Short bowel syndrome natural history, complications and prognosis
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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 initiates 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 200 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
- Vitamin deficiency
- Surgery related complications
- General complications of surgery
- Surgery on gastrointestinal system
- Catheter related complications:
- Post bowel transplant complications:
- Chronic complications
- 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
- Gastrointestinal 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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