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Short bowel syndrome in infancy: recent advances and practical management
  1. Elena Cernat1,
  2. Chloe Corlett2,
  3. Natalia Iglesias3,
  4. Nkem Onyeador4,
  5. Julie Steele5,
  6. Akshay Batra6
  1. 1Department of Gastroenterology and Nutrition, Leeds Children’s Hospital, Leeds, UK
  2. 2Department of Paediatric Gastroenterology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
  3. 3Medicines Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  4. 4Department of Paediatric Gastroenterology, St George’s Healthcare NHS Trust, London, UK
  5. 5Dietetic Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  6. 6Department of Paediatric Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
  1. Correspondence to Dr Akshay Batra, Paediatrics, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK; Akshay.batra{at}uhs.nhs.uk

Abstract

Short bowel syndrome (SBS) is a rare condition characterised by extensive loss of intestinal mass secondary to congenital or acquired disease. The outcomes are determined by dependency on parenteral nutrition (PN), its possible complications and factors that influence intestinal adaptation. In order to achieve the best results, patients should be managed by a specialised multidisciplinary team with the aims of promoting growth and development, stimulating intestinal adaptation and preventing possible complications. This involves timely surgical management aimed at rescuing maximum bowel length and eventually re-establishing intestinal continuity where appropriate. A combination of enteral and parenteral nutrition needs to be targeted towards maintaining a balance between fulfilling the nutritional and metabolic needs of the child while preventing or at least minimising potential complications. Enteral nutrition and establishment of oral feeding play a fundamental role in stimulating bowel adaptation and promoting enteral autonomy. Other measures to promote enteral autonomy include the chyme recycling in patients where bowel is not in continuity, autologous gastrointestinal reconstruction and pharmacological treatments, including promising new therapies like teduglutide. Strategies such as lipid reduction, changing the type of lipid emulsion and cycling PN are associated with a reduction in the rates of intestinal failure–associated liver disease. Even though vast improvements have been made in the surgical and medical management of SBS, there is still lack of consensus in many aspects and collaboration is essential.

  • short bowel syndrome
  • intestinal failure

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Footnotes

  • Contributors EC: contributed in planning of article, literature search and writing the final manuscript. CC: contributed in planning of article, literature search and writing the final manuscript. NI: contributed in planning of article, literature search and writing the final manuscript. JS: contributed in planning of article, literature search and writing the final manuscript. AB: contributed in planning of article, literature search and writing the final manuscript. NO: contributed in writing the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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