Summary
Short bowel syndrome is characterized by reversible or permanent loss of absorptive capacity due to intestinal resections. Causes of short bowel syndrome in children include necrotizing enterocolitis, intestinal atresia, and volvulus. In adults and the elderly, major causes are inflammatory bowel disease, intestinal ischemia, trauma, and volvulus. The prognosis of individuals with short bowel syndrome depends on the primary disease, the length of the remaining small intestine and colon, and the presence or absence of the ileocecal valve. Therapy is difficult due to the multiple metabolic disturbances. Treatment requires an interdisciplinary approach in a specialized center, and it varies according to the remaining absorptive capacity as well as the phase (hypersecretion phase, adaptation phase, stabilization phase). Therapy consists primarily of parenteral and/or enteral supplementation of fluid, electrolytes, vitamins, trace elements, and substrates. In the hypersecretion phase, proton pump inhibitors are also useful. It is important to start oral or enteral nutrition early on to stimulate adaptation of the remaining intestine. To limit fluid losses, the use of oral rehydration solutions is essential. A major problem in children with short bowel syndrome is bacterial overgrowth and bacterial translocation with sepsis and the development of cholestatic liver disease. In such patients, long-term antibiotic therapy is advised. If conservative therapy is not adequate, an intestinal transplant should be considered.