Short bowel syndrome - nutritional recommendations

Short bowel syndrome (SBS), also referred to as the condition of a shortened bowel, is a medical condition characterized by damage or removal of a section of the small intestine [1]. It may arise from various causes, including vascular diseases of the small intestine causing damage, severe malabsorption disorders (e.g., refractory celiac disease), external fistulas resulting in loss of digestive contents, internal fistulas leading to bypassing of part of the small intestine, and extensive resections due to other conditions such as Crohn's disease, cancer, injuries, and others [1]. Consequently, this may lead to significant impairment in nutrient and water absorption, potentially resulting in malnutrition and electrolyte imbalances [1]. Furthermore, the condition may be accompanied by debilitating diarrhea, which can cause dehydration and metabolic acidosis [1].

The management of short bowel syndrome involves three distinct phases: the post-operative, adaptive, and long-term stages. Each phase necessitates tailored nutritional approaches based on appropriate nutritional therapy and dietary interventions [1, 5]. During the post-operative phase, fluid and electrolyte imbalances must be corrected. At this stage, parenteral nutrition is administered intravenously to accelerate adaptive processes. Concurrently, enteral nutrition is introduced to prevent villous atrophy and support intestinal adaptation. Some patients may tolerate small amounts of oral intake [2-5]. Once peristalsis resumes, a liquid diet comprising neutral fluids such as boiled water, still mineral water, chamomile tea, and weak tea (500 ml/day, administered with a spoon) can be initiated [2-5]. In the adaptive phase, parenteral nutrition is gradually reduced in favor of oral feeding, depending on the patient's individual capacity (e.g., age, reason for resection, length of resected segment) [4-5]. Notably, significant intestinal changes, including villous hyperplasia, occur as early as two days post-surgery. In certain cases, parenteral and enteral nutrition are minimized to facilitate normal oral meals [2-5]. If fluid tolerance is well-established, a semi-solid diet containing rice, semolina, and oatmeal porridge may be introduced. The diet can be expanded to include butter, vegetable juices, mashed potatoes, carrots, and herbal infusions such as berry teas and water-based cocoa [2-5]. Subsequently, a blended diet is introduced, featuring pureed soups, cream soups (enriched with butter and cream), bread soaked in soup or tea, rusks, biscuits, minced or blended meat, poultry, and fish [2-5]. Depending on the specific form of short bowel syndrome, further dietary modifications may be required. The primary objective is to ensure optimal adaptation of the remaining intestine, encompassing increased absorptive surface area, enhanced gastrointestinal motility, hormonal secretion, and prevention of pathogenic bacterial overgrowth [2-5]. In severe cases of short bowel syndrome, parenteral or enteral nutrition remains essential, with oral nutrition serving an auxiliary role [2-5]. Following hospital discharge, patients with short bowel syndrome should be monitored by specialized nutrition clinics experienced in parenteral and enteral feeding [2-5]. Effective treatment necessitates multidisciplinary collaboration among gastroenterologists, surgeons, dietitians, and nurses [2-5].