CME Spark and the American Gastroenterological Association developed a Case Closed CME program for gastroenterologists and other healthcare providers involved in the care of patients with short bowel syndrome (SBS) to have a case-based learning experience that focuses on guidelines and best practices. John K. DiBaise, MD Professor of Medicine, Division of Gastroenterology and Hepatology Mayo Clinic Scottsdale, AZ

1. Jointly Provided by
Case Closed:
Optimizing Outcomes for Patients
with Short Bowel Syndrome
Chair
John K. DiBaise, MD, FACG, FASPEN
Professor of Medicine
Division of Gastroenterology and Hepatology
Mayo Clinic Arizona
|

2. Treatment Selection
Case Closed: Optimizing Outcomes for Patients with SBS

3. Case Study 1
u 48-year-old Caucasian man
u 6-12 urgent, loose-watery stools/day
u Some gas, no significant pain/discomfort
u Stable weight and hydration
u 9 months ago, had distal ileum (? 2-3 feet) and cecal
resection for complicated ruptured appendicitis
u Otherwise, healthy

4. Question
The most likely cause of this man’s diarrhea is which one of
the following?
A. Bile acid malabsorption
B. Exocrine pancreatic insufficiency
C. Irritable bowel syndrome
D. Small intestinal bacterial overgrowth
E. Short bowel syndrome

5. What Is Short Bowel Syndrome?
u Malabsorptive syndrome generally related
to reduced gut length
u Results in inability to maintain nutrition,
hydration, electrolytes/micronutrients
consuming a normal diet
u Can be temporary or permanent
u Wide range in normal SB length: 300-800 cm
u Tremendous functional reserve
SB, small bowel.
O’Keefe et al, 2006; Pironi et al, 2015.
<200 cm small bowel
remaining

6. Causes of SBS
Infants
u Congenital anomalies
u Midgut volvulus
u Gastroschisis
u Atresia
u Aganglionosis
u Necrotizing
enterocolitis
Adults
u Postoperative
u Mesenteric ischemic
events
u Crohn’s disease
u Radiation enteritis
u Trauma
u Other
Dabney et al, 2004.
• Surgical resection
• Congenital defect
• Disease-associated loss of
absorption

7. Practice Advice
u When evaluating patients with SBS:
u Define the anatomy of the residual GI tract with
specific reference to the length of remnant small
bowel, measured beyond the duodeno-jejunal flexure
u Define whether the colon is in continuity
u Define whether the ileo-cecal valve is present
u Define whether the bowel ends in a stoma
• Identify complication risk
• Determine best treatment
Pironi et al, 2016.
Images courtesy of Mayo Clinic.

8. Treatment Goals in SBS
u Maintain adequate nutrition and growth
u Prevent and correct nutritional deficiencies
u Prevent and correct dehydration, diarrhea
u Prevent and correct other complications
u Improve quality of life
Restore enteral autonomy
Nightingale et al, 2006.

9. Practice Advice
u The major emphasis of the diet for SBS
u Compensatory hyperphagia rather than diet restrictions
u SBS patients with chronic borderline dehydration or sodium
depletion should use an oral rehydration solution (ORS)
u Particularly important in high output end-jejunostomy
Pironi et al, 2016.
Images courtesy of AGA.

10. General Diet/Fluid Recommendations
General • ≥6 small meals/snacks per day
• Chew foods well
• Tailor diet to individual
• Encourage hyperphagia
Fluids •Oral rehydration solution in those without colon mainly
•Avoid hypertonic fluids
•In some, all fluids may need to be limited & IVF given
Carbohydrates •Complex CHO; limit simple sugars & sugar alcohol in
both foods/fluids
Fat •Limit fat to <30% in those w/ a colon; may need to limit
in those without; ensure oils w/ essential fatty acids
Protein •High-quality protein at each meal
Fiber •Some fiber is good in those with a colon segment
Oxalate •Limit in those w/ a colon; ensure adequate urine
output first
Salt •Usual intake in those w/ colon; increased salt intake
without
CHO, carbohydrate; IVF, intravenous fluids.
Matarese, 2012.

11. Practice Advice
u Conventional medications should be used
aggressively as first-line agents in the
management of SBS-related diarrhea/excessive
stoma losses
u Antimotility agents and antisecretory agents
• Most oral meds absorbed
within the first 60 cm of
jejunum
• Sustained- and delayed-
release medications should
be avoided
When lack of clinical response
consider:
• Escalating the dose
• Changing to a different dosing
schedule/frequency
• Changing to a different drug
formulation or route of
administration
• Monitor drug levels when
applicable

12. Conventional Pharmacotherapies in SBS
Antisecretory Antimotility Other
Proton pump inhibitors
and H2 blockers
• High doses; oral and IV
Clonidine
• α2-adrenergic receptor
agonist
• Oral and transdermal
Octreotide
• Also slows GI transit
• Short-lasting, expensive,
requires injection
• Increases risk of gallstones
• May inhibit bowel
adaptation
• May be useful in high stool
output conditions
• Subcutaneous (IV
available)
• Short/long-acting forms
Loperamide
• OTC; 1-4 tabs ac/hs
• Does not cross BBB
• Tolerable at high dose
• Increases anal sphincter
tone
• Reports of abuse
Diphenoxylate
w/atropine
• Prescription; 1-4 tabs
ac/hs
• Crosses BBB
• Dose-limited side effects
Codeine and tincture
of opium
• Crosses BBB
• Pharmacogenomic
concerns
• Rx “Hassle factor”
Antimicrobials
• Mainly for SIBO
• Diagnostic challenge
• May negatively affect
CHO salvage
Probiotic, prebiotic or
synbiotic
• No quality studies
demonstrating role
Bile acids
• Limited availability
Bile acid binders
• May worsen fat
malabsorption
• No role if no colon
Pancreatic enzymes
• No evidence of reduced
enzyme secretion in SBS
but potential for
mismatch
ac/hs, before meals and at bedtime; BBB, blood-brain barrier; OTC, over-the-counter; SIBO, small intestinal bacterial
overgrowth.
Kumpf, 2014; Pironi et al 2016.

13. Case Study 2
u A previously healthy 52-year-old man underwent
massive intestinal resection 9 months ago due to acute
intestinal ischemia from SMA thrombosis
u Has 90 cm of jejunum and half his colon
u Having 8-12 loose, foul-smelling stools day/night
u After multiple admissions for dehydration, electrolyte
abnormalities, and weight loss, PN was initiated
u Diet revised; aggressive antidiarrheals & PPI initiated
u Weight returned to near normal, UOP >1000 mL/day
u Micronutrient and electrolyte deficiencies corrected
u PN tapered, but attempts to wean stall at 4
nights/week
PN, parenteral nutrition; PPI, proton pump inhibitor; SMA, superior mesenteric artery; UOP, urinary output.

14. Question
Which one of the following settings is the best indication for
use of an intestinotrophic agent in SBS?
A. Difficult to control diarrhea
B. Recent central line infection
C. >1 year on PN or IV fluids that cannot be weaned
D. Recurrent oxalate kidney stones

15. Risk Factors for Permanent SBS-IF
uRemnant bowel length
u <100 cm end-jejunostomy
u <65 cm jejunocolic anastomosis
u <30 cm jejunoileocolic anastomosis
uResidual disease in remnant
bowel
uAbsence of colon
uDegree to which adaptation has
occurred
uTime on PN
uNutritional status
SBS-IF, short bowel syndrome with intestinal failure.
Messing et al, 1999; Jeppesen et al, 2003.
Trophic Factors
• Facilitate intestinal
adaptation
• Intestinal adaptation
• Morphological and
functional
• Ileum > Colon >
Jejunum
• Lasts 1-2 years
• Variety of stimulators
of adaptation

16. Managing SBS-IF
End-jejunostomy Jejunocolic Jejunoileocolic
Conduct nutrition assessment
Micronutrient monitoring and supplementation
Optimize diet and fluid intake
Careful monitoring of fluid and electrolytes
Aggressive use of antidiarrheal and antisecretory medications
When possible, titrate drug dosing according to measurable clinical effects or plasma concentrations
Educate patient on catheter care and home PS issues
Attempt to wean parenteral support
Unsuccessful or incomplete Successful
Continue above measures
Monitor for complications
Continue
PS
Consider use
of GLP-2
analogue
Consider non-
transplant surgical
options
Unsuccessful or
incomplete
Successful
Tolerant of
PS
Intolerant of
PS
Consider intestinal
transplant
PS, parenteral support.

17. u Use of glucagon-like-peptide 2 (GLP-2) analog
should be considered for patients with SBS-IF
u Meet criteria for SBS
u PN/IV fluids required >3 times/week for ≥1 year (?) versus
stable condition following a period of intestinal
adaptation
u After optimization of routine medical (and surgical
therapy)
u No contraindications to GLP-2
u Is compliant/reliable with therapies
u Partnership exists between treating team and patient
FDA-approved trophic factors
• rhGH in adults 2003 together with optimized diet ± oral
glutamine; still considered investigational in peds
• Teduglutide in adults 2012; peds 2019
Practice Advice
rhGH, recombinant human growth hormone.

18. RDBPCT of Teduglutide in SBS-IF
Responder Rate Reduction in PN/IV Volume
n=27/43
63%
n=13/43
30%
P = 0.002
RDBPCT, randomized double-blind placebo-controlled trial.
Jeppesen et al, 2012.
Primary and Secondary Endpoints
1) % patients responding with
>20% PN reduction/week at
weeks 20-24
2) Reduction in PN volume

19. Question
Which one of the following is needed in patients
receiving teduglutide?
A. Colonoscopy before and 1 year after starting
B. ECG before and every 6 months while using
C. Dose escalation in those with renal failure
D. Liver and pancreatic blood tests before, but not
after, starting
EKG, electrocardiogram.

20. Precautions with Teduglutide Use
u Risk for acceleration of GI neoplastic growth
u Colonoscopy before treatment and 1 year later
u Contraindicated in active GI/hepatobiliary/pancreatic cancers
u Intestinal obstruction
u Pancreaticobiliary disease
u Labs before and every 6 months
u Fluid overload
u Potential to increase concomitant drug absorption
u Reduce dose in mod-severe chronic kidney disease
What about use in non-GI malignancy?
Based on “benefit-risk ratio”
Jeppesen, 2012.

21. Take Home Points
u Defining the residual bowel anatomy is important to
identify complication risk and optimize treatment
u Nutrition and hydration therapies are important in the
management of SBS
u Aggressive use of conventional antimotility and
antisecretory drugs is considered first-line therapy
u The role of GLP-2 analogs is evolving
u Long-term safety/efficacy, optimal patient selection, cost-
effectiveness and timing of administration relative to onset of SBS
require additional study

22. Managing Complications
Case Closed: Optimizing Outcomes for Patients with SBS

23. Practice Advice
u An important priority of care in SBS is the prevention and
treatment of complications
u Related to SBS
u Related to parenteral nutrition
u Related to the underlying disease
These are often inter-related

24. Complications in SBS
u Diarrhea/malabsorption
u Weight loss/malnutrition
u Micronutrient/EFA deficiencies
u Fluid and electrolyte disturbances
u ‘Net secretor’, hypomagnesemia
u Renal dysfunction
u Stones, chronic kidney disease
u Metabolic bone disease
u Cholelithiasis
u Acid peptic disease
u Anastomotic ulceration/stricture, GERD, dyspepsia
u Small intestinal bacterial overgrowth
u D-lactic acidosis
Other SBS management challenges
PN-related – liver disease
CVC – sepsis, loss of access
CVC, central venous catheter; EFA, essential fatty acid; GERD, gastroesophageal reflux disease.
Johnson et al, 2018.

25. Case Study 3
u 46-year-old woman with 50 cm of jejunum and half colon
after resection 6 months ago for internal hernia with
gangrenous small bowel following Roux-en-Y gastric bypass
u 10-15 loose, foul-smelling BMs day/night
u Considerable fecal urgency and incontinence
u Home-bound and miserable due to the diarrhea
u Previously tried loperamide, diphenoxylate w/atropine (1
tab TID), tincture of opium (QID) and cholestyramine in the
past – didn’t help so no longer using
u Urine output: about 600 mL/d
u Excessive weight loss following bariatric operation
QID, four times a day; TID, three times a day.

26. Question
Diarrhea in SBS may be caused by which one of the
following?
A. Increased secretions
B. Malabsorption of nutrients
C. Accelerated transit
D. Reduced absorptive surface area
E. All of the above

27. Diarrhea
• Causes
• Reduction of absorptive surface area
• Decreased intestinal transit time
• Gastric hypersecretion
• Humorally-mediated rapid gastrointestinal transit
• Small intestinal bacterial overgrowth
• Treatment
• Dietary/oral fluid modifications
• Oral rehydration solution
• Antidiarrheal agents
• Antisecretory agents
• Somatostatin analogues (infrequently)
• Intestinotrophic factor (?)
Most common and
oftentimes disabling
complication

28. Fluid and Electrolyte Disturbances
u Most problematic in those with
an ostomy
u Major cause of morbidity and
hospitalization
u Sodium/fluid deficiency,
hypokalemia,
hypomagnesemia and
hypocalcemia common
u Large fluid (and sodium) losses
u Direct losses in the stool and
indirect losses in the urine
u Volume depletion can
contribute to nephrolithiasis
and AKI/CKD
u IVF sometimes needed
AKI, acute kidney injury; CKD, chronic kidney disease.
Messaris et al, 2012.
Hydration Goals
• Urine output ≥800 mL/d
(≥ 0.5 mL/kg/h) on PN-
free nights (>1500 mL/d
if prior kidney stones)
• Normal serum creatinine,
sodium and magnesium
• Random urine sodium
>20 mmol/L
• Enteral balance >500
mL/d

29. Hypomagnesemia in SBS
u 45% of patients with high output stoma
u 69% of patients with <200 cm of SB will require long-term
supplementation
u Fatigue, tremors, muscle spasms or cramps (tetany),
paresthesias, nystagmus, convulsions, apathy, coma
Baker et al, 2011; Fukumoto et al, 1987.
Concomitant hypokalemia and/or hypocalcemia typically
refractory to treatment until magnesium deficit corrected

30. Treatment of Hypomagnesemia
General measures
u Correct metabolic
acidosis
u Correct vitamin D
deficiency
u Rule out hyperthyroidism
u Slow intestinal transit
u Lessen steatorrhea
u Review med list (PPI use)
u Correct secondary
hyperaldosteronism
(chronic water and Na+
depletion)
u Control blood glucose
u Oral magnesium salts
u When levels 1.0-1.5
u Limited by laxative
effect
u Parenteral
administration
u For severe (<1.0)
and/or symptomatic
u Cannot tolerate oral
drugs
u 2-4 grams MgSO4 –
best when
administered slowly
Management
Baker et al, 2011; Fukumoto et al, 1987.

31. Case Study 4
u 38-year-old woman with longstanding Crohn’s
disease and multiple small bowel and colon
resections presents to clinic complaining that her
hair is falling out and her taste has changed making
it difficult to eat
u She has chronic diarrhea but doesn’t take any
medications because “nothing helps”
u On examination, dry, scaly, sharply demarcated,
red, eczematous patches are noted on her face
and torso

32. Question
Deficiency of which micronutrient is most likely
responsible for this woman’s clinical presentation?
A. Zinc
B. Manganese
C. Copper
D. Vitamin A

33. Manifestations Typical Supplementation
Vitamin A Night blindness, follicular
hyperkeratosis
Oral: 5000–50,000 IU daily (sometimes more); IM
administration also available
Vitamin B12 Macrocytic anemia, glossitis,
loss vibratory/position sense
SC/IM: 300–1000 µg monthly; oral and intranasal
administration also available
Vitamin C Scurvy, perifollicular
hemorrhage, corkscrew hairs
Oral: 200–500 mg daily; IV administration also
available
Vitamin D Bone pain, fractures, muscle
cramps
Oral: 50,000 IU once weekly (or calcitriol 0.25–2 µg
daily); IM administration also available
Vitamin E Decreased tendon reflexes Oral: 400 IU up to three times daily
Folate Macrocytic anemia, glossitis Oral: 1 mg daily
Iron Microcytic anemia, fatigue,
koilonychia, glossitis, pica
Oral: 100–200 mg once daily or every other day; IV
and IM administration also available
Zinc Dysgeusia, dermatitis, hair loss Oral: 50 mg elemental zinc (220 mg tablet) once or
twice daily
Selenium Muscle pain, cardiomyopathy Oral: 100–200 µg daily
Copper Weakness, paresthesia, gait
abnormalities
Oral: 2 mg elemental copper daily (higher dose may
be needed); IV administration also available
Micronutrient Deficiencies
IM, intramuscular; SC, subcutaneous.
Matarese, 2012.

34. Nephrolithiasis
• Types of stones
• Calcium oxalate most common
• Urate stones
• Causes
• Fat malabsorption with colon-in-continuity (oxalate only)
• Volume depletion
• Prolonged duration of SBS
• Decreased Oxalobacter formigenes in the colon
• Chronic kidney disease
• Treatment
• Maintain adequate urine output with increased fluid
intake
• Low fat, low oxalate diet
• Potassium citrate
• Calcium carbonate
Nightingale et al, 2006; Johnson et al, 2018.
Recurrent stones can lead to
irreversible dialysis-requiring
CKD

35. Cholelithiasis
• Type of stones
• Cholesterol mainly
• Clinical scenarios
• Asymptomatic, symptomatic, complicated
• Causes
• Altered enterohepatic circulation with lithogenic bile
• Gallbladder stasis in those with little PO intake
• Chronic PN, medications (e.g., Octreotide)
• Management
• Prophylactic cholecystectomy when abdominal surgery is being
undertaken for other reasons
• ? ursodeoxycholic acid in non-surgical patients
Johnson et al, 2018; Thompson et al, 2018.

36. Metabolic Bone Disease
• Type
• Osteomalacia, osteopenia, osteoporosis
• Causes
• Effects of long-term PN
• Malabsorption of micro- and macronutrients including vitamin D
• Electrolyte alterations
• Chronic metabolic acidosis
• Underlying patient factors including medications
• Insufficient sun exposure
• Management
• Periodic assessment of bone mineral density
• Calcium, magnesium, and vitamin supplementation
• Metabolic acidosis correction
• Specific osteoporosis treatments
Johnson et al, 2018; Nygaard et al, 2018.

37. Intestinal Failure-Associated
Liver Disease (IFALD)
• Causes
• Altered bowel anatomy (small bowel <50 cm, lack of colon-in-continuity)
• PN-related factors
• Underlying systemic and/or liver-related conditions
• Recurrent sepsis
• Lack of oral/enteral intake
• ? Small intestinal bacterial overgrowth
• Management
• Avoid excesses and deficiencies in PN formula
• Limit intravenous lipid dose to <1 g/kg/day
• Reduce/eliminate soybean-based intravenous lipid emulsion
• Use non-soybean-based intravenous lipid emulsions
• Cycle PN
• Increase oral/enteral intake
• Identify/treat sepsis and/or SIBO
Lal et al, 2018; Kelly, 2010.

38. Take Home Points
u An awareness of the SBS bowel anatomy (colon
present or not) provides a clue to the risk of
potential complications
u Familiarity with the potential complications
occurring in the SBS patient is important in both
their prevention and treatment
u Regular monitoring of renal function and fluid
balance, body weight, micronutrient levels, and
bone density is recommended

39. Providing Patient Support
Case Closed: Optimizing Outcomes for Patients with SBS

40. Case Study 5
u A 52-year-old man recently underwent extensive small
bowel resection following complications of an elective
cholecystectomy
u He was told he was going to need to be on PN for the
rest of his life and that he “should get his affairs in
order”
u He was previously healthy and is now anxious/worried
about his life expectancy
u He has many questions for you

41. Question
Which one of the following statements concerning SBS
survival and quality of life is true?
A. About 75% of SBS patients on home PN will be able to
weaned from PN after 5 yrs
B. Quality of life is better in those SBS patients receiving
home PN compared to those who are not
C. 80% of SBS patients on home PN for 1 year will develop
liver failure
D. Effective management of symptoms like diarrhea and
prevention of complications is important for improving
quality of life, reducing health care costs, and
improving survival in SBS

42. SBS Survival and PN Dependency
u SBS occurs in about 15% of adults undergoing intestinal
resection
u 75% result from single massive resection; 25% multiple resections
u About 70% of those with newly acquired SBS are eventually
able to be discharged from the hospital
u US and France reports demonstrate 2-year and 5-year
survival rates of 80% and 70%, respectively
u French study reported PN-dependency in
nonmalignant SBS at 1, 2, and 5 years was 74%, 64%,
and 48%, respectively
u PN dependency reduced when remaining colon >57%, and
small bowel remnant length >75 cm
Amiot et al, 2013; Scolapio et al, 1999; Messing et al, 1995.

43. SBS Quality Of Life
u QoL
u Worse in SBS compared to general population
u Worse in SBS patients on home PN compared to SBS patients
not requiring PN
u Strong self-esteem and good family/social support
favor better QoL
u Factors that negatively impact SBS-QoL:
u Age greater than 55 years, underlying disease, sleep
disturbance, diarrhea/presence of complications, presence
of a stoma, use of narcotics
Carlsson et al, 2003; Baxter et al, 2019.
Effective management of symptoms like diarrhea and
prevention of complications is important for improving quality
of life, reducing health care costs and improving survival in SBS

44. Factors Affecting Home PN QoL
u Inconvenience
u Expense
u Interference with social
and leisure activities
u Altered body
image/disfigurement
u PN-related
complications
u Emotional strain
u Pain
u Lack of employment or
lowered status at work
u Loss of income
u Decreased social
interaction
u Loss of independence
u Loss of control of bodily
functions
u Inability to eat normally
u Sexual functioning
u Self esteem
u Family and social
support
Carlsson et al, 2003; Baxter et al, 2019.

45. Patient-Centered Care Approach
u Listen
u Discuss diagnosis and potential complications
u Explain treatment options, goals and expectations
u Reassure and encourage
u Educate
Educate, educate, and educate

46. Practice Advice
u Clinicians should encourage ongoing education for
patients and caregivers
u Clinicians should also encourage their participation
in sources of psycho-social support
u Physical burdens
u Psycho-social burdens
u Financial burdens
u Frequent dependence on intrusive chronic therapy in the
form of PN

47. Question
Which one of the following is essential education
for the SBS patient?
A. Sterile catheter technique
B. Rationale for diet and fluid modifications
C. Availability of support groups
D. Role of available treatments
E. All of the above are essential

48. Educating the SBS Patient
u Educate on importance of sterile technique
u Educate on the importance of monitoring
u Recognize signs and symptoms of complications and to
respond appropriately
u Monitor weight, body temperature, urine output, and blood
sugars
u Educate on treatments available and rationale for use
u Diet, fluids, medications
u Educate on the availability of support groups and
networking opportunities

49. Educating the SBS Patient on
Home PN
u Careful handwashing techniques
u Storage of home PN components
u Maintenance of a clean work area at home
u Central venous catheter site care and management
u Addition of vitamins and other additives to the bag
u Connection and disconnection of tubing
u Use of the infusion pump

50. Patient Involvement in Support Groups
Does It Matter?
u Case-control study of home PN consumers
u 49 members of Oley Foundation compared to 50 non-members
u Matched for age, gender, diagnosis and duration of PN use
u Home PN patients affiliated with the Foundation
u Fewer CVC infections
u Less depression
u Better QoL
Encourage involvement
Smith et al, 2002.

51. SBS Resources for Patients/Caregivers
The Oley Foundation www.oley.org
• Provides information on practical topics
(e.g., travel)
• Regional/national meetings offer
education, opportunity for networking, and
social activities
Short Bowel Syndrome
Website
https://www.shortbowelsyndrome.com/
• Provides education and information on
resources
Short Bowel Syndrome
Foundation
www.shortbowelfoundation.org
• Provides education and information on
resources

52. Educating the Clinicians
u Health care providers are also in need of further
education in the care of these complex patients
u Recent 20-question knowledge survey of GI specialists
pertaining to chronic intestinal failure
u Definition, anatomy, prognosis
u Basics of diet and home PN
u Home PN maintenance, monitoring and complications
u Advanced issues including use of GLP-2 analog and intestinal
transplantation
u 100 respondents (55 self-reported experts in PN)
u Overall mean score 8.8 equivalent to a convenience sample of
nonexperts (mean for experts 15.2)
u No correlation with years of experience or self reported expertise
u Only 3 scored ≥14/20 correct
Opportunities for improvement!
Iyer et al, 2022.

53. SBS Resources for Clinicians
Professional Textbook • DiBaise JK, Parrish CR, Thompson JS, eds. Short Bowel
Syndrome: Practical Approach to Management. 2016
• Corrigan ML, Roberts K, Steiger E. Adult Short Bowel
Syndrome: Nutritional, Medical, and Surgical
Management. 2018
Learn Intestinal Failure
Tele-ECHO clinic (LIFT-
ECHO)
https://liftecho.org/web/home
• Uses multipoint video-conferencing to conduct virtual
clinics with community providers
• Provides education and networking
Short Bowel Syndrome
Website
https://www.shortbowelsyndrome.com/
• Provides education and information on resources
The Oley Foundation www.oley.org
• Provides information on practical topics (e.g., travel)
• Regional/national meetings offer education, opportunity
for networking, and social activities
Short Bowel Syndrome
Foundation
www.shortbowelfoundation.org
• Provides education and information on resources

54. Thank You for Joining Us!
u We are excited to see the impact of this
educational activity on patient care in SBS!
u In 4 weeks, you will receive a follow-up survey to
see if you’ve been able to implement any of your
intended changes as a result of what you learned
today
u If you have any questions, send us an email:
contact@cmespark.com

55. References
u Amiot A, Messing B, Corcos O, et al (2013). Determinants of home parenteral nutrition dependence and survival of 268
patients with non-malignant short bowel syndrome. Clin Nutr. 32(3):368-74. DOI:10.1016/j.clnu.2012.08.007
u Baker ML, Williams RN & Nightingale JMD (2011). Causes and management of high-output stoma. Colorectal Dis.
13(2):191-7. DOI:10.1111/j.1463-1318.2009.02107.x
u Baxter JP, Fayers PM, Bozzetti F, et al (2019). An international study of the quality of life of adult patients treated with home
parenteral nutrition. Clin Nutr. 38(4):1788-96. DOI:10.1016/j.clnu.2018.07.024
u Carlsson E, Bosaeus I & Nordgren S (2003). Quality of life and concerns in patients with short bowel syndrome. Clin Nutr.
22(5):445-52. DOI:10.1016/S0261-5614(03)00042-6
u Dabney A, Thompson J, DiBaise J, et al (2004). Short bowel syndrome after trauma. Am J Surg. 188(6):792-5.
DOI:10.1016/j.amjsurg.2004.08.032
u Fukumoto S, Matsumoto T, Tanaka Y, et al (1987). Renal magnesium wasting in a patient with short bowel syndrome with
magnesium deficiency: effect of 1 alpha-hydroxyvitamin D3 treatment. J Clin Endocrinol Metab. 65(6):1301-4.
DOI:10.1210/jcem-65-6-1301
u Iyer KR, Winkler M, Zubizarreta N, et al (2022). Knowledge of chronic intestinal failure among US gastroenterologists: Cause
for concern and learning opportunity. JPEN J Parenter Enteral Nutr. 46(3):730-33. DOI:10.1002/jpen.2283
u Jeppesen PB (2012). Teduglutide, a novel glucagon-like peptide 2 analog, in the treatment of patients with short bowel
syndrome. Therap Adv Gastroenterol. 5(3):159-171. DOI:10.1177/1756283X11436318
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