ABSTRACT
This chapter reviews the pathophysiology and nutritional-metabolic treatment of patients with short-bowel syndrome. It presents the scientific rationale for and the clinical utility of enteral nutrition and elemental diets. The severity of the short-bowel syndrome is determined by several factors including the remaining length of small bowel, concomitant or previous gastric and colonic resections, resection of the terminal ileum, ileocecal valve, and persistence of disease in the remaining bowel. The length of resected ileum determines the pathophysiology of diarrhea, and this, in turn, has important therapeutic and prognostic implications. Most patients with short-bowel syndrome are fed solely with total parenteral nutrition (TPN) during their early postoperative recovery. Animals and patients receiving TPN, either with or without intestinal resection, have been used to identify factors which promote and/or regulate mucosal growth and function. The most important stimulus for intestinal growth and function is the presence of food in the gut lumen; this stimulus acts both indirectly and directly.
