Enteral and parenteral nutrition in patients with short-bowel syndrome

Short-bowel syndrome is functionally defined as a state of malabsorption fo llowing loss of small bowel. Most: cases occur in the neonatal period after extensive resection for necrotizing enterocolitis, or due to congenital an omalies of the gastrointestinal tract. A smaller percentage originate later in life from surgical treatment of Crohn's disease, neoplastic disorders, or vascular events. The physiological, morphological and functional intesti nal gradient determines the clinical picture leading to better tolerance of jejunal than ileal resections. The subsequent adaptation process requires enteral feeding with a different impact of specific nutrients, and is also influenced by a number of humoral mediators such as enteroglucagon, gastrin , growth factors, prostaglandins and polyamines, Nutritional management sta rts parenterally via a central venous line covering basic demands, substitu ting current losses and restoring pre-existing deficiencies. Continuous ent eral tube feeding is added as soon as postoperative ileus resolves, beginni ng with an elemental diet, which is gradually increased first in concentrat ion, then in quantity, and supplemented by small oral meals. Cycling of par enteral nutrition is the next step. As soon as sufficient stability is reac hed, the child should be discharged home under continued outpatient care. M ain long-term problems comprise bacterial overgrowth, fluid and electrolyte disequilibration, nutritional deficiencies, parenteral nutrition-related l iver disease, and central venous line complications such as sepsis and thro mbosis.