Nutritional management of patients with short-bowel syndrome

The healthy small intestine plays a vital role in the absorption of fluid, electrolytes, and nutrients. This function is severely compromised after surgical resection, although the remaining gut has a large capacity for adaptation. The nature of the nutritional support offered to patients with short-bowel syndrome depends on the length and site of small intestine resected, time after surgery, underlying disease, and nutritional status of the patient. If sufficient gut remains, oral supplementation is the treatment of choice, but attention must be given to potential malabsorption, particularly of micronutrients. Oral feeding is perhaps the most important means of promoting intestinal adaptation, which can be much delayed. Inevitably, some patients will not be able to tolerate or thrive on oral nutrition, and these few may need to resort to intravenous feeding support. This approach is often considerably challenging and should be managed only by those with expertise, because numerous and sometimes significant difficulties can be encountered.