Management of the short bowel syndrome.

The short bowel syndrome has become an increasingly common clinical condition. Malnutrition and its complications should be avoidable with use of a combination of enteral and parenteral nutrition support. Dietary management needs to be individualized. Drugs directed against gastric hypersecretion, increased motility, intestinal secretion, unabsorbed bile salts, and bacterial overgrowth improve intestinal function. Complications specific to the short bowel syndrome (gastric hypersecretion, cholelithiasis, nephrolithiasis) can be minimized and diagnosed early. Surgical management includes preserving intestinal remnant length and improving its function. Intestinal transplantation is evolving as a promising therapeutic alternative for patients with complications of long-term parenteral nutrition support.