Short bowel syndrome

Abstract

Short bowel syndrome continues to be an important clinical problem due to its high mortality and morbidity as well as to its devastating socioeconomic effects. The etiology of short bowel syndrome, its pathophisiology, the cellular and molecular mechanisms of intestinal adaptation are reviewed. Most common complication of short bowel syndrome including intestinal failure associated liver disease and sepsis are outlined with strategies to reduce them. The medical management and nutritional support of a patient with short bowel syndrome is complex and requires a multidisciplinary approach with the surgeon, gastroenteroliogist, pharmacist and dietitian working together. A review of the pharmacologic substances and growth factors that have been studied experimentally and administered clinically for the management of short bowel syndrome is presented. The mechanisms of action of peptide growth factors in intestinal cell proliferation as well as the effects of these factors on intestinal re-growth in an animal model of short bowel syndrome are discussed. Surgical options to promote intestinal adaptation and intestinal lengthening are described. Such knowledge may allow us to exploit various factors that act as growth agents for the remaining bowel mucosa and suggest new therapeutic strategies to maintain gut integrity after massive bowel resection, eliminate the dependence on total parenteral nutrition, and avoid the need for intestinal transplantation. © 2012 Nova Science Publishers, Inc. All rights reserved.