Jonathan E Rhoads lecture: experiences and observations in the management of patients with short bowel syndrome

In an era before parenteral nutrition (PN) was made practical by Stanley Dudrick, MD, and his colleagues, patients with prolonged intestinal dysfunction or short bowel syndrome would often die of malnutrition or its sequelae. Over the past 4 decades, the treatment of patients with short bowel syndrome had progressed from PN in the hospital to small bowel transplantation. Multimodal therapies have evolved in the management of these patients, including specialized diets and enteral supplements, oral rehydration fluids, antisecretory medication, and the use of growth factors. Home PN is lifesaving when these modalities are ineffective and a surgical procedure to restore or enhance gastrointestinal tract length or absorptive potential is impossible. Small intestine transplantation had been used to salvage those patients who developed life-threatening complications of home PN, but as the survival after intestinal transplant has approached that of liver transplantation, it may soon be considered as primary therapy for patients with short bowel syndrome. This article presents the author's experiences and observations after a 4-decade experience in the management of patients with short bowel syndrome.