Short Bowel Syndrome Overview

Short Bowel Syndrome with intestinal failure is a chronic, highly debilitating and potentially life threatening malabsorption disorder1,2

Short Bowel Syndrome with intestinal failure (SBS-IF) is defined as the reduction of gut function below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous (IV) supplementation is required to maintain health and/or growth.3

In SBS-IF, usually a large portion of the small intestine is removed surgically, resulting in impaired intestinal function and malabsorption.1,3,4

Malabsorption1,3

Impaired absorption of macronutrients, micronutrients, water and electrolytes

Associated risks2

Malabsorption puts patients at risk for malnutrition, diarrhoea and dehydration

Parenteral nutrition/intravenous fluids (PN/IV)3

Patients require long-term PN/IV to maintain health and/or growth

In adults

SBS-IF may be the result of congenital diseases of the bowel3 or extensive resection due to:5-8

  • Vascular events (e.g., embolism/thrombosis)
  • Crohn’s disease
  • Radiation enteritis
  • Surgical complications
  • Abdominal trauma
  • Complications of bariatric surgery
  • Malignancy
  • Strangulated hernia
  • Small bowel fistulae
  • Intestinal volvulus
  • Familial polyposis
  • Complicated intussusception

In children

SBS-IF is most commonly caused by congenital diseases including:9-12

  • Necrotising enterocolitis
  • Midgut volvulus
  • Intestinal atresia
  • Intestinal aganglionosis
  • Gastroschisis
  • Malrotation
  • Trauma
  • Hirschsprung disease

Long-term parenteral nutrition/IV fluids (PN/IV) is associated with severe complications and can affect patient’s quality of life7,13

PN/IV is usually administered for an average of 5 days per week (range: 3-7 days) and at night.7,14

Complications of short bowel syndrome arising from long-term PN/IV include risk of infection and sepsis, thrombosis, and intestinal failure-associated liver disease.1,15

Catheter-related infection1,7

The most frequent PN/IV complication and accounts for the majority of PN/IV-related hospitalisations

Hospitalisation16

Over a 12-month period*:

  • 23 days were spent in the hospital
  • Approximately one-half of hospitalisations were due to home parenteral nutrition complications

*A multicentre European survey of long-term home parenteral nutrition patients (n=228)
PN/IV= parenteral nutrition/intravenous fluids; SBS-IF= short bowel syndrome – intestinal failure

SBS-IF Patient Film Series

Hayley C

Hayley T
Joel
Leo
Rosie
Robyne
Dario

References

  1. Jeppesen PB. Spectrum of short bowel syndrome in adults: intestinal insufficiency to intestinal failure. JPEN J Parenter Enteral Nutr. 2014;38(1 Suppl):8S-13S.
  2. Seidner DL, Schwartz LK, Winkler MF, et al. JPEN J Parenter Enteral Nutr. 2013;37:201-211.
  3. Pironi L, Arends J, Bozzetti F, et al. ESPEN guidelines on chronic intestinal failure in adults. Clin Nutr. 2016;35:247-307
  4. O’Keefe SJ, Jeppesen PB, Gilroy R, et al. Safety and efficacy of teduglutide after 52 weeks of treatment in patients with short bowel intestinal failure. Clin Gastroenterol Hepatol. 2013;11:815-823.
  5. Buchman AL, Scolapio J, Fryer J. AGA technical review on short bowel syndrome and intestinal transplantation. Gastroenterology. 2003;124:1111-1134.
  6. Pironi L, Arends J, Baxter J, et al. ESPEN endorsed recommendations. Definition and classification of intestinal failure in adults. Clin Nutr. 2015;34:171-180.
  7. Hofstetter S, Stern L, Willet J. Key issues in addressing the clinical and humanistic burden of short bowel syndrome in the US. Curr Med Res Opin. 2013;29:495-504.
  8. Parrish CR. The clinician’s guide to short bowel syndrome. Pract Gastroenterol. 2005;XXIX(9):67-106.
  9. Chandra R, Kesavan A. Current treatment paradigms in pediatric short bowel syndrome. Clin J Gastroenterol. 2018;11:103-112.
  10. Wales PW, Christison-Lagay ER. Short bowel syndrome: epidemiology and etiology. Semin Pediatr Surg. 2010;19:3-9.
  11. Buchman AL. In: Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Saunders Elsevier; 2016:1832-1848.
  12. Duggan CP, Jaksic T. Pediatric intestinal failure. N Engl J Med. 2017;377:666-675.
  13. Huisman-de Waal G, Schoonhoven L, Jansen J, et al. The impact of home parenteral nutrition on daily life-a review. Clin Nutr. 2007;26:275-288.
  14. Kelly DG, Tappenden KA, Winkler MF. Short bowel syndrome highlights of patient management, quality of life, and survival. JPEN J Parenter Enteral Nutr. 2014;38:427-437.
  15. Carroll RE, Benedetti E, Schowalter JP, et al. Management and complications of short bowel syndrome: an updated review. Curr Gastroenterol Rep. 2016;18:40.
  16. Van Gossum A, Vahedi K, Abdel-Malik, et al. ESPEN-HAN Working Group. Clinical, social and rehabilitation status of long-term home parenteral nutrition patients: results of a European multicentre survey. Clin Nutr. 2001;20:205-210.

 
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