Oral nutritional management in short bowel syndrome

Patients with short bowel syndrome (SBS) have less than 200 cm of functional small intestine resulting in significantly impaired digestion and absorption of nutrients and fluids. When malabsorption becomes severe and cannot be compensated by oral intake, patients develop intestinal failure (IF) and require parenteral support (PS) to survive. Over time, however, intestinal adaptation may improve absorption and reduce the need for PS. Oral nutrition plays a central role in the management of SBS and can positively influence the clinical outcomes. This review synthesizes current knowledge on the role of oral nutrition in SBS and provides practical, ready-to-use recommendations for clinical practice. We focus on nutritional assessment, energy- and macronutrient needs, and fluid intake tailored to the different SBS anatomy types. Additionally, we discuss risks associated with oral nutrition, such as high outputs, dehydration and enteric hyperoxaluria. Overall, this review highlights the importance of combining evidence-based strategies with practical guidelines to optimize oral nutritional support and improve long-term outcomes in SBS.