Short Bowel Syndrome

Short Bowel Syndrome results from loss of sufficient small intestinal length or function, typically defined as less than 150-200 cm of functioning small bowel (normal is 300-600 cm). The loss of absorptive surface area leads to malabsorption of water, electrolytes, nutrients, and medications. The severity depends on the length and location of remaining bowel (duodenum and jejunum preferentially absorb certain nutrients and are more crucial than ileum), whether the colon is present (colonic presence improves prognosis), and intestinal adaptation. After resection, the remaining bowel undergoes adaptive changes over months to years, including increased absorptive capacity per unit length through villous elongation and mucosal thickening. However, adaptation has limits. Most patients become parenteral nutrition-dependent, with associated complications including central line infections, cholestasis (liver disease), and thrombosis. Quality of life is significantly impacted by dependence on intravenous nutrition, dietary restrictions, and chronic diarrhea. Intestinal bacterial overgrowth frequently complicates Short Bowel Syndrome. Some patients can eventually achieve nutritional independence through dietary modifications, medications (antiperislatics), and supportive measures.