Nutrition in intestinal failure/short bowel syndrome

Intestinal failure is the critical reduction of functional gut mass below the minimal amount necessary for adequate digestion and absorption to satisfy body nutrient and fluid requirements for maintenance and growth in children and adults. Short-bowel syndrome (SBS) is the most common cause of intestinal failure in infants, and results from surgical resection, congenital defect, or disease-associated loss of absorption capacity of the gut. It is characterized by the inability to maintain protein-energy, fluid, electrolyte, or micronutrient balances when on a conventionally accepted, normal diet, resulting in dependence on parenteral nutrition (PN). The duration of PN significantly correlates with the length of residual gut. The most common cause of SBS (35-50∈% of cases) in the neonatal period is necrotizing enterocolitis. The other causes include abdominal wall defects such as gastroschisis, and omphalocele, midgut volvulus, and intestinal atresia. Approximately, 80∈% of SBS in the paediatric population occurs in the neonatal period. The health burden of SBS is significant with high mortality (27.5-37.5∈%), and morbidity including recurrent bouts of sepsis needing hospitalisation, prolonged hospital stay, impaired long term growth and development, and high cost of care. The pathophysiology, mechanisms of intestinal adaptation, and management of SBS are reviewed.