Nutritional management of short bowel syndrome.

Short-bowel syndrome refers to malabsorption, diarrhea, and weight loss following an extensive resection of small bowel. A main consequence is malabsorption of macro- and micronutrients. Nutritional outcome after intestinal resection depends on the extent and location of resection, presence of ileocecal valve and a colon, functional status of the residual intestine, and adaptation. Intraluminal nutrients and trophic factors are critical for intestinal adaptation. The dietary management is focused on the enhancement of intestinal adaptation and optimal caloric intake. Patients with short-bowel syndrome require an individualized diet, and some may require total parenteral nutrition indefinitely. Growth hormone, glutamine, and GLP-2 are reviewed with emphasis on their current use in clinical practice. The nutritional aspect of short-bowel syndrome is complex, with the ultimate goal of weaning the patients from parenteral nutrition. Intestinal transplant is a treatment option for select patients.