficits depend on the anatomically resected portions of the intestine. […] The process of intestinal adaptation begins after surgical resection to increase the absorptive function and continues for about 2 years. […] A study in adult patients showed that when enteral nutrition (EN) was given early and continuously, it was possible to achieve enteral autonomy about 36 days post-surgery. […] Nutritional management during different SBS phases requires considering the physiological changes during adaptation. […] The early phase of SBS is characterized by gastric hypersecretion due to loss of inhibitory hormonal feedback signals due to resection; this is attributed to a deficiency in hormones usually produced by the endocrine cells of the proximal GI tract, such as glucagon-like peptide (GLP) -1 and GLP-2, neurotensin, and peptide YY.

• #3 Gut Microbiota Modulation of Short Bowel Syndrome and the Gut–Brain Axis

  https://www.mdpi.com/2072-6643/15/11/2581

  What seems apparent is that the link between the gut–brain axis and the role it plays in gastrointestinal orders such as SBS remains an area ripe for research. […] As previously noted, changes in microbiota can be adaptive and respond positively to assist in disease states such as SBS and lack of luminal nutrition or can be pathologic as a result of maladaptive change. […] Overall, evidence in the literature points to microbial dysregulation as a consequence rather than cause of SBS, with an emphasis on the concurrent state of nutrition, i.e., TPN vs. EN. […] SBS can present in several variants based on anatomical location and length of resection or missing tissue. Additionally, SBS can result in an altered microbiome, resulting in SIBO or dysbiosis. […] Probiotics are used to add healthy bacteria to the gut and could theoretically be used to restore the alterations in gut microbiome that are the consequence of SBS.

• #3 Concise review on short bowel syndrome: Etiology, pathophysiology, and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9649563/

  Malabsorption is the physiologic consequence of SBS, resulting in nutrient deficiencies. […] Patients who undergo terminal ileal resections suffer from a deficiency in the absorption of vitamin B12-intrinsic factor and thus would require supplementation if they have 60 cm resection. […] The necessity of home parenteral nutrition home PN or IV fluids depends on the enterocyte function and colon preservation, which role lies in the absorption of water, electrolytes, and fatty acids. […] Different patients with SBS require PN for varying periods, depending on the remaining bowel length and the type of SBS resulting after resection. […] The metabolic bone disease may result in osteoporosis or osteomalacia. […] Intestinal transplantation has long been an exciting aspect of gastroenterology that has faced several challenges until professionals could finally carry it out successfully.

• #3 An Overview of Short-Bowel Syndrome in Pediatric Patients: Focus on Clinical Management and Prevention of Complications

  https://www.mdpi.com/2072-6643/15/10/2341

  In the following months, the remaining bowel gradual modifications are seen. […] Already in the initial stages, epithelial hyperplasia occurs, which includes the lengthening of residual villi and deepening of the crypts; furthermore, microvilli proliferation is observed. […] A more adaptive capacity of the ileum compared to the jejunum is well-documented. […] Structural and functional changes are more prominent in the ileum than in the jejunum. […] The preservation of the continuity of the gastrointestinal tract is important to potentiate the mucosal absorptive and digestive capacity, the early closure of stomas promotes the weaning from the PN. […] The pathogenesis of IFALD is multifactorial. […] Risk factors for the development of IFALD include prematurity, interruption of enterohepatic circulation of bile acids, intestinal stasis with bacterial proliferation and translocation, reduced portal venous return, leading to ischemia or decreased blood flow resulting in inflammation and intestinal necrosis, recurrent sepsis related to the central venous catheter, excessive glucose intake, which causes hyperinsulinism and subsequent steatosis, and long-term parenteral nutrition. […] Significant research has improved our understanding of the pathophysiology and the way we care for these patients, in order to promote enteral autonomy and improve patient outcomes.

• #3 Improved Electrolyte and Fluid Balance Results in Control of Diarrhea with Crofelemer in Patient with Short Bowel Syndrome: A Case Report

  http://clinmedjournals.org/articles/jcgt/journal-of-clinical-gastroenterology-and-treatment-jcgt-8-086.php?jid=jcgt

  Diarrhea is caused by elevated secretion of fluid and electrolytes into the intestine through active chloride ion (Cl-) transport across intestinal epithelium coupled with significantly decreased absorptive capacity of the remaining small and large bowel. […] In SBS patients, the reduced surface area of the small intestine also leads to malabsorption of bile acids, stimulating fluid secretion (via Cl- transporters) into the small intestine and colon. […] Crofelemer is a novel antidiarrheal agent that modulates two of the apical intestinal Cl- ion channels: the cAMP-stimulated cystic fibrosis transmembrane conductance regulator (CFTR) and the calcium-activated Cl- channel (CaCC). […] It is hypothesized that in short bowel syndrome, crofelemer may reduce the relatively excessive fluid and electrolyte secretion, increasing transit time, indirectly facilitating electrolyte, fluid and nutrient absorption, and improving stool consistency and mitigating debilitating diarrhea.

• #4 Short Bowel Syndrome: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/14725-short-bowel-syndrome-in-children

  Just like its name, the cause of short bowel syndrome is a short bowel. The length of your small intestine affects your bodys ability to break down and absorb the foods you eat. This can affect how well your body absorbs nutrients from food and how well your small intestine functions. […] Causes of short bowel syndrome in children include: Small intestine growth abnormalities at birth, including your childs small intestine being too short, a section of their bowel is missing or their bowel didnt form completely (intestinal atresia) during fetal development. […] A side effect of surgery, which removed a section of your childs small intestine to treat an underlying condition. […] Short bowel syndrome can be life-threatening if left untreated, especially if your childs body isnt able to absorb nutrients from the food they eat.

• #4 What Is SBS-IF? – Review Tables, Infographics, and Overviews

  https://www.gattexhcp.com/short-bowel-syndrome/

  SBS is the result of physical loss and functional deficiency of portions of the intestine, primarily due to surgical resection. […] SBS can be a heterogeneous condition due to variations in intestinal function and remnant bowel anatomy. […] Patients with SBS may have limited GLP-2 secretion due to the removal of L cells following resections. […] Any resection can impact GLP-2 secretion resulting in SBS. […] GLP-2 is an intestinal hormone that maintains the structure and function of the intestine to facilitate absorption. Patients with SBS may have limited GLP-2 secretion due to the removal of L cells following resections.

• #4 Short bowel syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Short_bowel_syndrome

  SIBO leads to malabsorption as the bacteria colonizing the small intestine metabolize nutrients, directly competing with the intestinal absorption of nutrients. The bacteria colonizing the small intestines in SIBO may also cause bile acid deconjugation leading to malabsorption of lipids. […] In a process called intestinal adaptation, physiological changes to the remaining portion of the small intestine occur to increase its absorptive capacity. These changes usually take place over 12 years. […] Osteoporosis is a very common comorbidity in people with short bowel syndrome who are on parenteral nutrition, with an estimated prevalence of 57-67%. The contributing factors to the osteoporosis include malnutrition, vitamin D deficiency due to malabsorption and vitamin D deficiency due to scarce sunlight exposure due to chronic disability.

• #4 Pediatric Short Bowel Syndrome: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/931855-overview

  Short bowel syndrome (SBS) is the result of the alteration of intestinal digestion and absorption that occurs following extensive bowel resection. […] Short bowel syndrome represents a complex disorder that affects normal intestinal physiology with nutritional, metabolic, and infectious consequences. […] The jejunum cannot develop site-specific carriers for the transportation of vitamin B12 and bile salts, and, consequently, these are malabsorbed permanently in patients, following ileal resection. […] In addition to the effects of long-term parenteral nutrition on the liver, small bowel dilation in children with short bowel syndrome is associated with mucosal damage, bowel-derived bloodstream infections, and cholestatic hepatic injury. […] The presence of a pathologic small bowel diameter ratio exceeding 2.17 was associated with increased fecal calprotectin and decreased citrulline, and small bowel diameter ratio was greater in the presence of intestinal bloodstream infections.

• #4 Improved Electrolyte and Fluid Balance Results in Control of Diarrhea with Crofelemer in Patient with Short Bowel Syndrome: A Case Report

  http://clinmedjournals.org/articles/jcgt/journal-of-clinical-gastroenterology-and-treatment-jcgt-8-086.php?jid=jcgt

  Crofelemer is an antidiarrheal drug with a physiological mechanism of action that regulates Cl- transport by normalizing the gating function of two chloride ion channels, CFTR and CaCC. […] The unique physiological mechanism of crofelemer results in inhibition of secretion of excess chloride ions and water into the intestine and normalization of electrolyte and fluid balance in the GI tract, thus improving stool consistency and relief from diarrhea. […] In this SBS patient, crofelemer also may have reduced the hypersecretion of chloride and fluids into the intestine that occurs due to bowel adaptation after extensive surgical resection. […] By reducing excess chloride and fluid secretion, crofelemer likely resulted in less fluid volume in the intestine, enabling better absorption of nutrients by the small intestine. […] Crofelemer warrants further evaluation in clinical trials in patients with SBS, including those dependent on PN. However, because of the decreased intestinal transit time experienced in SBS patients, a reformulation of crofelemer and expanded dosing regimens should be studied.

• #5 Short Bowel Syndrome | Concise Medical Knowledge

  https://www.lecturio.com/concepts/short-bowel-syndrome/

  Short bowel syndrome (SBS) is a malabsorptive condition due to the insufficient length of functional small intestine. The condition leads to diarrhea, malnutrition, and dehydration. Intestinal failure is reduced GI function that cannot meet the minimum requirements for absorption of electrolytes, water, and macronutrients. […] May be permanent or transient. […] Caused by SBS, intestinal dysmotility, small bowel mucosal disease, mechanical obstruction, or intestinal fistula. […] Results in dependence on supplemental IV nutrition and hydration. […] Several factors determine the degree of intestinal function loss after bowel resection: The length of remaining small bowel after resection. […] 180-200 cm places a patient at very high risk for SBS. […] Loss of the ileocecal valve stimulates colonic fluid and electrolyte secretion. […] Malabsorption and Maldigestion of vitamin B12. […] The length of remaining small bowel after resection is critical in determining the risk of developing SBS.

• #5 What Is Short Bowel Syndrome? | SBS

  https://www.shortbowelsyndrome.com/what-is-sbs

  Short bowel syndrome (SBS) is a serious and chronic malabsorption disorder. […] SBS occurs when parts of the intestine are removed surgically and the remaining intestine may not be able to absorb enough nutrients from food and drink. […] After bowel resection surgery, the lining of the remaining intestine may change to absorb more nutrients and fluid through a natural process called intestinal adaptation. Intestinal adaptation is an important goal for people with SBS. […] When parts of the intestines are removed, key hormones for absorption may be affected. One example of those hormones is glucagon-like peptide-2, also known as GLP-2, which helps the body absorb nutrients or fluids. […] Since people with SBS have had parts of their intestines removed, they may not make enough GLP-2 or other key hormones involved in absorption.

• #5 Short bowel syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Short_bowel_syndrome

  SIBO leads to malabsorption as the bacteria colonizing the small intestine metabolize nutrients, directly competing with the intestinal absorption of nutrients. The bacteria colonizing the small intestines in SIBO may also cause bile acid deconjugation leading to malabsorption of lipids. […] In a process called intestinal adaptation, physiological changes to the remaining portion of the small intestine occur to increase its absorptive capacity. These changes usually take place over 12 years. […] Osteoporosis is a very common comorbidity in people with short bowel syndrome who are on parenteral nutrition, with an estimated prevalence of 57-67%. The contributing factors to the osteoporosis include malnutrition, vitamin D deficiency due to malabsorption and vitamin D deficiency due to scarce sunlight exposure due to chronic disability.

• #5 Pediatric Short Bowel Syndrome: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/931855-overview

  Short bowel syndrome (SBS) is the result of the alteration of intestinal digestion and absorption that occurs following extensive bowel resection. […] Short bowel syndrome represents a complex disorder that affects normal intestinal physiology with nutritional, metabolic, and infectious consequences. […] The jejunum cannot develop site-specific carriers for the transportation of vitamin B12 and bile salts, and, consequently, these are malabsorbed permanently in patients, following ileal resection. […] In addition to the effects of long-term parenteral nutrition on the liver, small bowel dilation in children with short bowel syndrome is associated with mucosal damage, bowel-derived bloodstream infections, and cholestatic hepatic injury. […] The presence of a pathologic small bowel diameter ratio exceeding 2.17 was associated with increased fecal calprotectin and decreased citrulline, and small bowel diameter ratio was greater in the presence of intestinal bloodstream infections.

• #5 Improved Electrolyte and Fluid Balance Results in Control of Diarrhea with Crofelemer in Patient with Short Bowel Syndrome: A Case Report

  http://clinmedjournals.org/articles/jcgt/journal-of-clinical-gastroenterology-and-treatment-jcgt-8-086.php?jid=jcgt

  Crofelemer is an antidiarrheal drug with a physiological mechanism of action that regulates Cl- transport by normalizing the gating function of two chloride ion channels, CFTR and CaCC. […] The unique physiological mechanism of crofelemer results in inhibition of secretion of excess chloride ions and water into the intestine and normalization of electrolyte and fluid balance in the GI tract, thus improving stool consistency and relief from diarrhea. […] In this SBS patient, crofelemer also may have reduced the hypersecretion of chloride and fluids into the intestine that occurs due to bowel adaptation after extensive surgical resection. […] By reducing excess chloride and fluid secretion, crofelemer likely resulted in less fluid volume in the intestine, enabling better absorption of nutrients by the small intestine. […] Crofelemer warrants further evaluation in clinical trials in patients with SBS, including those dependent on PN. However, because of the decreased intestinal transit time experienced in SBS patients, a reformulation of crofelemer and expanded dosing regimens should be studied.

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