Short bowel syndrome pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]


Short bowel syndrome occurrs as a result of bowel resection following various diseases of the gut such as Crohn's disease, malignancies, ischemia, and trauma. Short bowel syndrome occurs when the length of the small intestine is less than 2 meters and requires nutritional therapy to prevent malnutrition. Post bowel resection, adaptation might occur which includes structural, motility and functional changes in the remaining intestine. Changes usually start in the first 24 hours following bowel resection and last for about two years. Adaptation depends upon multiple factors including individual, intestinal and therapeutic measurements. Following bowel resectionadaptation occurs in three phases including acute, adaptive, and maintenance phases. Successful adaptation depends on the length of remaining intestine, portion of the resected intestine, and early introduction of nutrition therapy. The term total intestinal adaptation is used when the patient is weaned from parenteral nutrition. The main reason for malabsorption following bowel resection is reduced absorptive capacity of the small intestine due to loss of surface area. On gross and microscopic examination, the resected bowel segment may show the underlying causes including Crohn's diseasemalignancies or ischemia.



Diagram of the small bowel 01. Source: By Cancer Research UK - Original email from CRUK, CC BY-SA 4.0,[1]

The small intestine has an average length of 5.5-6 meters and is responsible for digestion and absorption of food and nutrients. Three portions of small intestine are duodenum, jejunum, and ileum. There is an anatomic gradient for absorption throughout the gastrointestinal tract.[2][3]


Post bowel resection adaptation

Change Main features
Structural changes
Motility changes
  • Greater motility during the initial phase
  • Reduced motility during the adaptive phase
Functional changes
Intestinal adaptation
Phase Duration Main feature
Acute phase 1 to 3 months
Adaptive phase 1 to 2 years
Maintenance phase Following adaptive phase


Associated Conditions

Short bowel syndrome might be associated with following pathologies:

Gross Pathology

Terminal ileum resected for Crohn's disease. By PPSE15 - Own work, CC BY-SA 4.0[12]
Partial Jejunum affected by morbus Crohn. Source: By Jaroslav Cehovsky - Camera, Public Domain[13]

Microscopic Pathology


  1. "File:Diagram of the small bowel 01 CRUK 045.svg - Wikimedia Commons".
  2. 2.0 2.1 Tappenden KA (2014). "Pathophysiology of short bowel syndrome: considerations of resected and residual anatomy". JPEN J Parenter Enteral Nutr. 38 (1 Suppl): 14S–22S. doi:10.1177/0148607113520005. PMID 24500909.
  3. Thomson, Alan B.R.; Drozdowski, Laurie; Iordache, Claudiu; Thomson, Ben K.A.; Vermeire, Severine; Clandinin, M. Tom; Wild, Gary (2003). Digestive Diseases and Sciences. 48 (8): 1546–1564. doi:10.1023/A:1024719925058. ISSN 0163-2116. Missing or empty |title= (help)
  4. Sundaram A, Koutkia P, Apovian CM (2002). "Nutritional management of short bowel syndrome in adults". J. Clin. Gastroenterol. 34 (3): 207–20. PMID 11873098.
  5. 5.0 5.1 Eça, Rosário; Barbosa, Elisabete (2016). "Short bowel syndrome: treatment options". Journal of Coloproctology. 36 (4): 262–272. doi:10.1016/j.jcol.2016.07.002. ISSN 2237-9363.
  6. 6.0 6.1 Warner, Brad W. (2013). "Adaptation: Paradigm for the gut and an academic career". Journal of Pediatric Surgery. 48 (1): 20–26. doi:10.1016/j.jpedsurg.2012.10.014. ISSN 0022-3468.
  7. Rowland, Kathryn J.; McMellen, Mark E.; Wakeman, Derek; Wandu, Wambul S.; Erwin, Christopher R.; Warner, Brad W. (2012). "Enterocyte expression of epidermal growth factor receptor is not required for intestinal adaptation in response to massive small bowel resection". Journal of Pediatric Surgery. 47 (9): 1748–1753. doi:10.1016/j.jpedsurg.2012.03.089. ISSN 0022-3468.
  8. Matarese LE, O'Keefe SJ, Kandil HM, Bond G, Costa G, Abu-Elmagd K (2005). "Short bowel syndrome: clinical guidelines for nutrition management". Nutr Clin Pract. 20 (5): 493–502. doi:10.1177/0115426505020005493. PMID 16207689.
  9. Wall, Elizabeth A. (2013). "An Overview of Short Bowel Syndrome Management: Adherence, Adaptation, and Practical Recommendations". Journal of the Academy of Nutrition and Dietetics. 113 (9): 1200–1208. doi:10.1016/j.jand.2013.05.001. ISSN 2212-2672.
  10. Misiakos EP, Macheras A, Kapetanakis T, Liakakos T (2007). "Short bowel syndrome: current medical and surgical trends". J. Clin. Gastroenterol. 41 (1): 5–18. doi:10.1097/01.mcg.0000212617.74337.e9. PMID 17198059.
  11. Vanderhoof JA, Young RJ (2003). "Enteral and parenteral nutrition in the care of patients with short-bowel syndrome". Best Pract Res Clin Gastroenterol. 17 (6): 997–1015. PMID 14642862.
  12. "File:ResectedIleum.jpg - Wikimedia Commons". External link in |title= (help)
  13. "File:Crohn Jejunum.PNG - Wikimedia Commons".