Short bowel syndrome and malnutrition

Short bowel syndrome is a rare but devastating malabsorptive condition resulting from extensive loss of intestinal length. Common etiologies in adults include Crohn’s disease and mesenteric thrombosis, while necrotizing enterocolitis and congenital abnormalities predominate in children. Patients with short bowel experience diarrhea, weight loss, and nutrient deficiencies as a result of loss of intestinal surface area. Treatment is focused on controlling diarrhea, enhancing bowel absorption, and optimizing nutritional status. Medications, hormonal therapy (teduglutide), dietary modifications, tube feeding, and total parenteral nutrition (TPN) are key components of this process. Surgical interventions to restore intestinal continuity and enhance bowel function should also be considered. The ultimate goal of short bowel management is to wean patients off of TPN. Residual intestinal length and bowel health are highly predictive of long-term TPN dependence. Patients who cannot be weaned off of TPN are at higher risk for complications requiring intestinal transplantation.