The nutritional management of short bowel syndrome.

Short bowel syndrome (SBS) is the predominant cause of intestinal failure and is associated with a high degree of morbidity and mortality. One of the reasons this occurs is because of the dramatic reduction in nutrient absorptive capacity. There are many causes for the development of SBS, but the most common is extensive surgical resection. The bowel has an impressive ability to adapt both morphologically and functionally. This adaptation becomes critical in decreasing morbidity and mortality. It is also critical for the improvement of quality of life and long-term outcomes. Provision of sufficient nutritional and fluid support is essential to the management of SBS patients. The primary goal is to prevent or eliminate the need for total parenteral nutrition. Specific diets and hormonal therapy may enhance the adaptation process depending on the characteristics of the remaining bowel. For those patients who experience both intestinal failure and life-threatening complications from total parenteral nutrition, bowel transplantation may be indicated.