Concise review on short bowel syndrome: Etiology, pathophysiology, and management

Table 1 Three phases for the process of intestinal adaptation

Phase	Time duration	Symptom
Phase 1	1-3 mo	Severe diarrhea, limited absorption. Complete nutrient and fluid support with parenteral nutrition is needed
Phase 2	Few months to 1 yr	Improvement of absorption. Start reducing PN
Phase 3	Second-year	Maximal adaptation. PN is eliminated or reduced to several nights per week

PN: Parenteral nutrition.

Table 2 List of deficiency disorders encountered in patients with short bowel syndrome

Deficiency	Disease
Vitamin C	Scurvy
Calcium	Osteoporosis
Vitamin A	Night blindness, corneal ulcerations
Vitamin E	Paresthesia, ataxia
Vitamin K	Prolonged bleeding
Iron	Anemia, glossitis
Zinc	Stomatitis, alopecia

Table 3 Dietary management in patients with colon vs without colon

Surgical operation	Dietary management
End-jejunostomy without colon	(1) Complex carbohydrates are preferred over simple carbohydrates to reduce stoma output; (2) Can tolerate a higher fat diet (30%-40%) than patients with colon continuity; (3) Long-chain triglycerides are favored over MCT because with such anatomy, MCT decreases protein and carbohydrate absorption; (4) Soluble fibers may be administered; and (5) Magnesium (as it is normally absorbed in the distal small intestine or colon), Vitamin B12 and bile salts[14]
Jejuno-colonic anastomosis with some colon in continuity	(1) Due to colon continuity, colonic bacterial fermentation allows salvage of 1,000 additional calories per day. They can benefit from a diet high in complex carbohydrates[9]; (2) Superior outcomes with diets of lower fat compared to higher fat content[52]; (3) Medium-chain triglycerides improve overall fat absorption compared with a similar diet that has only long-chain triglycerides[53]; (4) Prefer diets with low oxalate and high calcium content to avoid calcium oxalate nephrolithiasis[11]; and (5) Soluble fibers are preferred compared to insoluble fibers. Fibers should be avoided in patients with diarrhea of > 3 L/d[11]
Jejuno-ileocolic anastomosis with full colon

MCT: Medium-chain triglycerides.

Table 4 Contraindications to intestinal transplant

Contraindication
Non-resectable malignancy
Severe immunological deficiencies
Advanced cardiopulmonary disease
Advanced neurologic dysfunction
Sepsis with multisystem organ failure
Major psychiatric illness
Demonstrated patient non-compliance
Insufficient vascular patency for central venous access for < 6 mo after intestinal transplant