Short bowel syndrome (SBS)

Short bowel syndrome (SBS) is

• a functional definition of SBS is necessary due to the wide variation in small bowel length in adults (300-800 cm) and the ability of the remaining bowel to compensate for the lost length (1)
  • therefore SBS is defined as the inability to maintain nutritional, fluid, and/or electrolyte homeostasis while consuming a normal, healthy diet following a bowel resection
  • caused by physical or functional loss of significant portions of the small intestine
    • physical loss - in adults, usually result from extensive intestinal resection for recurrent Crohn's disease, mesenteric vascular events (eg, embolism, thrombus), trauma, volvulus, malignancy, and complications from previous abdominal surgery
    • functional loss - less common
      • occur in the presence of an intact small intestine that is not adequately performing its normal digestive and absorptive functions
      • causes include inflammatory bowel disease, radiation enteritis, recurrent intestinal pseudo-obstruction, and congenital villus atrophy
  • conditions leading to SBS most frequently affect the jejuno-ileal segment, although the colon may also be affected
• clinical features of SBS vary along a continuum, depending on the extent and anatomy of intestine lost and the ability of the patient and the remaining intestine to compensate for the loss
  • clinical complications ssociated with SBS include:
    • central venous catheter-related complications e.g. infection, occlusion, thrombosis
    • parenteral nutrition–related e.g. hepatic complications (steatosis, cholestasis, fibrosis, cirrhosis); gallstones
    • bowel anatomy–related e.g. malabsorptive diarrhoea, malnutrition, fluid and electrolyte disturbances
      
• in patients with SBS who are receiving long-term home parenteral nutrition (PN)
  • 2- and 5-year survival rates have been reported to be up to 80% and 70%, respectively (2,3)
• factors affecting survival with SBS include:
  • the anatomy and function of the remaining bowel,
  • age of the patient,
  • primary disease process,
  • comorbid diseases,
  • presence of chronic intestinal obstruction,
  • and the experience of the management team

Reference:

• O’Keefe SJ, Buchman AL, Fishbein TM, Jeejeebhoy KN, Jeppesen PB, Shaffer J. Short bowel syndrome and intestinal failure: consensus definitions and overview. Clin Gastroenterol Hepatol. 2006;4(1):6-10.
• Scolapio JS, Fleming CR, Kelly DG, Wick DM, Zinsmeister AR. Survival of home parenteral nutrition-treated patients: 20 years of experience at the Mayo Clinic. Mayo Clin Proc. 1999;74(3):217-222.
• Messing B, Lémann M, Landais P, et al. Prognosis of patients with nonmalignant chronic intestinal failure receiving long-term home parenteral nutrition. Gastroenterology. 1995;108(4):1005-1010.