Clinical management of short-bowel syndrome. Enhancing the patient's quality of life.

Management of patients following extensive small-bowel resection is complex. Parenteral nutrition is necessary initially because of a greatly reduced absorptive capacity. Intestinal adaptation occurs gradually and is stimulated by enteral feeding. Evaluation of specific nutrient status is essential, and supplementation may be required. The degree and consequences of malabsorption are more dependent on the anatomic location of resection than on the extent, but the outcome and eventual capacity for absorption in any given patient cannot be absolutely predicted. Even patients who do not achieve independence from parenteral nutrition receive many psychological and physiologic advantages by attaining the ability to consume some foods. Certain patients may subsist well on parenteral nutrition every other day without intravenous lipid. Such a regimen considerably reduces expense and simplifies clinical management, improving the quality of life.