Current treatment options for adult patients with short bowel syndrome: Do prebiotics, probiotics, and synbiotics play a role?

Short bowel syndrome (SBS) is a malabsorptive disorder characterized by reduced small intestinal length that results in nutrient deficiencies. Most commonly in adults, it occurs in the setting of surgical bowel resection related to trauma, infarction, or inflammatory bowel disease. Management principles include optimizing nutrition and hydration status via parenteral nutrition and oral diet and utilizing antisecretory, antimotility, and enterohormone agents to enhance intestinal absorption, facilitate intestinal adaptation, and reduce stool output. Other therapeutics include antibiotics to treat small intestinal bacterial overgrowth (SIBO) and microbial dysbiosis. Considering limitations to antibiotic use, in addition to a greater understanding of the nuances of the microbiome in digestive health regulation, there is also burgeoning interest in the role of prebiotics, probiotics, and synbiotics in SBS management. This review highlights current management principles of SBS with a broader discussion of clinical indications and safety considerations for use of prebiotics, probiotics, and synbiotics in this population. Although current research is in its infancy, prebiotics, probiotics, and synbiotics may represent a viable future therapeutic option in the management of this complex disorder, with further studies needed to define definitive regimens and update guidelines.