Gastrointestinal symptoms such as severe dehydration, diarrhea, severe fatigue and weight loss are hallmarks of SBS [6]. Diarrhea is often exacerbated after oral intake of either liquid or solid food [3]. Due to loss of many vitamins, minerals and macronutrients, failure to thrive and a poor general condition that ensues within days or weeks is frequently encountered and the severity of symptoms has shown to depend on the site of bowel resection. Namely, patients with end-jejunostomy develop a more severe clinical presentation, while a somewhat slower onset of symptoms is seen in patients who underwent jejunocolic anastomosis [2]. Because of B12 and iron loss, anemia can manifest as pale skin and tachycardia, while hypotension is a frequent finding on physical examination due to extensive volume depletion.

• Malnutrition

  […] short bowel syndrome A complication of major small intestine resections (e.g., for ischaemia or inflammation), resulting in complex nutritional imbalances and/or malnutrition. [medical-dictionary.thefreedictionary.com]

  […] gastrointestinal surgery Malnutrition post GI surgery Post gastrointestinal tract surgery hypoglycemia Post-gastrointestinal tract surgery malnutrition Postoperative malabsorption Postprocedural intestinal steatorrhea Postprocedural steatorrhea Post-surgical [icd9data.com]

  Extensive bowel resection may lead to a state of inadequate nutrient absorption and malnutrition known as short bowel syndrome. Deficiencies in fat-soluble vitamins may occur from this condition, with sequelae such as a bleeding diathesis. [ncbi.nlm.nih.gov]

  Short bowel syndrome treatment typically involves special diets and nutritional supplements and may require nutrition through a vein (parenteral nutrition) to prevent malnutrition. [mayoclinic.org]

• Weight Loss

  Patients with SBS suffer from diarrhoea and symptoms of malabsorption such as weight loss, electrolyte disturbances and vitamin deficiencies. [ncbi.nlm.nih.gov]

  Others include: Dehydration Bloating Cramping Heartburn Fatigue Weight loss Sensitivity to new foods Swelling, especially of the legs Pale, greasy and especially foul-smelling stools If you experience any of these symptoms, see your health care provider [premierhealth.com]

  Diarrhea can lead to dehydration, malnutrition, and weight loss. Other symptoms may include cramping, bloating, heartburn, weakness, and fatigue. [iffgd.org]

  Adults with SBS often experience symptoms of malnutrition including, poor skin and nails, weight loss, and low energy. Infants and children fail to grow and develop. Symptoms vary according to the individual. [ostomy.org]

• Fatigue

  Symptoms of short bowel syndrome The symptoms of short bowel syndrome can include: abdominal pain diarrhoea stools that float or smell particularly bad fluid retention unintended weight loss extreme fatigue. [betterhealth.vic.gov.au]

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: May 13, 2019 [patientslikeme.com]

  Problems associated with dehydration and malnutrition include weight loss, weakness, fatigue, anemia, and bacterial infections. [medicinenet.com]

  Symptoms Common signs and symptoms of short bowel syndrome may include: Diarrhea Greasy, foul-smelling stools Fatigue Weight loss Malnutrition Swelling (edema) in the lower extremities Causes Causes of short bowel syndrome include having parts of your [mayoclinic.org]

  Symptoms often include: diarrhea, fatigue, and pale greasy stools (steatorrhea). Swelling of lower extremities (edema), foul smelling stools, weight loss as a result of dehydration, electrolyte losses, and malnutrition are often experienced. [iffgd.org]

• Inflammation

  […] short bowel syndrome A complication of major small intestine resections (e.g., for ischaemia or inflammation), resulting in complex nutritional imbalances and/or malnutrition. [medical-dictionary.thefreedictionary.com]

  […] bowel diameter was measured in contrast series and expressed as the ratio to the height of the fifth lumbar vertebra (small bowel diameter ratio), and correlated retrospectively to fecal calprotectin and plasma citrulline-respective markers of mucosal inflammation [ncbi.nlm.nih.gov]

  […] and blocked blood flow, usually due to prematurity) Crohn disease (intestinal inflammation or scarring) tumors (cancerous and non-cancerous) trauma (injury, including radiation therapy from cancer treatment) blood clots (blocked blood flow to the intestine [nemours.org]

  The inflammation in the eye and ear are due to the patient’s own immune system producing antibodies that attack the inner ear and eye tissue. [health.economictimes.indiatimes.com]

• Sepsis

  He was born at 30 weeks gestation but unfortunately developed fulminant sepsis secondary to necrotising enterocolitis. He underwent a laparotomy and had 15 cm of dead gut removed. [dontforgetthebubbles.com]

  There are often sepsis, enterocolitis, and poor body weight gain noted among short bowel patients. With breast milk feeding and probiotics usage, there were few complications of short bowel syndrome noted in our patient. [ncbi.nlm.nih.gov]

  Prolonged NPO Gut MUCOSAL ATROPHY BACTERIAL TRANSLOCATION SEPSIS 30. [slideshare.net]

• Diarrhea

  Natural conjugated bile acids improve steatorrhea to a smaller extent and greatly worsen diarrhea. [ncbi.nlm.nih.gov]

  Extensive resection or loss of small bowel can cause significant diarrhea and malabsorption. [merckmanuals.com]

• Abdominal Pain

  Abdominal pain Diarrhea (due to malabsorption ) Poor growth (failure to thrive) Vomiting How is Pediatric Short Bowel Syndrome (Short Gut) diagnosed? A series of tests can help doctors diagnose short bowel syndrome. [childrens.com]

  Symptoms A patient with short bowel syndrome may experience a range of symptoms related to the insufficient function of the intestine, including: Diarrhea Dehydration Weight loss Malnutrition Abdominal pain Bloating or cramping Fatigue and weakness Heartburn [news-medical.net]

  Some of the symptoms of SBS may include: Diarrhea and/or steatorrhea (oily, sticky stools which are unusually foul-smelling due to the malabsorption of fats) Unintended weight loss Fatigue Abdominal pain Additionally, patients with SBS may suffer from [disability-benefits-help.org]

• Lactose Intolerance

  intolerance, and foul-smelling stool.[1] Complications can include anemia and kidney stones.[2] Most cases are due to the surgical removal of a large portion of the small intestine.[1] This is most often required due to Crohn's disease in adults and [en.wikipedia.org]

• Intestinal Disease

  The main cause of short bowel syndrome is surgical removal of half or more of the small intestine to treat intestinal diseases, injuries, or defects present at birth. [iffgd.org]

  胃腸疾患　gastrointestinal disease 腸疾患　intestinal disease 吸収不良症候群　malabsorption syndrome 短腸症候群　short bowel syndrome 病的状態と徴候・症状　pathological condition, sign and symptom 病理過程　pathologic process 術後合併症　postoperative complication 短腸症候群　short bowel syndrome 関連語 [lsd-project.jp]

  017213, 腸疾患, ﾁｮｳｼｯｶﾝ, intestinal disease, 054586, 胃腸疾患, ｲﾁｮｳｼｯｶﾝ, gastrointestinal disease, 054588, 消化器疾患, ｼｮｳｶｷｼｯｶﾝ, digestive system disease, 012793, 消化器外科, ｼｮｳｶｷｹﾞｶ, digestive system surgery, 055933, 外科術, ｹﾞｶｼﾞｭﾂ, operative surgery, 045593, 治療法, [togodb.biosciencedbc.jp]

  Diseases Gastrointestinal Diseases Digestive System Diseases Postoperative Complications Teduglutide Gastrointestinal Agents Radiation-Protective Agents Protective Agents Physiological Effects of Drugs [clinicaltrials.gov]

• Failure to Thrive

  Protracted postnatal postprandial vomiting with progressive failure to thrive was noted. A laparotomy showed the small bowel was only about 20 cm in length. [ncbi.nlm.nih.gov]

  Patients are born with a short small bowel (less than 75 cm in length) that compromises proper intestinal absorption and leads chronic diarrhea, vomiting and failure to thrive. [orpha.net]

  As a result of these changes, symptoms such as severe diarrhea, dehydration, failure to thrive, extreme fatigue and weight loss are hallmarks of SBS. [symptoma.com]

  Abdominal pain Diarrhea (due to malabsorption ) Poor growth (failure to thrive) Vomiting How is Pediatric Short Bowel Syndrome (Short Gut) diagnosed? A series of tests can help doctors diagnose short bowel syndrome. [childrens.com]

• Tachycardia

  Because of B12 and iron loss, anemia can manifest as pale skin and tachycardia, while hypotension is a frequent finding on physical examination due to extensive volume depletion. [symptoma.com]

  Vitamin B1 deficiency - oedema, tachycardia, ophthalmoplegia, depressed deep tendon reflexes. Vitamin B6 deficiency - peripheral neuropathies (also a feature of B12 deficiency) and seizures. Vitamin D depletion - poor growth, bowed extremities. [patient.info]

  Vitamin B1 deficiency is associated with edema, tachycardia, ophthalmoplegia, and depressed deep tendon reflexes. Vitamin B6 deficiency can cause peripheral neuropathies and seizures. Peripheral neuropathy can be a feature of B12 deficiency also. [emedicine.medscape.com]

  […] the mouth (stomatitis) and tongue (glossitis), dry scaling of the lip (cheilosis), swelling due to fluid accumulation (edema), low levels of circulating red blood cells (anemia), weakness of certain eye muscles (ophthalmoplegia), irregular heartbeats (tachycardia [rarediseases.org]

• Hypotension

  Because of B12 and iron loss, anemia can manifest as pale skin and tachycardia, while hypotension is a frequent finding on physical examination due to extensive volume depletion. [symptoma.com]

  The clinician should determine which patients are in need based on urine output, hypotension, recurrent dehydration, and acute kidney injury. Medications Treatment of SBS requires aggressive use of several medications. [gastroenterologyandhepatology.net]

  Musculature Muscles wasting, particularly in the buttocks and thighs Skeletal Deformities usually a result of calcium, vitamin D, or vitamin C deficiencies Abdomen Distended – hepatomegaly with fatty liver, ascites may be present Cardiovascular Bradycardia, hypotension [en.wikipedia.org]

• Arthritis

  Bowel-associated dermatosis-arthritis syndrome (BADAS) is a neutrophilic dermatosis, characterized by the occurrence of arthritis and skin lesions related to bowel disease with or without bowel bypass. [ncbi.nlm.nih.gov]

  So if you are suffering from Arthritis this Guide will help you to learn about simple measures in your daily life & diet you must fix for a fast recovery & boost your immune system against future arthritis attacks. 2.Freyja Canada Freyja Canada Inc. is [glovesmag.com]

  The doctor will want to rule out an infection (especially Syphilis, Tuberculosis, Viral Infection and Chlamydia) or another Rheumatic disease (including Rheumatoid Arthritis, Sarcoidosis and Granulomatosis with Polyangitis) as the cause of the symptoms [health.economictimes.indiatimes.com]

  If you develop arthritis behind the knee cap—more common in older individuals—then there are even more solutions that go beyond the typical physical-based treatments. [runnersworld.com]

• Night Blindness

  ERG might be more sensitive than serum vitamin A level and is recommended in case of night blindness but still normal vitamin A level. [ncbi.nlm.nih.gov]

  Vitamin and mineral deficiency can cause: Night blindness and xerophthalmia (vitamin A). Paraesthesias (vitamins D and E, calcium, magnesium). Tetany (vitamins D and E, calcium, magnesium). [patient.info]

    Weight loss, fatigue, malaise, and lethargy  Vitamin A - night blindness and xerophthalmia  Vitamin D - paresthesias and tetany  Vitamin E - paresthesias, ataxic gait, and retinopathy  Vitamin K depletion - easy bruisability or prolonged bleeding [slideshare.net]

  Vitamin and mineral deficiencies can lead to some specific symptoms, as follows: Patients with vitamin A deficiencies may report night blindness and xerophthalmia Vitamin D depletion can be associated with paresthesias and tetany Loss of vitamin E can [emedicine.medscape.com]

  Deficiency of vitamin A can be associated with difficulties seeing at night (night blindness) and abnormal dryness and thickening of the conjunctiva and cornea (xerophthalmia). Affected individuals may develop corneal ulcerations. [rarediseases.org]

• Alopecia

  Zinc deficiency - angular stomatitis, poor wound healing, alopecia, scaly erythematous rash around the mouth, eye, nose and perineum. [patient.info]

  Patients with essential fatty acid deficiency experience growth retardation, dermatitis, and alopecia. The physical features of vitamin A deficiency include corneal ulcerations and growth delays. [emedicine.medscape.com]

  Zinc deficiency can result in information of the mucous membrane of the mouth (stomatitis), patchy areas of hair loss (alopecia), poor wound healing and a reddened, scaly skin rash. [rarediseases.org]

  […] stomatitis, cheilitis, glossitis, spongy bleeding gums (vitamin C), parotid enlargement Teeth Enamel mottling, delayed eruption Hair Dull, sparse, brittle hair, hypopigmentation, flag sign (alternating bands of light and normal color), broomstick eyelashes, alopecia [en.wikipedia.org]

• Hunger

  The Global Hunger Index (GHI) is a multidimensional statistical tool used to describe the state of countries’ hunger situation. The GHI measures progress and failures in the global fight against hunger.[128] The GHI is updated once a year. [en.wikipedia.org]

• Dizziness

  During the first 3 months when parenteral nutrition including a lipid emulsion containing 50% soybean oil/50% medium-chain triglyerides was administered daily, the patient reported feeling unwell (experiencing dizziness and palpitations) and her triglycerides [ncbi.nlm.nih.gov]

  Shortly after the occurrence of these ocular symptoms, the patient develops bilateral audio-vestibular (Ear-related) symptoms, including hearing loss, dizziness (Vertigo) and ringing in ears (Tinnitus). [health.economictimes.indiatimes.com]

  When these conflicting signals collide, he may experience sweating, dizziness, a headache, and, in some cases, a wave of nausea that can lead to vomiting. Use our free first-aid essentials checklist before your next trip! [parents.com]

  […] intestine [ Top ] Seek Help for Signs or Symptoms of Severe Dehydration People who have any signs or symptoms of severe dehydration should call or see a health care provider right away: excessive thirst dark-colored urine infrequent urination lethargy, dizziness [web.archive.org]

  A 5-8% decrease can cause fatigue and dizziness. Loss of over ten percent of total body water can cause physical and mental deterioration, accompanied by severe thirst. [en.wikipedia.org]

• Peripheral Neuropathy

  Vitamin B6 deficiency can cause peripheral neuropathies and seizures. Peripheral neuropathy can be a feature of B12 deficiency also. Vitamin D depletion is associated with poor growth and bowed extremities. [emedicine.medscape.com]

  Vitamin B6 deficiency - peripheral neuropathies (also a feature of B12 deficiency) and seizures. Vitamin D depletion - poor growth, bowed extremities. [patient.info]

• Echolalia

  A 24-year-old woman with a short bowel syndrome following post-ischemic small bowel resection, developed several episodes of lethargy, echolalia and ataxia. D-lactic acidosis was identified as the cause of neurological disturbances. [ncbi.nlm.nih.gov]

• Vertigo

  Shortly after the occurrence of these ocular symptoms, the patient develops bilateral audio-vestibular (Ear-related) symptoms, including hearing loss, dizziness (Vertigo) and ringing in ears (Tinnitus). [health.economictimes.indiatimes.com]

The most important step in the diagnostic workup is a proper patient history that may reveal recent bowel surgery. When combined with severe GI symptoms, the initial diagnosis should be made based on these criteria without hesitation. Laboratory studies should evaluate serum electrolytes, including sodium, potassium, chloride, magnesium, calcium and iron. Imaging studies are of little use as macroscopic changes seen on ultrasonography and radiography may not reveal pathological findings.

• Nephrolithiasis

  Limketkai Cholelithiasis and Nephrolithiasis Andrew Ukleja and John Rivas Metabolic Bone Disease in Adults with Short Bowel Syndrome Lynn R. Mack and Fedja A. [routledge.com]

    Complications of short bowel syndrome  Therapy related  Diarrhea and steatorrhea  Metabolic abnormalities  Nutritional deficiencies  Infectious complications  Liver disease  Physiologic  Cholelithaisis  Nephrolithiasis  Gastric hypersectretion [slideshare.net]

  Fat restriction is most important in the SBS patient with a remaining colon, severe steatorrhea, and/or a history of oxalate nephrolithiasis. [gastroenterologyandhepatology.net]

  Several authors recommend prophylactic cholecystectomy in these patients when laparotomy is undertaken for other reasons. [28] Calcium oxalate stones are formed as a result of increased oxalate absorption from the colon. [28] Nephrolithiasis is more common [dx.doi.org]

• Hypoalbuminemia

  Her liver dysfunction was characterized by abnormal coagulation, only partially corrected by blood products and vitamin K, hypoalbuminemia, and hypoproteinemia. [journalofethics.ama-assn.org]

• Zinc Increased

  Daily zinc increases the chances of reducing the severity and duration of the diarrhea, and continuing with daily zinc for ten to fourteen days makes diarrhea less likely recur in the next two to three months.[117] In addition, malnourished children need [en.wikipedia.org]

• Colitis

  E.1 Medical condition or disease under investigation E.1.1Medical condition(s) being investigated Patients with ileostomy because of ulcerative colitis, rectal cancer or short bowel syndrom Patienter med Ileostomi opereret for colitis ulcerosa, rectumcancer [clinicaltrialsregister.eu]

  Where to get help Your doctor Gastroenterologist Australian Crohn’s and Colitis Association Tel. (03) 9726 9008 Things to remember Short bowel syndrome refers to the malabsorption of food nutrients due to disease or surgical removal of parts of the small [betterhealth.vic.gov.au]

  C. difficile colitis or enteritis 15. laxative abuse Other conditions may present with significant unintentional weight loss but not the associated diarrhea and decreased transit time. [clinicaladvisor.com]

Patients in whom a strong suspicion toward SBS is made, immediate administration of intravenous fluids and electrolytes should be made done, with appropriate electrolyte corrections after the arrival of laboratory results. Oral intake is strictly prohibited in early stages of care as it may provoke further volumes loss through diarrhea [6]. To further reduce the severity of diarrhea, the use of proton pump inhibitors such as pantoprazole is recommended to suppress gastric hypersecretion that may even lead to peptic ulcer disease [3]. Antimotility agents, such as loperamide, histamine-2 receptor blockers, cholestyramine and octreotide are also drugs that are readily used in management of diarrhea seen in SBS [5]. GLP-2 analogs, such as teduglutide, have shown to be of significant benefit for many patients due to their numerous positive effects such as promotion of intestinal adaptation and nutrient absorption [9] [12]. Total parenteral nutrition (TPN), however, is the definite therapeutic measure [7]. TPN provides all the necessary nutrients and gives the intestines enough time to undergo adaptation undisturbed, but life-long TPN may be required for patients in whom adaption did not occur in satisfactory levels. Moreover, adverse effects such as liver failure, bacterial overgrowth and bowel dysmotility have been documented with long-term use of TPN, which is why surgery may be performed as a last resort [6]. The goal of surgical therapy is to increase the surface area of the small intestine or improve its capacity for absorption [11]. By prolonging intestinal transit through reversing intestinal segments or colonic transposition, narrowing of the dilated intestinal segments (tapering enteroplasty), increasing the length of the intestine and transplantation, surgery may improve long-term outcomes [5].

Despite the introduction of TPN and advances in critical care medicine, the overall prognosis is still poor for the majority of patients suffering from SBS. The main prognostic factor is the degree of intestinal adaptation, a process that involves progressive functional and anatomical increase in bowel capacity for nutrient absorption after surgery [5]. Enhanced formation of crypts, villi lengthening, motor activity, mucus production and various other compensatory mechanisms occur in the first 2-3 years after surgery and the exact physiological mechanism remains unknown [6]. The site of resection is also an important prognostic factors, as patients with illeal resection often have better outcomes, since this part of the small intestine possesses greater capacities for adaptation than jejunum [5]. Unfortunately, this process does not develop fully in many patients and life-long TPN is necessary, which carries many risks and significantly affects the quality of life. Case fatality ratios range from 10%-50% according to various reports [6], indicating that SBS is a serious condition that requires prolonged and complex interdisciplinary management.

SBS stems from a reduced surface area for absorption of nutrients and water that is caused by either single massive or repeated lesser bowel resections [10]. Conditions such as Crohn disease or enteritis due to radiation often require extensive ileal resection, while intestinal ischemia, gastric bypass surgery and other diseases that necessitate procedures such as end-jejunostomy, jejunocolic anastomosis and jejunoileal anastomosis can also cause SBS [3] [8]. In the pediatric population, necrotizing enterocolitis, volvulus repair, intestinal atresia and abdominal defects are most common indications for bowel resective surgery [7]. In general, the definition of SBS implies a malabsorptive syndrome that develops after resective surgery that leaves less than 200 cm of viable intestine [11].

SBS is a condition that is rarely encountered in clinical practice, but approximately 15% of patients in whom intestinal resection is performed will develop this malabsorptive syndrome [2]. Much higher rates are observed in patients who undergo single massive resection (75% of all cases) compared to smaller repeated resection and mortality rates were shown to be higher in this group as well [10]. Prevalence rates of SBS in the United States are estimated at 3-4 per 1 million individuals, while incidence rates range from 24.5 per 100,000 live births to more than 300 per 100,000 neonates born before 37 weeks of gestation [7].

All important nutrients, including water, proteins, carbohydrates, fats, vitamins and minerals are absorbed at various parts of the GI tract. Proteins and carbohydrates are absorbed in the stomach and duodenum, while the jejunum is the site of calcium, folate, iron, magnesium, phosphorus water, fat-soluble vitamins and free fatty acid absorption [2] [3]. The ileum, on the other hand, is the site of intrinsic factor and vitamin B12 absorption, as well as bile acids and moderate amounts of sodium and water [3]. Finally, the principal action of the colon is to regulate water and electrolyte content. The site of resection may significantly influence the degree and severity of symptoms, but in general, the reduced surface area of the remaining intestine after surgery is the most important factor in the pathogenesis of SBS [5]. Because of this loss, water, electrolytes and both micro and macronutrients cannot be absorbed at a rate that is necessary for normal metabolic functions. In addition to malabsorption, deficits of glucagon-like peptides (GLP) 1 and 2, neurotensin and YY peptide are observed, which leads to accelerated gastric emptying and more rapid bowel movement [4]. Although the colon is often intact, increased concentrations of bile salts induce cAMP activation, leading to even further water and electrolyte loss [3].

Prevention of SBS is somewhat difficult due to the necessity of intestinal resection in various diseases. More importantly, however, is the prevention of its complications, such as sepsis, metabolic alterations that can include numerous dietary inefficiencies and liver failure that develops in approximately 15% of patients who are on life-long TPN [5]. Prevention of nutrient deficiencies by performing regular evaluation of electrolytes, adequate intake of balanced calories by using less than 30% of fat of the total caloric intake, while the use of ursodexycholic acid, a drug used for treatment of billiary cirrhosis, has shown benefit in some patients, are some of the strategies used in preventive purposes [5].

Short bowel syndrome (SBS) is a potentially severe and life-threatening malabsorptive disease that occurs after resective bowel surgery, usually leaving less than 200 cm of intestinal length [1]. In approximately 15% of patients undergoing surgical procedures such as end jejunostomy, jejunocolic anastomosis and jejuno-ileal anastamosis, SBS may develop [2]. Indications for surgery among adults include radiation enteritis, Crohn disease, ischemia of the bowels and the mesenterium and gastric bypass surgery, while necrotizing enterocolitis and volvulus repair are most frequent causes in the pediatric population [2] [3]. Rare cases of congenital SBS have been described in literature [5]. Epidemiology studies have determined an incidence rate of 24.5 per 100 000 live births and the most significant risk factor is shown to be premature birth (before 37 weeks of gestation) [6]. In this group of patients, incidence rates are around 350 per 100,000 [6]. Other studies estimated a prevalence rate of 3-4 per 1 million individuals [5]. The pathogenesis starts with reduction of the surface area where absorption of all micro and macronutrients, as well as water, takes place [4]. Proteins, carbohydrates, fats, vitamin B12, iron, phosphorus, zinc and magnesium are insufficiently absorbed and the severity of malabsroption depends on the extent of bowel that is removed and the site of removal [5] [7]. The majority of these elements are absorbed in the proximal 1-1.5 meters of small intestine and more severe outcomes are expected in patients in whom significant small intestinal resection was performed [5]. In addition to malabsorption, increased concentrations of bile salts in the colon stimulate cyclic adenosine monophosphate (cAMP) production and promote further water loss [3]. As a result of these changes, symptoms such as severe diarrhea, dehydration, failure to thrive, extreme fatigue and weight loss are hallmarks of SBS [6]. Patient history that reveals recent intestinal resection, together with typical signs and symptoms should be sufficient to make a presumptive diagnosis. Laboratory findings often reveal anemia, hypomagnesemia, hyponatremia and hypokalemia [7]. Rapid initiation of treatment is detrimental in these patients and consists of adequate intravenous fluid and electrolyte administration, proton pump inhibitors and antimotility agents to reduce diarrhea. Total parenteral nutrition (TPN), however, is the mainstay of long-term management of patients suffering from SBS [8]. Patient outcomes significantly depend on the process of intestinal adaptation, a spontaneous physiological process that enhances the capacity of the remaining intestines for nutrient absorption [7]. If intestinal adaptation does not occur within a few years after surgery, life-long TPN may be necessary, which carries a great risk for numerous complications, such as cholestasis, liver failure and development of systemic infections, whereas the quality of life is also severely impaired [7]. Glucagon-like peptide 2 (GLP-2) analogs, such as teduglutide, an other similar drugs have shown to promote intestinal adaptation and absorptive capacities and are increasingly being used in SBS patients, mainly because they may aid in reducing the need for TPN [9].

Short bowel syndrome (SBS) is a condition that develops in approximately 15% of patients who undergo bowel resection surgery. It is characterized by severe malabsorption due to reduced amount of viable intestine (less than 2 meters), leading to insufficient absorption of all nutrients, including vitamins, minerals, proteins, carbohydrates, fats, and water. Numerous diseases have been described as indications for bowel surgery and consequent SBS, such as Crohn disease, enteritis as a result of radiation, mesenteric and intestinal ischemia and gastric bypass surgery. In the pediatric population, severe infections of the bowels and volvulus repair are the most common causes of SBS. This condition is considered to be a rare medical condition, affecting about 3 to 4 per 1 million individuals in the United States. Because of severe malnutrition and malabsorption, symptoms such as dehydration, profuse watery diarrhea that is provoked by oral ingestion of any kind of food, severe malaise and failure to thrive are commonly encountered. Patients are often in poor general condition and report weight loss in a matter of days or weeks. To make the diagnosis, patient history that reveals recent bowel surgery and severe symptoms that involve the gastrointestinal tract should be sufficient. Treatment requires immediate intravenous administration of fluids and electrolytes together with drugs that reduce gastric acid secretion and bowel motility such as proton pump inhibitors (PPIs), loperamide, histamine-receptor blockers and octreotide. Long-term management, however, is achieved by total parenteral nutrition (TPN), a technique that bypasses the gastrointestinal system in order to replenish the body with all the necessary nutrients. More importantly, during TPN, the intestines try to heal and trigger several compensatory mechanisms in the absence of a substantial part of the bowel, such as increased mucus production and enhancement of absorption capacity. Sometimes, bowels may heal enough so that regular nutrition through food can be continued, but it many patients, life-long TPN is necessary. This method, however, carries significant long-term complications such as sepsis and liver failure, both being life-threatening. The overall prognosis of SBS is poor, as many patients require continuous treatment during their lives and frequent complications often lead to fatal outcomes. For these reasons, a multidisciplinary approach in both treatment and prevention of complications is necessary to maintain an adequate level of quality of life.

1. DiBaise JK, Young RJ, Vanderhoof JA. Intestinal rehabilitation and the short bowel syndrome: part 1. Am J Gastroenterol. 2004;99(7):1386-1395.
2. Bechtold ML, McClave SA, Palmer LB, Nguyen DL, Urben LM, Martindale RG, et al. The pharmacologic treatment of short bowel syndrome: new tricks and novel agents. Curr Gastroenterol Rep. 2014;16(7):392.
3. Jeejeebhoy KN. Short bowel syndrome: a nutritional and medical approach. CMAJ. 2002;166(10):1297-1302.
4. Hasosah M, Lemberg DA, Skarsgard E, Schreiber R. Congenital short bowel syndrome: A case report and review of the literature. Can J Gastroenterol. 2008;22(1):71-74.
5. Seetharam P, Rodrigues G. Short Bowel Syndrome: A Review of Management Options. Saudi J Gastroenterol. 2011;17(4):229-235.
6. Wales PW. Surgical therapy for short bowel syndrome. Pediatr Surg Int. 2004;20(9):647-657.
7. Nightingale J, Woodward JM. Guidelines for management of patients with a short bowel. Gut. 2006;55(4):iv1-iv12.
8. Jackson C, Buchman AL. Advances in the management of short bowel syndrome. Curr Gastroenterol Rep. 2005;7(5):373-378.
9. Jeppesen PB. Gut hormones in the treatment of short-bowel syndrome and intestinal failure. Curr Opin Endocrinol Diabetes Obes. 2015;22(1):14-20.
10. Thompson JS. Comparison of massive vs. repeated resection leading to short bowel syndrome. J Gastrointest Surg. 2000;4(1):101-104.
11. Donohoe CL, Reynolds JV. Short bowel syndrome. Surgeon. 2010;8(5):270-279.
12. Jeppesen PB. Teduglutide for the treatment of short bowel syndrome. Drugs Today (Barc). 2013;49(10):599-614.