"Gut-feeelng" or evidence-based approaches in the evaluation and treatmentof human short-bowel syndrome

Short bowel syndrome is the malabsorptive state that often follows extensiv e resection of the small intestine. Long-term survival without parenteral n utrition depends on the process of intestinal adaptation, through which the remaining small bowel gradually increases its absorptive capacity. The pro cess of intestinal adaptation is almost exclusively luminal nutrient depend ent. To date the clinical management of short bowel patients is mostly base d on a 'trial and error' regimen because human data and randomised trials u sing trophic substances are lacking due to the small number of patients ann ually present in pediatric surgical centres. We evaluate here the currently available as well as some more recently developed methods of measuring int estinal absorption and adaptation in short bowel patients. New techniques s uch as measurements of (1) intestinal permeability and carbohydrate absorpt ion using the sugar absorption test, (2) gastrointestinal hormone productio n of gastrin, cholecystokinin and peptide YY, (3) transmural potential diff erence of the gastrointestinal tract using electrophysiology and (4) mucosa l enzyme expression of lactase and sucrase-isomaltase using immunohistochem istry were evaluated. These new techniques are promising in monitoring the process of adaptation of the remaining intestine and evaluating the effect of therapeutic interventions in patients with short bowel syndrome.