Advances in Nutritional and Therapeutic Strategies for Type 2 Intestinal Failure: A Narrative Review.

Abstract

This narrative review aims to examine the nutritional consequences of type 2 intestinal failure (T2IF), assess current nutritional therapies, and explore advanced methodologies to address feeding challenges. Type 2 intestinal failure is characterized by severe nutrient malabsorption, micronutrient deficiencies, and disease-related malnutrition, compounded by complications such as microbiota disruption. Effective nutritional management is essential to improve clinical outcomes, yet an evidence gap hinders the establishment of standardized care guidelines. A literature search was conducted using major databases to identify clinical trials, cohort studies, and reviews on clinical nutrition and intestinal failure. Findings were analyzed narratively due to study design heterogeneity. Type 2 intestinal failure presents significant risks of disease-related malnutrition, inflammation, and muscle wasting due to impaired nutrient absorption and prolonged immobility. Optimizing protein and dietary fiber intakes is essential to preserve muscle mass and gut health. Parenteral nutrition (PN) remains essential but prolonged reliance may contribute to delayed intestinal adaptation and mucosal atrophy, highlighting the need for gut-focused strategies. Adjunct therapies, such as glucagon-like peptide 2 and somatostatin analogs, support intestinal adaptation but inadequately address protein, dietary fiber, and micronutrient requirements. Chyme reinfusion therapy, which returns nutrient-rich chyme to the gut, shows promise in reducing PN dependency, improving weight, and facilitating earlier oral intake, but it requires validation through robust comparative studies and clinical trials. Advanced methodologies, such as stable-isotope tracer techniques and positron emission topographic tracing, offer precise insights into tissue nutrient metabolism; however, cost and technical challenges are barriers. Tailored nutritional interventions are critical for mitigating disease-related malnutrition and optimizing outcomes in T2IF. Bridging evidence gaps through advanced techniques and standardized protocols will aid in refining therapeutic strategies, enhance patient quality of life, and inform comprehensive care guidelines.