ABSTRACT

The care of infants and children with short bowel syndrome (SBS) is primarily focused on meticulous nutritional support, while the remaining intestine undergoes adaptation thereby enhancing nutrient-absorptive capacity (reviewed in Chapter 2). Clinical experience and animal studies have demonstrated that the small intestine adapts through hypertrophy of the mucosa, which increases absorptive abilities [1-4]. Grossly, the bowel dilates, lengthens, and thickens; microscopically villus hyperplasia occurs with increased crypt depth, and muscle thickness [5]. Production of brush-border enzymes is augmented, as well as increases in mucosal weight, protein, RNA, and DNA content [5,6]. Intestinal adaptation begins within 24-48 h of resection, but may continue for several years [7]. Although systematic studies in humans are practically dif—cult, the data available support similar histological and functional adaptation in infants, which may take several years to complete [8]. Adequate intestinal adaptation is required before a patient with extensive GI resection is able to absorb suf—cient enteral nutrients and be weaned from parenteral nutrition (PN) support.