Advances in non-surgical treatment for pediatric patients with short bowel syndrome

Introduction Short bowel syndrome (SBS) is the most common cause of intestinal failure resulting in the need for long-term parenteral nutrition. Treatment for SBS involves the close management of parenteral and enteral nutrition as well as central venous access to prevent complications while allowing time for the remaining intestine to undergo the process of adaptation. Areas covered This review highlights the current state of management and treatment of SBS. Parenteral and enteral management strategies are outlined with a review of the evidence regarding lipid management, prevention of intestinal failure associated liver disease, and promotion of intestinal adaptation. Central venous access management and the evidence for prevention of central line-associated blood stream infections are reviewed. The most common nutritional deficiencies and complications associated with SBS are discussed and treatment strategies covered. Several hormone analogues have recently been developed which have been shown to promote intestinal adaptation. The evidence for these new drugs is also outlined. Expert opinion Previous treatments for SBS focused on symptom management and complication prevention. While these remain important in the intestinal rehabilitation of patients with SBS, the introduction of promising new hormonal therapies has provided a way to augment the process of adaptation.