Short Bowel Syndrome: Intestinal Adaptation and Medical Therapy

Short bowel syndrome is a clinical entity, a consequence ofsignificant loss of intestinal surface area, and manifests a variable picture ofdiarrhea, steatorrhea, malabsorprion and weight loss. Previously high mortalityrates have been reduced by the early use of parenteral nutrition and havesubsequently resulted in increased survival and prevalence of the condition.Ultimate patient survival is dependent on the intrinsic adaptive ability of residualintestine and this, in turn, is dependent upon length, type, functional state andthe presence or absence of an ileocecal valve. The mechanisms of intestinaladaptation are not entirely understood; however, they can be grouped into threebroad categories: luminal nutrition, hormonal factors, and pancreaticobiliarysecretion. Medical treatment of short bowel syndrome remains supportive andcentres around the control of three pathophysiological defects: decreased intestinaltransit time, gastric hypersecretion, and reduced functional mucosal surfacearea