Short bowel syndrome natural history, complications and prognosis
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The symptoms of short bowel syndrome usually develop immediately following bowel resection. Diarrhea may cause massive fluid and electrolyte loss. Immediately after surgery, intestinal adaptation develops in three phases, including acute, adaptive and maintenance phase. During the adaptation, structural, motility and functional changes occur. Patients need hydration and nutritional support via parenteral, enteral and oral routes. Length of remaining small bowel is the most important prognostic factor. Patients with more than 200 cm length of small bowel, usually do not need parenteral nutrition. Patients with shorter small bowel may not wean off from parenteral nutrition support. Complications might occur due to malnutrition, surgery and parenteral nutrition. Malnutrition presents with vitamin, mineral and essential fatty acids deficiencies. Complications related to surgery including thrombosis, infection, hemorrhage, atelectasis and anastomosis disruption might occur. Small intestinal bacterial overgrowth due to stasis and obstruction might also occur. Chronic liver disease following parenteral nutrition is a common complication in short bowel syndrome. There is no definite cure for short bowel syndrome. However, medications and nutritional therapy significantly improve the quality of life and survival of the patients. Prognosis of short bowel syndrome depends on the location and size of the bowel resection, underlying pathology, nutrition support, pharmacotherapy, and extent of intestinal adaptation. The 2 and 5-year survival rate of patients with short bowel syndrome are approximately 80% and 70%, respectively.
Natural History, Complications, and Prognosis
- The symptoms of short bowel syndrome usually develop immediately following bowel resection.
- Short bowel syndrome may cause diarrhea which presents with massive fluid and electrolyte loss.
- It is important to manage the patient following surgery, to hydrate and receive enough nutrients through parenteral or enteral routes.
- Immediately after surgery, intestinal adaptation develops in three phases, including acute, adaptive and maintenance phase.
- Structural, motility and functional changes occur to adapt intestine to the new situation.
- Patients with remaining small bowel of more than 120 cm length, usually do not need parenteral nutrition and may be adapted easily.
- It is not common for patients who have small bowel length of less than 50 to be weaned off from parenteral nutrition.
- Efforts must be applied to wean the patients from parenteral nutrition to enteral nutrition and if it is possible to oral nutrition.
- However, complications might happen even if all the precautions are done.
- Vitamin deficiency
- Vitamin A deficiency that presents with night blindness
- Vitamin B12 deficiency that presents with megaloblastic anemia
- Vitamin C deficiency that presents with bleeding tendency
- Vitamin D deficiency that presents with osteomalacia
- Vitamin E deficiency that presents with neuropathy
- Vitamin K deficiency that presents with bleeding
- Mineral deficiency
- Essential fatty acid deficiency
Surgery related complications
- General complications of surgery
- Surgery on gastrointestinal system
Catheter related complications:
- Infection of the central venous line
- Occlusion of the catheter due to thrombosis, fibrin formation, or precipitations
- Breakage of the central line
- Acute rejection
- Chronic rejection
- Hepatic, portal, or mesenteric vein thrombosis
- Opportunistic infection, such as CMV, ….
- Gastrointestinal complications
- Small intestinal bacterial overgrowth due to stasis
- Bowel obstruction
- Bowel motor abnormalities
- Stasis of intestinal contents
- Parenteral nutrition liver disease from steatosis to fibrosis and cirrhosis
- Bowel necrosis
- Peptic ulcers due to gastric hypersecretion
- Gallstones due to altered bile salt and bilirubin metabolism
- Hepatobiliary disease
- Lactose intolerance
- Permanent intestinal failure
- Extra-intestinal complications
- There is no definite cure for short bowel syndrome. However, medications and nutritional therapy significantly improve the quality of life and survival of the patients.
- Prognosis of short bowel syndrome depends on the location and size of the bowel resection, underlying pathology, nutrition support, pharmacotherapy, and extent of intestinal adaptation.
- The quality of life for patients with short bowel syndrome depends on their ability to previous activities. Majority of them on effective treatment could have an excellent quality of life.
- The 2 and 5-year survival rate of patients with short bowel syndrome are approximately 80% and 70%, respectively.
- The 6-year survival rate of patients with short bowel syndrome is approximately 65% for patients who have remaining short bowel of more than 50 cm.
- Much hope is vested in Omegaven, a type of lipid TPN feed, in which recent case reports suggest the risk of liver disease is much lower.
- Although promising, the small intestine transplant has a mixed success rate, with a postoperative mortality rate of up to 30%. One-year and 4-year survival rates are 90% and 60%, respectively.
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