Inflammatory disease and outcome of short bowel syndrome

The outcome of the short bowel syndrome (SBS) is influenced by several factors including intestinal disease, remnant length and location, the other digestive organs, and intestinal adaptation. Because underlying inflammatory disease might influence several of these, the aim of this study was to evaluate the outcome of SBS in inflammatory conditions.

A total of 106 adult patients with SBS evaluated over a 20-year period were studied. Thirty (28%) patients had either Crohn's disease (n = 10) or radiation enteritis (n = 20).

Multiple resections were more common in the inflammatory group (57% versus 12%, P <0.05.) These patients had longer intestinal remnants but the type of colonic remnant and the presence of an ileal remnant, the ileocecal junction and a stoma was similar in both groups. A similar proportion of patients in both groups required parenteral nutrition (PN) in the first year (73% versus 68%). Patients with inflammatory conditions were less likely to require PN after the first year (33% versus 63%; P<0.05).

Patients with SBS resulting from inflammatory disease appear to have a better nutritional prognosis after the first year. While they are more likely to have had multiple resections and develop SBS with longer remnant length, inflammatory disease itself is an important prognostic factor. This may be related to resolution of inflammatory disease or a greater adaptive response.