Advances in non-surgical treatment for pediatric patients with short bowel syndrome

ABSTRACT

Introduction

Short bowel syndrome (SBS) is the most common cause of intestinal failure resulting in the need for long-term parenteral nutrition. Treatment for SBS involves the close management of parenteral and enteral nutrition as well as central venous access to prevent complications while allowing time for the remaining intestine to undergo the process of adaptation.

Areas covered

This review highlights the current state of management and treatment of SBS. Parenteral and enteral management strategies are outlined with a review of the evidence regarding lipid management, prevention of intestinal failure associated liver disease, and promotion of intestinal adaptation. Central venous access management and the evidence for prevention of central line-associated blood stream infections are reviewed. The most common nutritional deficiencies and complications associated with SBS are discussed and treatment strategies covered. Several hormone analogues have recently been developed which have been shown to promote intestinal adaptation. The evidence for these new drugs is also outlined.

Expert opinion

Previous treatments for SBS focused on symptom management and complication prevention. While these remain important in the intestinal rehabilitation of patients with SBS, the introduction of promising new hormonal therapies has provided a way to augment the process of adaptation.

KEYWORDS:

• Short bowel syndrome
• intestinal failure
• parenteral nutrition
• central venous access
• intestinal adaptation
• glucagon-like peptide-2

Article highlights

• Treatment for SBS involves the close management of parenteral and enteral nutrition as well as central venous access to prevent complications while allowing time for the remaining intestine to undergo the process of adaptation.

• Mixed lipid emulsions are available that provide a balance of essential fatty acids while protecting the liver from intestinal failure associated liver disease even at higher doses.

• Standardized central line care and antimicrobial locks have helped to prevent central line-associated blood stream infections which can be potentially life-threatening.

• Prevention and management of central line-related thrombi is necessary for preservation of long-term central venous access.

• SBS patients require close monitoring as nutritional deficiencies are common both while receiving parenteral nutrition as well as after becoming enterally autonomous.

• The majority of treatments for SBS focus on symptom management and complication prevention.

• Hormone analogue therapies are available with new potential drugs in development that aid in the process of intestinal adaptation.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.