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Query: UMLS:C0024523 (malabsorption)
 7,319 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Short bowel syndrome is the clinical manifestation of a fundamental reduction in the functional intestinal absorptive surface area and malabsorption. The development of total parenteral nutrition has improved the natural course of this disease. Home parenteral nutrition-related complications continue to generate significant morbidity and mortality for these patients. Small-bowel transplantation is an alternative to home parenteral nutrition. There are significant risks of graft rejection and the potential complications of long-term immunosuppression. Small-bowel transplantation is an option, but it should be reserved for patients no longer considered candidates for continued home parenteral nutrition.
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PMID:The current role of small-bowel transplantation in intestinal failure. 845 29

Short bowel syndrome is defined as malabsorption following small intestinal resection. There are many causes in children, most of whom present during infancy. The clinical presentation and physiologic consequences depend heavily on the segment of bowel removed and the extent of resection. The remaining intestine has the capacity to adapt anatomically and functionally, and stimulating the adaptation process is a major component of therapy. Clinical management of long-term complications, such as bacterial overgrowth, nutrient deficiency states, and parenteral nutrition-induced liver disease, are often key outcome determinants. The recent availability of intestinal transplantation now provides an additional therapeutic option for patients in whom all other forms of therapy fail.
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PMID:Short bowel syndrome in children. 854 57

Short-bowel syndrome is a state of severe malabsorption secondary to extensive bowel resection. The most common reasons for extensive bowel resection are Crohn's disease and mesenteric infarction. The pathophysiological consequences depend on extent and site of resection, integrity and adaptation of the remaining bowel, and secondary effects on other organs. Most extensively bowel resected patients can be adequately nourished by mouth, especially since they develop compensatory hyperphagia. For patients with colon in function a high-carbohydrate low-fat diet is beneficial compared to a diet with a normal fat content, because it results in decreased diarrhoea, decreased faecal mineral losses, and increased energy assimilation. The relative amount of dietary fat does not influence stool mass or energy assimilation in jejunostomy patients. Patients with jejunostomy have a high faecal output of water, sodium, and divalent cations, and they often need permanent parenteral supply of saline as well as calcium and magnesium if their small intestinal remnant is < 200 cm and parenteral nutritional support if they retain < 100 cm small bowel. In contrast, 50 cm of the jejunum often suffices for adequate oral nutrition if most of the colon is preserved. The majority of patients needing long-term intravenous supply are trained to administer parenteral nutrition at home (HPN). Most patients on HPN obtain a good or fair quality of life with hospital readmissions corresponding to an average of 10% of the HPN duration and an overall HPN related mortality of about 4%.
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PMID:Nutrition in short-bowel syndrome. 872 85

Short-bowel syndrome refers to the clinical sequelae of resection of a substantial portion of the small intestine. Features of diarrhea, dehydration, malabsorption, malnutrition, or weight loss generally occur, at least transiently, when more than 75% of the small intestine is resected, although other factors in addition to residual length affect clinical outcome. Adaptation of the remnant bowel has been well documented to occur over months to years following resection, although the agents responsible for this process are not well defined. Ambulatory total parenteral nutrition has greatly improved the prognosis of this syndrome over the last 25 years. We review the anatomical and the pathophysiological basis of this syndrome, discuss its clinical manifestations, and review current knowledge of intestinal adaptation. We also review medical and surgical therapeutic options for these patients, as well as dietary, enteral, and parenteral nutritional aspects of their care.
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PMID:Short-bowel syndrome. 879 42

Short bowel syndrome (SBS) in the newborn results in limited intestinal absorptive capacity, leading especially to fatty acid (FA) malabsorption. It is unknown whether adaptation occurs in time in FA absorption, and whether this adaptation is chain-length dependent. The aid of the present study was to prospectively evaluate FA absorption and excretion during SBS in the newborn. Twenty-one neonates who underwent small bowel resection (of variable length) for various reasons (necrotizing enterocolitis, intestinal atresia, meconium peritonitis, cloacal extrophy, etc) were studied. Eight neonates had SBS, defined as a small bowel remnant of less than 50% of the original small bowel length related to gestational age. The mean remaining small bowel length in the SBS group was 34% (24% to 42%). The non-SBS control group consisted of 13 neonates who had only minor small bowel resections. The mean remaining bowel length for the non-SBS group was 95% (70% to 100%). The results show that the total fractional excretion of FA (FE-FA) at 2 weeks and 1, 2, 3, and 4 months postsurgery was 51% +/- 37%, 33% +/- 24%, 51% +/- 65%, 53% +/- 27%, and 7% +/- 2% in patients with SBS, versus 12% +/- 8%, 24% +/- 10%, 9% +/- 3%, 8% +/- 3% and 17% +/- 14% in the non-SBS controls, respectively (P < .05 by ANOVA). There appeared to be an amelioration in time in FA absorption, especially in the SBS group, after 3 months. FE-FA was chain-length related, being considerably less for C10 and C12 than for C14 and longer amounts. An amelioration of absorption occurred in the SBS patients, especially with the longer-chain FA. On the basis of the study data, the authors conclude that in the initial adaptation phase shorter chain lengths are better absorbed than longer chain lengths; however, in the latter FA group, substantial adaptation occurs with time.
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PMID:Prospective evaluation of faecal fatty acid excretion in short bowel syndrome in newborns. 880 4

Massive small bowel resection results in a short bowel syndrome, characterized by malabsorption, weight loss, diarrhea and steatorrhea. Different surgical techniques have been used to slow down intestinal transit time or to increase the area of absorption. Techniques for the deceleration of intestinal transit are reconstruction of the ileocecal-valve, antiperistaltic intestinal segments, colon interposition, recirculating intestinal loops and intestinal pacing. For increase of the area of absorption growth of neomucosa, mucosal autotransplantation, intestinal lengthening and small bowel transplantation have been performed. All these procedures are still at different experimental levels. Due to inconsistent results so far the surgical therapy of the short bowel syndrom cannot be recommended for routine use. However, some techniques offer hope of a successful surgical development.
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PMID:[Current status of surgical treatment of short bowel syndrome]. 885 33

Vitamin E is one of the most important lipid-soluble antioxidant nutrients. Severe vitamin E deficiency can have a profound effect on the central nervous system. Cystic fibrosis, chronic cholestatic liver disease, abetalipoproteinemia, short bowel syndrome, isolated vitamin E deficiency syndrome and other malabsorption syndromes all may cause varying degrees of neurologic deficits due to related vitamin deficiencies. The classic abnormalities in vitamin E deficiency progress from hyporeflexia, ataxia, limitations in upward gaze and strabismus to long-tract defects, profound muscle weakness and visual field constriction. Patients with severe, prolonged deficiency may develop complete blindness, dementia and cardiac arrhythmias. Treatment must be tailored to the underlying cause of vitamin E deficiency and may include oral or parenteral vitamin supplementation. The more advanced the deficits, the more limited the response to therapy. Therefore, a good neurologic examination and periodic serum vitamin E levels are essential in patients at risk of vitamin E deficiency.
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PMID:Neurologic findings in vitamin E deficiency. 901 78

The treatment of infants with short bowel syndrome aims at restoring the intestinal continuity and at improving the physiological process of gut adaptation. Appropriate parenteral and enteral feeding must be directed at maintaining an ptimal nutritional status. Due to a varying degree of long-chain triglyceride malabsorption, part of the dietary fat needs to be supplied in the form of medium-chain triglycerides in most patients. The dietary fat composition must also meet the needs for essential fatty acids and take into account the positive effects of long-chain lipids on gut trophicity. Appropriate dietary manipulations are of great benefit for infants and children with chronic digestive diseases.
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PMID:Lipid requirements in infants with digestive diseases with references to short bowel syndrome. 908 19

Carnitine CAR) plays an important role in the beta-oxidation of fatty acids. Less attention. however, has been paid to CAR compared to other nutrients even in total parenteral nutrition (TPN). To examine CAR metabolism during TPN and the effect of simultaneous oral L-CAR supplementation on CAR levels, the blood CAR level was measured in a 3-year-old boy receiving long-term TPN because of short bowel syndrome. Both the total and acyl CAR in the serum were evaluated under various nutritional conditions including oral supplementation of L-CAR. Low CAR concentrations were observed especially when lipid containing TPN regimens were in place. Oral L-CAR supplementation was not sufficient to restore the low CAR levels in the present index patient even when the dose was increased to 120 mg/kg in accordance with the result of the L-CAR absorption test that revealed poor intestinal absorption of this nutrient. Moreover, a markedly low CAR level was measured during the onset of sepsis in the patient, and the blood CAR was depleted when lipid metabolism was activated by lipid loading or sepsis. To date, the late effects of CAR depletion on child growth have not been well examined. It is recommended that the blood CAR level be maintained at normal levels before any prominent manifestations of the deficiency have developed. The intravenous administration of CAR appears to be necessary to supply a sufficient amount of CAR for patients with severe malabsorption.
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PMID:Carnitine depletion during total parenteral nutrition despite oral L-carnitine supplementation. 914 Dec 53

The profile of fecal bile acids was examined in 13 children with short bowel syndrome; 7 of the 13 did not have diarrhea and the other 6 had intractable diarrhea. In children without diarrhea, no severe fat malabsorption was recognized, and the content of total bile acids in the feces was within the normal range or slightly higher. The ratio of primary to total bile acids showed various patterns. In children with intractable diarrhea, in contrast, fat malabsorption was observed and the fecal content of total bile acids in these patients was more than ten times higher than that of the control group, primary bile acids accounting for more than 95% of the total bile acids and taurine- or glycine-conjugated bile acids for 10%. In the children with intractable diarrhea, the values for the D-xylose absorption test were lower than the normal range. These results suggested that, in children with short bowel syndrome with diarrhea, the loss of bile acids was strongly associated with a decrease in the actual absorptive surface area of the residual small intestine, and the growth of the normal bacterial flora was disturbed in the residual intestine. Some children with or without diarrhea also had hyper bile acidemia. Ursodeoxycholic acid was not effective for the treatment of hyper bile acidemia or fat malabsorption.
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PMID:Disorder of bile acid metabolism in children with short bowel syndrome. 925 Aug 93


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