Review
Short Bowel Syndrome and Intestinal Failure: Consensus Definitions and Overview

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Short bowel syndrome (SBS)–associated intestinal failure is a highly disabling condition that impairs quality of life and social integration. Although the condition is not uniformly fatal, it might lead to serious, life-threatening complications. The basic goals of medical treatment are to maintain fluid, electrolyte, and nutrient balances and to make appropriate modifications in disease management to avoid side effects. Various definitions have been proposed for SBS and intestinal failure within the medical literature, but many focus on different aspects of the conditions, leading to confusion. In the past, identifying the cause of intestinal failure was of little consequence, because all patients were managed on total parenteral nutrition at home. However, with the recent development of medical therapies such as recombinant growth hormone, octreotide, and glucagon-like peptide-2 analogues and with improvements in small bowel transplantation, many patients can be made nutritionally autonomous. To evaluate the relative efficacy of these therapies, there is now a need to develop consensus definitions so that patients can be properly categorized before therapy. To this end, a group of experts on the subject was convened to develop the following new definitions: “Intestinal failure results from obstruction, dysmotility, surgical resection, congenital defect, or disease-associated loss of absorption and is characterized by the inability to maintain protein-energy, fluid, electrolyte, or micronutrient balance.” “Short-bowel syndrome results from surgical resection, congenital defect, or disease-associated loss of absorption and is characterized by the inability to maintain protein-energy, fluid, electrolyte, or micronutrient balances when on a conventionally accepted, normal diet.”

Section snippets

Incidence

The true incidence of SBS and intestinal failure in the United States is unknown, in part because of the lack of precise definitions. Surveys of clinicians have produced variable figures; some practicing gastroenterologists report never having seen a patient with SBS. Undoubtedly, some of their patients are those who have had minor, well-tolerated resections, and who thus do not require therapy. Registries of home TPN patients generally produce incidence figures representing the severe end of

Evolution of Definitions: Short Bowel Syndrome and Intestinal Failure

The reported “normal” length of the small intestine varies considerably from 300–850 cm.1, 16 Although evidence suggests that patients with less than 200 cm of small bowel are likely to develop intestinal failure, this number is of little use in clinical practice, because outcome depends on the prognostic factors already mentioned, important among which are the quality of bowel remaining and whether the large bowel has been conserved. For example, loss of bowel in a patient with Crohn’s disease

Proposed New Definitions

Recognizing the limitations and overlap in current definitions of conditions related to short bowel and intestinal failure, our group convened for the purpose of developing consensus definitions for both intestinal failure and SBS-associated intestinal failure to help practicing gastroenterologists categorize patients with short bowel and to provide uniformity of view when registering such patients with regulatory authorities or assessing their response to novel forms of therapy. The panel

Conclusions

Consensus working definitions of SBS and intestinal failure have been proposed in this review to help the practicing gastroenterologist manage patients with intestinal failure caused by massive intestinal loss and, at the same time, to help in the evaluation of novel pharmacologic therapies.

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    Dr Jeppesen has served as a consultant for NPS Pharmaceuticals.

    Funding for the meeting of the panel of experts was provided by NPS Pharmaceuticals, Salt Lake City, Utah. The views contained are solely those of the expert panel.

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