The role of gut microbiota in paediatric short bowel syndrome

Short bowel syndrome (SBS) is one of the leading causes of intestinal failure in children. Its development is influenced not only by the length and function of the residual intestine but is also closely related to the homeostasis of the gut microbiota. In recent years, the role of the gut microbiota in intestinal adaptation, metabolic regulation, and the development of complications in pediatric SBS has gradually garnered attention. This review summarizes the characteristics of the gut microbiota, mechanisms underlying dysbiosis, associations with complications, and microbiota-targeted therapeutic strategies in pediatric SBS. Existing studies indicate that children with SBS exhibit reduced microbiota diversity, compositional abnormalities, and metabolic dysfunction. Gut microbiota dysbiosis may be associated with intestinal barrier disruption, immune dysregulation, alterations in residual intestinal structure, and parenteral nutrition, and may contribute to the development and progression of complications such as small intestinal bacterial overgrowth (SIBO), D-lactic acidosis (D-LA), and liver injury. Strategies such as probiotics, nutritional modulation, and fecal microbiota transplantation (FMT) have shown potential clinical value, although their efficacy and safety require further validation. Future studies integrating multi-omics approaches and long-term longitudinal investigations are needed to elucidate the mechanisms underlying interactions between the microbiota and host, thereby providing a theoretical basis for microbiota-targeted interventions and improving long-term outcomes in children with SBS.