Short bowel syndrome (SBS) is a state of intestinal malabsorption following resection. The remaining colon and its microbiota play a decisive role in how the intestine adapts after resection.
SBS follows more or less significant resection of the small intestine, as the remaining intestine does not have sufficient capacity to perform its original functions of absorbing nutrients and maintaining fluid and electrolyte balance. SBS manifests clinically through diarrhea induced by fluid and electrolyte imbalance, dehydration, protein-energy malnutrition and micronutrient deficits1-2.
Role of the colon in SBS
Parenteral nutrition (PN) allows the patient to be kept nutritionally stable. The intestine’s ability to adapt, and particularly that of the colon, reduces the dependency on PN1. Colon bacteria play a major role in the integrity of the colonic mucosa and energy recovery, by metabolizing nutrients not previously absorbed that reach the colon. Thus, the colon and its microbiota play an essential role in recovering sufficient digestion and absorption capacity to reduce or stop PN altogether1, 3.
Dysbiosis has been documented in patients with SBS, with a reduction in bacterial diversity associated with predominance of certain species such as acid-resistant lactobacilli4-7. This bacterial composition resembles that of premature infants at risk for necrotizing enterocolitis and patients with IBDs1, 8. Changes in intestinal microbiota in SBS patients are accompanied by:
- intraluminal intestinal bacterial proliferation (frequently)
- D-lactic acidosis that may lead to episodes of D-lactic encephalopathy
- anastomotic ulcerations (rarely)
Use of probiotics
The existence of dysbiosis and the key role played by the microbiota in intestinal adaptation for patients with SBS suggest that probiotics might be used4,6,7. That was evaluated in an animal model of extensive resection of the small intestine; treatment with S. boulardii had a positive effect on the intestinal mucosa9,-11. In young patients with SBS, the addition of S. boulardii led to a significant improvement in symptoms12, 13. Approaches focusing on microbiota modulation need to be further refined, to allow patients a full return to digestive autonomy and to correct dysbiosis.
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9. Zaouche A. et al. Effects of oral Saccharomyces boulardii on bacterial overgrowth, translocation, and intestinal adaptation after small-bowel resection in rats. Scand J Gastroenterol 2000 ; 35 : 160-5. https://www.ncbi.nlm.nih.gov/pubmed/10720113
10. Mogilner JG et al. Effect of probiotics on intestinal regrowth and bacterial translocation after massive small bowel resection in a rat. J Pediatr Surg 2007 ; 42 : 1365-71. https://www.ncbi.nlm.nih.gov/pubmed/17706498
11. Buts JP et al. Saccharomyces boulardii upgrades cellular adaptation after proximal enterectomy in rats. Gut 1999 ; 45 : 89-96. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1727579/
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