SHORT-BOWEL SYNDROME IN CHILDREN AND ADULTS

Short-bower syndrome is the malabsorptive state that follows extensive resection of the small intestine. Potential long-term survival withou t parenteral nutrition heavily depends on stimulation of the process o f intestinal adaptation, through which the remaining small intestine g radually increases its;absorptive capacity. This process is heavily nu trient dependent, and aggressive use of enteral nutrition is required to stimulate its completion. A combination of osmotic sensitivities, n utrient malabsorption, bower dilatation and dysmotility, and changes i n bacterial flora influence the symptoms and the management of this di sorder. Chronic complications include parenteral nutrition-induced liv er disease, nutrient deficiency states, and, frequently, small bowel b acterial overgrowth. Intestinal transplantation has been successfully developed in some centers in the United States, and preliminary experi ence suggest a long-term survival of 50%-75%, better in patients recei ving an isolated intestinal transplant than a combined liver/bower tra nsplant. The ultimate role of intestinal transplantation is still unde rgoing evaluation.