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{{Short bowel syndrome}}
{{Short bowel syndrome}}


{{CMG}}
{{CMG}}; {{AE}} {{SSH}}


==Overview==
==Overview==
Management of short bowel syndrome is complicated and requires close collaboration of all medical team members including the physician, nutritionist, and nurse with the patient and their families. Medical therapy consists of [[Nutrition|nutritional]] therapy and [[pharmacotherapy]]. [[Nutrition|Nutritional]] therapy is essential for short bowel syndrome and to restore the [[Intestine|intestinal]] [[adaptation]]. It could be provided through [[Mouth|oral]], [[Feeding tube|enteral]] and [[Route of administration|parenteral]] routes. The ultimate goal is to provide necessary [[Nutrient|nutrients]] via [[Route of administration|oral route]] other than [[Route of administration|parenteral]] or [[Feeding tube|enteral]] routes. All patients require enough [[fluid]], [[Electrolyte|electrolytes]], [[Dietary supplement|supplements]] and [[Calorie|calories]]. Medications are used to control [[symptoms]] of short bowel syndrome include antimotility agents, antisecretory agents, and [[Tropic hormone|trophic agents]]. Lifelong follow-up is usually needed.


==Medical Therapy==
==Medical Therapy==
*Management of short bowel syndrome is complicated and requires close collaboration of all medical team members including the physician, nutritionist, and nurse with the patient and their families.  
*Management of short bowel syndrome is complicated and requires close collaboration of all medical team members including the physician, nutritionist, and nurse with the patient and their families.<ref name="pmid16770167">{{cite journal |vauthors=Matarese LE, Steiger E |title=Dietary and medical management of short bowel syndrome in adult patients |journal=J. Clin. Gastroenterol. |volume=40 Suppl 2 |issue= |pages=S85–93 |year=2006 |pmid=16770167 |doi=10.1097/01.mcg.0000212678.14172.7a |url=}}</ref><ref name="pmid24247092">{{cite journal |vauthors=Kelly DG, Tappenden KA, Winkler MF |title=Short bowel syndrome: highlights of patient management, quality of life, and survival |journal=JPEN J Parenter Enteral Nutr |volume=38 |issue=4 |pages=427–37 |year=2014 |pmid=24247092 |doi=10.1177/0148607113512678 |url=}}</ref>
*Management of short bowel syndrome consists of medical therapy and surgical interventions.  
*Management of short bowel syndrome consists of medical therapy and surgical interventions.<ref name="pmid25052938">{{cite journal |vauthors=Bechtold ML, McClave SA, Palmer LB, Nguyen DL, Urben LM, Martindale RG, Hurt RT |title=The pharmacologic treatment of short bowel syndrome: new tricks and novel agents |journal=Curr Gastroenterol Rep |volume=16 |issue=7 |pages=392 |year=2014 |pmid=25052938 |doi=10.1007/s11894-014-0392-2 |url=}}</ref><ref name="RodriguesSeetharam2011">{{cite journal|last1=Rodrigues|first1=Gabriel|last2=Seetharam|first2=Prasad|title=Short bowel syndrome: A review of management options|journal=Saudi Journal of Gastroenterology|volume=17|issue=4|year=2011|pages=229|issn=1319-3767|doi=10.4103/1319-3767.82573}}</ref><ref name="Wall2013">{{cite journal|last1=Wall|first1=Elizabeth A.|title=An Overview of Short Bowel Syndrome Management: Adherence, Adaptation, and Practical Recommendations|journal=Journal of the Academy of Nutrition and Dietetics|volume=113|issue=9|year=2013|pages=1200–1208|issn=22122672|doi=10.1016/j.jand.2013.05.001}}</ref><ref name="ThompsonWeseman2011">{{cite journal|last1=Thompson|first1=Jon S.|last2=Weseman|first2=Rebecca|last3=Rochling|first3=Fedja A.|last4=Mercer|first4=David F.|title=Current Management of the Short Bowel Syndrome|journal=Surgical Clinics of North America|volume=91|issue=3|year=2011|pages=493–510|issn=00396109|doi=10.1016/j.suc.2011.02.006}}</ref><ref name="EçaBarbosa2016">{{cite journal|last1=Eça|first1=Rosário|last2=Barbosa|first2=Elisabete|title=Short bowel syndrome: treatment options|journal=Journal of Coloproctology|volume=36|issue=4|year=2016|pages=262–272|issn=22379363|doi=10.1016/j.jcol.2016.07.002}}</ref><ref name="pmid15494290">{{cite journal |vauthors=Keller J, Panter H, Layer P |title=Management of the short bowel syndrome after extensive small bowel resection |journal=Best Pract Res Clin Gastroenterol |volume=18 |issue=5 |pages=977–92 |year=2004 |pmid=15494290 |doi=10.1016/j.bpg.2004.05.002 |url=}}</ref><ref name="pmid17198059">{{cite journal |vauthors=Misiakos EP, Macheras A, Kapetanakis T, Liakakos T |title=Short bowel syndrome: current medical and surgical trends |journal=J. Clin. Gastroenterol. |volume=41 |issue=1 |pages=5–18 |year=2007 |pmid=17198059 |doi=10.1097/01.mcg.0000212617.74337.e9 |url=}}</ref><ref name="pmid16207689">{{cite journal |vauthors=Matarese LE, O'Keefe SJ, Kandil HM, Bond G, Costa G, Abu-Elmagd K |title=Short bowel syndrome: clinical guidelines for nutrition management |journal=Nutr Clin Pract |volume=20 |issue=5 |pages=493–502 |year=2005 |pmid=16207689 |doi=10.1177/0115426505020005493 |url=}}</ref><ref name="pmid11873098">{{cite journal |vauthors=Sundaram A, Koutkia P, Apovian CM |title=Nutritional management of short bowel syndrome in adults |journal=J. Clin. Gastroenterol. |volume=34 |issue=3 |pages=207–20 |year=2002 |pmid=11873098 |doi= |url=}}</ref><ref name="pmid14642862">{{cite journal |vauthors=Vanderhoof JA, Young RJ |title=Enteral and parenteral nutrition in the care of patients with short-bowel syndrome |journal=Best Pract Res Clin Gastroenterol |volume=17 |issue=6 |pages=997–1015 |year=2003 |pmid=14642862 |doi= |url=}}</ref>
*Medical therapy consists of nutritional therapy and pharmacotherapy.
*Medical therapy consists of [[Nutrition|nutritional]] therapy and [[pharmacotherapy]].
*Lifelong follow-up is usually needed.
*Lifelong follow-up is usually needed.
===Nutritional therapy===
===Nutritional therapy===
*Nutritional therapy is essential for short bowel syndrome and to restore the intestinal adaptation. It could be provided through oral, enteral and parenteral routes.
*[[Nutrition|Nutritional]] therapy is essential for short bowel syndrome and to restore the [[Intestine|intestinal]] [[adaptation]]. It could be provided through [[Mouth|oral]], [[Feeding tube|enteral]] and [[Route of administration|parenteral]] routes.
** 1 '''Fluid'''
*[[Total parenteral nutrition|Parenteral nutrition]] should be started after [[bowel resection]].
*** 1.1 Acute phase
*The ultimate goal is to provide necessary [[Nutrient|nutrients]] via [[Route of administration|oral route]] other than [[Route of administration|parenteral]] or [[Feeding tube|enteral]] routes.
**** Preferred regimen (1): Normal saline
*Required [[Diet (nutrition)|diet]] must be started as soon as possible after [[surgery]]. However the composition of their [[Diet (nutrition)|diet]] would be different depending upon the condition of the patient.
**** Preferred regimen (1): Ringer lactate  
*All patients require enough [[fluid]], [[Electrolyte|electrolytes]], [[Dietary supplement|supplements]] and [[Calorie|calories]].
** '''1 Fluids'''
*** '''1.1 Acute phase'''
**** Preferred regimen (1): [[Saline (medicine)|Normal saline]]
**** Preferred regimen (1): [[Lactated Ringer's solution|Ringer's lactate]]
*** '''1.2 Maintenance phase'''
**** [[Oral rehydration therapy|Oral rehydration solutions]] ([[Oral rehydration therapy|ORS]])
**** Water
**** Sports drinks
**** Sodas without caffeine
**** Salty broths


** 1.2 Maintenance phase
* '''Note (1):''' 300-500 ml must be added to [[fluid loss]] as an [[Insensible water loss|insensible loss]].


*** Water
*'''Note (2):''' [[Urine|Urine output]] should be at least 1 L per day.
*** Sports drinks
**'''2 Diet'''
*** Sodas without caffeine
*** Preferred regimen (1): 30-40 kcal/kg/day diet consists of [[carbohydrate]] 55-60%, [[fat]] 20-25%, and [[protein]] 20%
*** Salty broths
* '''Note (1):''' Small and frequent [[Diet (nutrition)|diet]] is recommended.
Note (1): 300-500 ml must be added to fluid loss as an insensible loss.
* '''Note (2):''' Foods high in [[sugar]], [[protein]], [[fat]], and [[Fiber (food)|fiber]] must be avoided.
** 2 '''Parenteral infusion'''
* '''Note (3):''' Patients with preservation of the [[Colon (anatomy)|colon]] require [[Diet (nutrition)|diet]] rich in [[Carbohydrate|carbohydrates]] but low [[fat]].
*** 2.1 Acute phase
* '''Note (4):''' Patients with [[Ileum|ileal]] resection more than 100cm, require low [[oxalate]] and high [[calcium]] [[Diet (nutrition)|diet]].
**** 2.1.1 Diet
* '''Note (5):''' Patients who have [[diarrhea]] more than 3L per day, must avoid high levels of [[Fiber (food)|fiber]] in their [[Diet (nutrition)|diet]]. 
***** Preferred regimen (1): 30-40 kcal/kg/day diet consists of carbohydrate 55-60%, fat 20-25%, and protein 20%
* '''Note (6):''' Medium-chain [[Triglyceride|triglycerides]] should be avoided in patients with a jejunostomy or ileostomy.
**** 2.1.2 Electrolytes
** '''3 Supplement'''
***** 2.1.2.1 Sodium
*** 3.1 [[Electrolyte|Electrolytes]]
***** 2.1.2.2 Potassium
**** 3.1.1 [[Sodium]]
***** 2.1.2.3 Magnesium
**** 3.1.2 [[Potassium]]
***2.2 Maintenance phase
**** 3.1.3 [[Magnesium]]
**** Preferred regimen (1): 30-40 kcal/kg/day diet consists of carbohydrate 55-60%, fat 20-25%, and protein 20%
*** '''3.2 Vitamins'''
* Note (1): Small and frequent diet is recommended.
**** '''3.2.1 [[Vitamin A]]'''
* Note (2): Foods high in sugar, protein, fat, and fiber must be avoided.
***** Preferred regimen (1): [[Vitamin A]] 10,000–50,000 U PO qd 
* Note (3):  
**** '''3.2.2 [[Vitamin B12]]'''
** 3 '''Enteral nutrition'''
***** Preferred regimen (1): [[Vitamin B12]] 300 mcg SC qm (following terminal ileum resection)
*** 1.2.1 '''Adult'''
**** '''3.2.3 [[Vitamin C]]'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
***** Preferred regimen (1): [[Vitamin C]] 200–500 mg PO qd  
*** 1.2.2 '''Pediatric'''
**** '''3.2.4 [[Vitamin D]]'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
***** Preferred regimen (1): [[Vitamin D]] 1600 U PO qd  
** 4 '''Supplement'''
**** '''3.2.5 [[Tocopherol|Vitamin E]]'''
*** 4.1 Vitamins
***** Preferred regimen (1): [[Tocopherol|Vitamin E]] 30 IU PO qd  
**** 4.1.1 Vitamin A
**** '''3.2.6 [[Vitamin K]]'''
**** 4.1.2 Vitamin B12
***** Preferred regimen (1): [[Vitamin K]] 10 mg PO qw  
**** 4.1.3 Vitamin D
*** '''3.3 [[Mineral|Minerals]]'''
**** 4.1.4 Vitamin E
**** '''3.3.1 [[Calcium]]'''
*** 4.2 Minerals
***** Preferred regimen (1): [[Calcium]] 1000-1500 mg PO qd
**** 4.2.1 Calcium
**** '''3.3.2 [[Iron]]'''
***** Preferred regimen (1): Calcium 1000-1500 mg PO qd
***** Preferred regimen (1): [[Ferrous sulfate]] 30-90 mg PO qd (Elemental [[iron]] 6-18 mg per day)
**** 4.2.2 Iron
**** '''3.3.3 [[Zinc]]'''
**** 4.2.3 Zinc
***** Preferred regimen (1): [[Zinc]] 220–440 mg PO qd  
*** 4.3 Exogenous enzyme replacement 
**** '''3.3.4 [[Selenium]]'''
**** 4.3.1 Pancreatic enzyme
***** Preferred regimen (1): [[Selenium]] 60–100 mg PO qd  
**** 4.3.2 Lactase
*** '''3.4 Exogenous enzyme replacement''' 
*** 4.4 Bile acid sequestrants
**** '''3.4.1 [[Pancreas|Pancreatic]] enzyme'''
***** Preferred regimen (1): [[Pancreatin]] 25,000-40,000 U PO per meal
**** '''3.4.2 [[Lactase]]'''
***** Preferred regimen (1): [[Lactase]] 3,000-9,000 units PO with meals or dairy
*** '''3.5 [[Bile acid sequestrant|Bile acid sequestrants]]'''
**** Preferred regimen (1): [[Cholestyramine]] 4 to 8 gr PO qd or q12h (maximum 24 gr per day)
**** Preferred regimen (2): [[Colestipol]] 2-16 gr PO qd or q12h
**** Preferred regimen (3): [[Colesevelam]] 3.75 gr PO qd
*** '''3.6 [[Probiotic|Probiotics]]'''
*** '''3.7 [[Essential amino acid|Essential amino acids]]'''
**** Preferred regimen (1): [[Essential amino acid|Essential amino acids]] 186 mg/kg PO qd


===Pharmacotherapy===
===Pharmacotherapy===
* Medications are used to control symptoms of short bowel syndrome. They include:
Medications are used to control [[symptoms]] of short bowel syndrome. They include:
** 1 Antimotility agents
* 1 '''Antimotility agents'''
*** Preferred regimen (1): Loperamide 
** Preferred regimen (1): [[Loperamide]] 4-16 mg PO qd
*** Preferred regimen (2): Codeine 60 mg IM q4h
** Preferred regimen (2): [[Codeine|Codeine phosphate]] 30-60 mg PO q6h as needed
*** Preferred regimen (3): Lomotil (diphenoxylate and atropine) 2.5-5 mg q6h
** Preferred regimen (3): [[Diphenoxylate hydrochloride and atropine sulfate|Lomotil]] ([[diphenoxylate]] and [[atropine]]) 2.5-7.5 mg q6h (maximum 30 mg per day)
*** Alternative regimen (1): Clonidine
** Alternative regimen (1): [[Cholestyramine]] 24 g PO qd (recommended for patients with an intact [[Colon (anatomy)|colon]] and partial [[Ileum|ileal]] resection of <100 cm)
*** Alternative regimen (2): Tincture of opium 5-10 mL q4h
** Alternative regimen (2): [[Codeine]] 60 mg IM q4h
*** Alternative regimen (3): Teduglutide (glucagon-like peptide-2 analogue)
**Alternative regimen (3): [[Laudanum|Tincture of opium]] 5-10 mL PO q4h
** 2 Antisecretory agents
 
*** Histamine H2 antagonists
* '''Note (1):''' Antimotility agents reduce [[peristalsis]] and increase transit time which improve [[nutrient]] [[absorption]].
**** Preferred regimen (1):
* '''Note (2):''' Antimotility agents must be used 30 minutes before meal and at bedtime.
*** Proton pump inhibitors
* '''Note (3):''' Patients who receive [[Opiate|opiates]] to control their [[diarrhea]] must be closely monitored.
**** Preferred regimen (1):
** 2 '''Antisecretory agents'''
** 3 Hormones
*** '''2.1 [[H2 antagonist|Histamine H2 antagonists]]'''
*** 3.1 Growth hormone
**** Preferred regimen (1): [[Ranitidine]] 300-600 mg PO qd
**** Preferred regimen (1): Somatropin 0.03-0.14 mg/kg SC qd for up to 4 weeks (not to exceed 8 mg/day)
**** Preferred regimen (2): [[Famotidine]] 40-80 mg PO qd
*** 3.2 Somatostatin analogue
*** '''2.2 [[Proton pump inhibitor|Proton pump inhibitors]]'''
**** Preferred regimen (1): Octreotide 100 μg SC q8h
**** Preferred regimen (1): [[Omeprazole]] 40 mg PO BID or TID
** 4 Antibiotics
*** '''2.3 [[Somatostatin|Somatostatin analogue]]'''
*** Preferred regimen (1):  
**** Preferred regimen (1): [[Octreotide]] 100 mcg SC q8h (maximum 1,500 mcg per day)
Note (1): Antibiotic is used to prevent and treat small bowel bacterial overgrowth.
*** 2.4 [[Clonidine]] 0.1–0.2 mg PO q12h
** 3 '''Trophic agents'''<ref name="pmid25052938">{{cite journal |vauthors=Bechtold ML, McClave SA, Palmer LB, Nguyen DL, Urben LM, Martindale RG, Hurt RT |title=The pharmacologic treatment of short bowel syndrome: new tricks and novel agents |journal=Curr Gastroenterol Rep |volume=16 |issue=7 |pages=392 |year=2014 |pmid=25052938 |doi=10.1007/s11894-014-0392-2 |url=}}</ref>
*** '''3.1 [[Growth hormone]]<ref name="pmid16770169">{{cite journal |vauthors=Steiger E, DiBaise JK, Messing B, Matarese LE, Blethen S |title=Indications and recommendations for the use of recombinant human growth hormone in adult short bowel syndrome patients dependent on parenteral nutrition |journal=J. Clin. Gastroenterol. |volume=40 Suppl 2 |issue= |pages=S99–106 |year=2006 |pmid=16770169 |doi=10.1097/01.mcg.0000212680.52290.02 |url=}}</ref>'''
**** Preferred regimen (1): [[Somatropin]] 0.03-0.14 mg/kg SC qd for up to 4 weeks (not to exceed 8 mg/day) '''(Contraindicated in [[Cancer|malignancy]], or with acute critical illness in [[Intensive care unit|intensive care units]])'''
*** '''3.2 [[Glutamine]]'''
**** Preferred regimen (1): [[Glutamine]] 0.16 g/kg IV qd
**** Preferred regimen (2): [[Glutamine]] 30 g PO qd
*** '''3.3 [[Glucagon-like peptide-2|Glucagon-like peptide-2 analogue]]'''
**** Preferred regimen (1): [[Teduglutide]] 0.1–0.2 mg PO q12h '''(Contraindicated in patients with current or a past [[Cancer|malignancy]], except for [[basal cell carcinoma]])'''
===Follow-up===
*Close long-term follow-up is needed.
*Monitoring and measuring [[blood]] levels of [[Nutrient|nutrients]] are required.<ref name="WilmoreRobinson2014">{{cite journal|last1=Wilmore|first1=Douglas W.|last2=Robinson|first2=Malcolm K.|title=Short Bowel Syndrome|journal=World Journal of Surgery|volume=24|issue=12|year=2014|pages=1486–1492|issn=0364-2313|doi=10.1007/s002680010266}}</ref>
Table below summarizes the tests and imaging studies which are required in patients with short bowel syndrome when discharge from the hospital.
{| class="wikitable"
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Measurement
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Frequency
|-
|'''Clinic visit'''
|Every 6 to 12 months
|-
|'''Weight'''
|Every week to check for [[malnutrition]] and [[dehydration]]
|-
|'''Intake and output'''
|Every 1 to 4 weeks to check for [[malnutrition]] and [[dehydration]]
|-
|'''Comprehensive metabolic panel including [[magnesium]]'''
|Every 4 weeks to check for [[malnutrition]] and [[dehydration]]
|-
|[[Essential fatty acid|'''Essential fatty acids''']]
|Every 6 to 12 months to check for [[malnutrition]]
|-
|'''[[Vitamin]] levels'''
|Every 6 to 12 months to check for [[malnutrition]]
|-
|[[Mineral|'''Minerals''']]
|Every 6 to 12 months to check for [[malnutrition]]
|-
|[[Liver function tests|'''Liver function tests''']]
|Every 6 months to check for [[Hepato-biliary diseases|liver disease]]
|-
|[[Dual energy X-ray absorptiometry|'''Dual-energy x-ray absorptiometry scan''']]  
|Every 2 years to check for [[osteoporosis]]
|}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
​
[[Category:Medicine]]
[[Category:Gastroenterology]]
[[Category:Surgery]]
[[Category:Up-To-Date]]

Latest revision as of 00:10, 30 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

Overview

Management of short bowel syndrome is complicated and requires close collaboration of all medical team members including the physician, nutritionist, and nurse with the patient and their families. Medical therapy consists of nutritional therapy and pharmacotherapy. Nutritional therapy is essential for short bowel syndrome and to restore the intestinal adaptation. It could be provided through oral, enteral and parenteral routes. The ultimate goal is to provide necessary nutrients via oral route other than parenteral or enteral routes. All patients require enough fluid, electrolytes, supplements and calories. Medications are used to control symptoms of short bowel syndrome include antimotility agents, antisecretory agents, and trophic agents. Lifelong follow-up is usually needed.

Medical Therapy

  • Management of short bowel syndrome is complicated and requires close collaboration of all medical team members including the physician, nutritionist, and nurse with the patient and their families.[1][2]
  • Management of short bowel syndrome consists of medical therapy and surgical interventions.[3][4][5][6][7][8][9][10][11][12]
  • Medical therapy consists of nutritional therapy and pharmacotherapy.
  • Lifelong follow-up is usually needed.

Nutritional therapy

Pharmacotherapy

Medications are used to control symptoms of short bowel syndrome. They include:

Follow-up

  • Close long-term follow-up is needed.
  • Monitoring and measuring blood levels of nutrients are required.[14]

Table below summarizes the tests and imaging studies which are required in patients with short bowel syndrome when discharge from the hospital.

Measurement Frequency
Clinic visit Every 6 to 12 months
Weight Every week to check for malnutrition and dehydration
Intake and output Every 1 to 4 weeks to check for malnutrition and dehydration
Comprehensive metabolic panel including magnesium Every 4 weeks to check for malnutrition and dehydration
Essential fatty acids Every 6 to 12 months to check for malnutrition
Vitamin levels Every 6 to 12 months to check for malnutrition
Minerals Every 6 to 12 months to check for malnutrition
Liver function tests Every 6 months to check for liver disease
Dual-energy x-ray absorptiometry scan   Every 2 years to check for osteoporosis

References

  1. ↑ Matarese LE, Steiger E (2006). "Dietary and medical management of short bowel syndrome in adult patients". J. Clin. Gastroenterol. 40 Suppl 2: S85–93. doi:10.1097/01.mcg.0000212678.14172.7a. PMID 16770167.
  2. ↑ Kelly DG, Tappenden KA, Winkler MF (2014). "Short bowel syndrome: highlights of patient management, quality of life, and survival". JPEN J Parenter Enteral Nutr. 38 (4): 427–37. doi:10.1177/0148607113512678. PMID 24247092.
  3. ↑ 3.0 3.1 Bechtold ML, McClave SA, Palmer LB, Nguyen DL, Urben LM, Martindale RG, Hurt RT (2014). "The pharmacologic treatment of short bowel syndrome: new tricks and novel agents". Curr Gastroenterol Rep. 16 (7): 392. doi:10.1007/s11894-014-0392-2. PMID 25052938.
  4. ↑ Rodrigues, Gabriel; Seetharam, Prasad (2011). "Short bowel syndrome: A review of management options". Saudi Journal of Gastroenterology. 17 (4): 229. doi:10.4103/1319-3767.82573. ISSN 1319-3767.
  5. ↑ Wall, Elizabeth A. (2013). "An Overview of Short Bowel Syndrome Management: Adherence, Adaptation, and Practical Recommendations". Journal of the Academy of Nutrition and Dietetics. 113 (9): 1200–1208. doi:10.1016/j.jand.2013.05.001. ISSN 2212-2672.
  6. ↑ Thompson, Jon S.; Weseman, Rebecca; Rochling, Fedja A.; Mercer, David F. (2011). "Current Management of the Short Bowel Syndrome". Surgical Clinics of North America. 91 (3): 493–510. doi:10.1016/j.suc.2011.02.006. ISSN 0039-6109.
  7. ↑ Eça, Rosário; Barbosa, Elisabete (2016). "Short bowel syndrome: treatment options". Journal of Coloproctology. 36 (4): 262–272. doi:10.1016/j.jcol.2016.07.002. ISSN 2237-9363.
  8. ↑ Keller J, Panter H, Layer P (2004). "Management of the short bowel syndrome after extensive small bowel resection". Best Pract Res Clin Gastroenterol. 18 (5): 977–92. doi:10.1016/j.bpg.2004.05.002. PMID 15494290.
  9. ↑ Misiakos EP, Macheras A, Kapetanakis T, Liakakos T (2007). "Short bowel syndrome: current medical and surgical trends". J. Clin. Gastroenterol. 41 (1): 5–18. doi:10.1097/01.mcg.0000212617.74337.e9. PMID 17198059.
  10. ↑ Matarese LE, O'Keefe SJ, Kandil HM, Bond G, Costa G, Abu-Elmagd K (2005). "Short bowel syndrome: clinical guidelines for nutrition management". Nutr Clin Pract. 20 (5): 493–502. doi:10.1177/0115426505020005493. PMID 16207689.
  11. ↑ Sundaram A, Koutkia P, Apovian CM (2002). "Nutritional management of short bowel syndrome in adults". J. Clin. Gastroenterol. 34 (3): 207–20. PMID 11873098.
  12. ↑ Vanderhoof JA, Young RJ (2003). "Enteral and parenteral nutrition in the care of patients with short-bowel syndrome". Best Pract Res Clin Gastroenterol. 17 (6): 997–1015. PMID 14642862.
  13. ↑ Steiger E, DiBaise JK, Messing B, Matarese LE, Blethen S (2006). "Indications and recommendations for the use of recombinant human growth hormone in adult short bowel syndrome patients dependent on parenteral nutrition". J. Clin. Gastroenterol. 40 Suppl 2: S99–106. doi:10.1097/01.mcg.0000212680.52290.02. PMID 16770169.
  14. ↑ Wilmore, Douglas W.; Robinson, Malcolm K. (2014). "Short Bowel Syndrome". World Journal of Surgery. 24 (12): 1486–1492. doi:10.1007/s002680010266. ISSN 0364-2313.

​

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