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 Vol. 10 No. 7, July 2009
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NeoReviews Vol.10 No.7 2009 e339
© 2009 American Academy of Pediatrics

Short Bowel Syndrome

Complications, Treatment, and Remaining Questions

Fernando Navarro, MD*
Wallace A. Gleason, MD*
J. Marc Rhoads, MD*
Ruben E. Quiros-Tejeira, MD*

* The University of Texas Medical School at Houston and Department of Pediatrics, Children's Memorial Hermann Hospital, Houston, Tex

This review deals with the complications and treatment of short bowel syndrome (SBS), addressing the psychosocial, medical, and surgical complications in children receiving long-term parenteral nutrition (PN) support, as well as factors that affect the intestinal adaptation process. Whenever possible, as much of the colon as possible is retained in continuity because the colon is an avid absorber of sodium. It is also important for clinicians to be aware of the important absorption mechanisms in the different regions of the bowel. For example, resection of the terminal ileum removes vitamin B12 transporters and active sodium-coupled bile salt transporters. Treatment of patients missing the terminal ileum may require monthly vitamin B12 injections and oral bile salt binders, such as cholestyramine, when the colon is present to reduce the volume of diarrhea. Patients who do not have ileocecal valves (ICVs) are prone to small bowel bacterial overgrowth that requires treatment to facilitate the intestinal adaptation process. We discuss how the PN is decreased as enteral feedings are advanced as well as clinical monitoring and routine laboratory tests. Although much has been learned over the past 20 years about PN, major questions remain, including determining the optimal form of intravenous lipid (omega-3 preparations versus omega-6 lipids versus a combination of both) to prevent liver disease.

Abbreviations: GH: growth hormone • GLN: glutamine • HCLF: high-carbohydrate/low-fat • ICV: ileocecal valve • LCT: long-chain triglyceride • LMWH: low-molecular weight heparin • MAPK: mitogen-activated protein kinase • MCT: medium-chair triglyceride • NEC: necrotizing enterocolitis • PN: parenteral nutrition • SBBO: small bowel bacterial overgrowth • SBS: short bowel syndrome • STEP: serial transverse enteroplasty procedure • UDCA: ursodeoxycholic acid


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