Management of Short Bowel Syndrome and Intestinal Failure

Short Bowel Syndrome (SBS) and associated Intestinal Failure (IF) represent a continuum of disorders characterised by insufficient absorptive capacity following extensive small-bowel resection or congenital absence. Management aims to optimise residual gut function, promote intestinal adaptation and maintain nutritional homeostasis while minimising complications. Initial strategies comprise dietary modification with high-energy, low-volume feeds, targeted micronutrient supplementation and antimotility agents to reduce diarrhoeal losses. When oral and enteral routes are insufficient, parenteral nutrition (PN) provides lifesaving macronutrients and electrolytes via central venous access. Advances in hormonal therapy, notably analogues of glucagon-like peptide-2 (GLP-2), have demonstrated the capacity to enhance mucosal growth, increase absorptive surface and reduce dependence on PN. Surgical interventions, including intestinal lengthening procedures and transplantation, offer further options in selected patients but carry significant morbidity. Long-term care relies on multidisciplinary teams encompassing gastroenterologists, surgeons, dietitians, nursing specialists and pharmacists to coordinate patient-specific protocols. Monitoring addresses central catheter complications, such as bloodstream infection and thrombosis, as well as liver dysfunction and metabolic bone disease. Emerging research explores novel growth factors, microbiome modulation and tissue engineering to extend gut adaptation. Globally, standardised care pathways and collaborative registries aim to extend survival, improve quality of life and reduce the socioeconomic burden of chronic PN dependence.

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Management of Short Bowel Syndrome and Intestinal Failure publication trend

The graph below shows the total number of articles in management of short bowel syndrome and intestinal failure across all publications each year (not limited to Nature Index journals).

Technical terms

Short Bowel Syndrome (SBS): A malabsorptive state due to significant loss of small intestine, impairing nutrient and fluid uptake.

Intestinal failure (IF): A condition in which the gut cannot absorb sufficient water, electrolytes or nutrients to sustain health without intravenous support.

Parenteral nutrition (PN): The intravenous provision of carbohydrates, proteins, fats, vitamins and minerals to patients with insufficient gut function.

Enteral autonomy: Achievement of adequate nutritional status solely via the gastrointestinal tract without reliance on PN.

Glucagon-like peptide-2 (GLP-2) analogue: A synthetic hormone mimic that stimulates intestinal mucosal growth and enhances absorptive capacity.

References

1. Glepaglutide, a Long-Acting Glucagon-like Peptide-2 Analogue, Reduces Parenteral Support in Patients With Short Bowel Syndrome: A Phase 3 Randomized Controlled Trial. Gastroenterology (2024).
2. An Overview of Short-Bowel Syndrome in Pediatric Patients: Focus on Clinical Management and Prevention of Complications. Nutrients (2023).
3. Parenteral Nutrition and Intestinal Failure. Nutrients (2017).