Short bowel syndrome natural history, complications and prognosis
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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]
Overview
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
OR
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
OR
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
Natural History, Complications, and Prognosis
Natural History
- The symptoms of (disease name) usually develop in the first/ second/ third decade of life, and start with symptoms such as ___.
- The symptoms of (disease name) typically develop ___ years after exposure to ___.
- If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
Complications
Common complications of short bowel syndrome may be classified to different categories, including malnutrition, surgery related, and chronic complications.[1][2][3]
- Malnutrition
- Vitamin deficiency
- Vitamin A deficiency
- Vitamin B12 deficiency
- Vitamin C deficiency
- Vitamin D deficiency
- Vitamin E deficiency
- Vitamin K deficiency
- Mineral deficiency
- Iron deficiency
- Folic acid deficiency
- Calcium deficiency
- Zinc deficiency
- Magnesium deficiency
- Selenium deficiency
- Copper deficiency
- Micronutrient deficiency/excess
- Essential fatty acid deficiency
- Vitamin deficiency
- Surgery related complications
- General complications of surgery
- Thrombosis
- Hemorrhage
- Wound infection
- Postoperative pulmonary atelectasis
- Acute kidney injury
- Pulmonary embolism
- Deep vein thrombosis
- Surgery on GI system
- Anastomotic disruption
- Anastomotic bleeding
- Catheter related complications:
- Infection of the central line
- Occlusion of the catheter due to thrombosis, fibrin formation, or precipitations
- Breakage of the central line
- Post bowel transplant complications:
- Acute rejection
- Chronic rejection
- Hepatic, portal, or mesenteric vein thrombosis
- Opportunistic infection, such as CMV, ….
- General complications of surgery
- Chronic complications
- Gastrointestinal
- Small intestinal bacterial overgrowth due to stasis
- Bowel obstruction
- Bowel motor abnormalities
- Stasis of intestinal contents
- Parenteral nutrition liver disease from steatosis to 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
- Kidney stone due to hyperoxaluria
- Metabolic bone disease
- Lactic acidosis
- Gastrointestinal
Prognosis
- There is no cure for short bowel syndrome.
- In newborn infants, the 4-year survival rate on parenteral nutrition is approximately 70%. Some studies suggest that much of the mortality is due to a complication of the TPN, especially chronic liver disease.[4]
- 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.[5]
- 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.
- Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
- Depending on the extent of the [tumor/disease progression/etc.] at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor/good/excellent.
- The presence of [characteristic of disease] is associated with a particularly [good/poor] prognosis among patients with [disease/malignancy].
- [Subtype of disease/malignancy] is associated with the most favorable prognosis.
- The prognosis varies with the [characteristic] of tumor; [subtype of disease/malignancy] have the most favorable prognosis.
References
- ↑ 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.
- ↑ Thompson, Jon S.; Weseman, Rebecca; Rochling, Fedja A.; Mercer, David F. (2011). "Current Management of the Short Bowel Syndrome". Surgical Clinics of North America. 91 (3): 493–510. doi:10.1016/j.suc.2011.02.006. ISSN 0039-6109.
- ↑ 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.
- ↑ Vanderhoof JA, Langnas AN (1997). "Short-bowel syndrome in children and adults". Gastroenterology. 113 (5): 1767–78. PMID 9352883.
- ↑ Gura KM, Duggan CP, Collier SB; et al. (2006). "Reversal of parenteral nutrition-associated liver disease in two infants with short bowel syndrome using parenteral fish oil: implications for future management". Pediatrics. 118 (1): e197–201. doi:10.1542/peds.2005-2662. PMID 16818533.