Annu Rev Nutr. 2020 Jul 6.

Short Bowel Syndrome: A Paradigm for Intestinal Adaptation to Nutrition?

Johanne Le Beyec , Lore Billiauws , André Bado, Francisca Joly, Maude Le Gall
PMID: 32631145 DOI: 10.1146/annurev-nutr-011720-122203

 

Short bowel syndrome (SBS) is a rare disease that results from extensive  resection of the intestine. When the remaining absorption surface of the intestine cannot absorb enough macronutrients, micronutrients, and water, SBS results in intestinal failure. Patients with SBS who suffer from intestinal failure require parenteral nutrition for survival, but long-term parenteral nutrition may also lead to complications such as catheter sepsis or thrombosis and metabolic liver diseases, renal failure and oxalic lithiasis.

Spontaneous intestinal adaptation occurs weeks to months after resection,resulting in hyperplasia of the remnant gut, modification of gut hormone levels, dysbiosis (i.e;. modification of the intestinal microbiota), and hyperphagia. Oral nutrition and presence of the colon are two major positive drivers for this adaptation.

This review aims to summarize the current knowledge of the mechanisms underlying spontaneous intestinal adaptation, particularly in response to modifications of luminal content, including nutrients. In the future, dietary manipulations could be used to treat SBS

Figure : Three anatomical subtypes of short bowel syndrome.

  1. Small bowel resection with jejunostomy.
  2. Small bowel resection with removal of ileum, ileocecal valve, and part of the colon, resulting in jejunocolic anastomosis.
  3. Small bowel resection in which some ileum is preserved and the ileocecal valve and colon remain intact, resulting in jejunoileal anastomosis