Short Bowel Syndrome
Also covered as: intestinal failure · necrotizing enterocolitis · gastroschisis · intestinal atresia · Hirschsprung disease · liver disease · malrotation · volvulus
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Fundamentals
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Necrotizing Enterocolitis with Dr. Gail Besner
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Discussion between Dr. Todd Ponsky and Dr. Gail Besner about necrotizing enterocolitisHistory:Patients will often present with abdominal distention, high gastric residuals and bloody stools.First make sure the problem is in the abdomen.Pat
podcast46:29 · Dec 2020
Intestinal rehabilitation: What is intestinal rehab? - Episode 1
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We’re starting a new series about intestinal rehabilitation and all of its intricacies. We’re joined by Drs. Michael Helmrath and Paul Wales, leaders of the Intestinal Rehabilitation Program at Cincinnati Children’s. Hosted by: Todd Ponsky,
video14:33 · Dec 2021
Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?
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We’re starting a new series about intestinal rehabilitation and all of its intricacies. We’re joined by Drs. Michael Helmrath and Paul Wales, leaders of the Intestinal Rehabilitation Program at Cincinnati Children’s. Hosted by: Todd Ponsky,
podcast14:33 · Dec 2021
Surgical Management
1 item
Intestinal Rehabilitation, Episode 4: Surgical Management, Part 1
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We're back with a new topic, discussing surgical management with Drs. Michael Helmrath and Paul Wales from Intestinal Rehabilitation Center at Cincinnati Children's Hospital.
Hosts: Ellen Encisco & Em Tombash
Resources:
Bianchi A.
podcast19:07 · Oct 2022
Evidence & Research
4 items
Quick Literature Updates Episode 7
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We’re back with seventh episode of "Quick Literature Updates" the podcast series that delivers the latest updates in pediatric surgery literature in a quick and digestible format. In each episode, we review four articles covering the most i
video · May 2023
Disruption of enterohepatic Circulation of Bile acids ameliorates small bowel resection associated hepatic injury
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New article you should know by Cecilia Gigena
"Disruption of enterohepatic Circulation of Bile acids ameliorates small bowel resection associated hepatic injury"
Authors: Maria E. Tecos, Allie E. Steinberger, Jun Guo, Deborah C. Rubi
video0:59 · Aug 2023
Outcomes of Children With Short Bowel Syndrome: Experiences in a Multidisciplinary Intestinal Rehabilitation Unit Over Two Decades
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Jaime Tsz-wing Tsang, Adrian Chi-heng Fung , Stephen Cheuk-lam Lau,Kenneth Kak-yuen Wong
Background: Short bowel syndrome (SBS) is a rare but serious form of organ failure, and patients with SBS depend on total parenteral nutrition (PN)
video0:45 · Mar 2025
Impact of social determinants of health on outcomes in pediatric short bowel syndrome...
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This video discusses a retrospective cohort study from Cincinnati Children's, presented by Lizzy Lee, examining the impact of social determinants of health on outcomes for children with pediatric short bowel syndrome. The study found that f
video0:43 · Aug 2026
In-Depth Reviews
1 item
Intestinal Failure with Dr. Brad Warner
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Discussion with Dr. Brad W. Warner about intestinal failureWhat is intestinal failure?An umbrella term for when the small bowel is unable to digest and absorb an adequate amount of nutrients to sustain a patient through enteral means alone.
podcast52:46 · Dec 2020
Long-Term Care
1 item
Care transition from a pediatric intestinal rehabilitation program to adult care and the risk of all-cause mortality: A retrospective cohort study
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Gillian R Goddard, Stephanie Oliveira, Crystal Slaughter, Kim Klotz, Marilyn Stoops, Julie Schletker, Jackie Wessel, Michael Helmrath, Samuel Kocoshis, Monique Goldschmidt, Paul W WalesBackground: As patients with intestinal failure reach a
video1:01 · May 2026
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Short bowel syndrome (SBS), defined as intestinal loss requiring parenteral nutrition (PN) >90 days, affects ~7/1000 live births in very-low-birth-weight neonates . Salvageability thresholds in neonates are 10–15 cm with ileocecal valve (ICV) and colon, 15–20 cm without [e296-c3,e296-c4]; adults with <50 cm face 40% 5-year mortality . Necrotizing enterocolitis (NEC) patients show the best prognosis for enteral autonomy when standardized for bowel length . Intestinal adaptation occurs over 1–2 years ; 70% of pediatric patients wean from PN by 10 years, with 76% overall weaning . Citrulline >10 μmol/L predicts weaning success . Bowel diameter ratio ≥2.17 independently predicts prolonged PN dependence, correlating with mucosal inflammation, lower citrulline, and higher bloodstream infection rates [e4746-c2,e4746-c4,e4746-c5,e4746-c8]. Surgical lengthening (STEP or LILT) is indicated when diameter exceeds 4–5 cm with enteral plateau or regression ; 66% show improved tolerance, 47% achieve full weaning . Teduglutide (GLP-2 analog) reduces adult PN volume by 1–2 L/week but shows only 10% pediatric weaning in trials . Intestinal failure–associated liver disease (IFALD) resolves with enteral feeding or lipid reduction to <1 g/kg/day; fish oil (Omegaven) normalizes bilirubin in ~20 weeks . Multidisciplinary care has driven 5-year survival to 98.5% , though transition to adult care carries 33% mortality vs. 5% in continued pediatric programs [e11901-c4,e11901-c5].
- Bowel diameter ratio ≥2.17 predicts PN dependence independent of length, correlating with inflammation, sepsis, and cholestasis; tapering restores outcomes to non-dilated cohorts.
- Citrulline >10 μmol/L while fed predicts weaning; persistently low levels (<15 μmol/L) indicate PN dependence despite adequate bowel length.
- IFALD reverses with enteral feeding or lipid reduction <1 g/kg/day; fish oil monotherapy normalizes bilirubin in 20 weeks without essential fatty acid deficiency.
- Teduglutide reduces adult PN volume 1–2 L/week but achieves only 10% pediatric weaning in trials; reserve for medical management failures before lengthening.
- Transition to adult care carries 33% mortality vs. 5% in pediatric programs; structured transition protocols are critical for this vulnerable population.
For patients & families
Short bowel syndrome happens when a child's small intestine cannot absorb enough nutrition, fluids, and calories to support survival and growth, requiring intravenous feeding (parenteral nutrition or TPN) for at least 60 days [e296-c1, e4741-c2]. The most common causes in babies include birth defects like intestinal atresia or gastroschisis, and acquired conditions like necrotizing enterocolitis [e4741-c5, e4741-c6]. After significant bowel loss, the remaining intestine can adapt over one to two years, sometimes allowing children to transition fully to oral or tube feeding . Doctors have learned that breast milk supports this adaptation best, and keeping some nutrition flowing through the gut—even small amounts—helps the intestine heal and grow [e4742-c15, e4742-c20]. Survival has improved dramatically: specialized intestinal rehabilitation programs now report over 90% long-term survival, compared to much lower rates decades ago [e4741-c20, e10273-c4]. Treatment involves a team of specialists managing nutrition, preventing infections in IV lines, protecting the liver from TPN complications, and sometimes performing surgery to reshape dilated bowel [e4741-c19, e296-c26]. Some children need TPN for months or years, while others eventually eat normally; the outcome depends on how much bowel remains, whether the colon is intact, and how well the intestine functions [e296-c6, e10226-c21].
Short bowel syndrome happens when a child's small intestine cannot absorb enough nutrition, fluids, and calories to support survival and growth, requiring intravenous feeding (parenteral nutrition or TPN) for at least 60 days [e296-c1, e4741-c2]. The most common causes in babies include birth defects like intestinal atresia or gastroschisis, and acquired conditions like necrotizing enterocolitis [e4741-c5, e4741-c6]. After significant bowel loss, the remaining intestine can adapt over one to two years, sometimes allowing children to transition fully to oral or tube feeding . Doctors have learned that breast milk supports this adaptation best, and keeping some nutrition flowing through the gut—even small amounts—helps the intestine heal and grow [e4742-c15, e4742-c20]. Survival has improved dramatically: specialized intestinal rehabilitation programs now report over 90% long-term survival, compared to much lower rates decades ago [e4741-c20, e10273-c4]. Treatment involves a team of specialists managing nutrition, preventing infections in IV lines, protecting the liver from TPN complications, and sometimes performing surgery to reshape dilated bowel [e4741-c19, e296-c26]. Some children need TPN for months or years, while others eventually eat normally; the outcome depends on how much bowel remains, whether the colon is intact, and how well the intestine functions [e296-c6, e10226-c21].
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Intestinal rehabilitation: What is intestinal rehab? - Episode 1
Until recently, there was no standardized definition for intestinal failure.
clinicalPaul Wales1:56 ↗
Intestinal failure is when gut function is insufficient to absorb enough nutrients, fluids, and calories to support survival and, in children, growth.
clinicalPaul Wales2:03 ↗
New guidelines define intestinal failure as requiring parenteral support for at least 60 days due to inadequate intestinal function.
host_summaryRod Gerardo2:24 ↗
Earlier recognition and taking advantage of the gut's biology to adapt are time dependent.
clinicalMichael Helmrath2:40 ↗
An intestinal rehabilitation program is a multidisciplinary collaborative patient care paradigm that brings coordinated care for children with intestinal failure through comprehensive management of their specialized nutrition and other associated needs, as defined in recent ASPEN guidelines.
guidelinePaul Wales3:03 ↗
Intestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.
host_summaryRod Gerardo3:33 ↗
The intestinal rehabilitation approach streamlines care and improves communication with families and between care providers.
clinicalPaul Wales3:44 ↗
Intestinal rehabilitation depends on nutrition in the gut, nutrition in the body, and healing.
clinicalMichael Helmrath4:07 ↗
Pattern recognition from multiple experienced clinicians observing patients over time is essential in intestinal rehabilitation.
clinicalMichael Helmrath4:19 ↗
Causes of intestinal failure divide into three categories: short bowel syndrome, motility disorders, and congenital enteropathies.
clinicalPaul Wales4:39 ↗
Short bowel syndrome is by far the most common category of intestinal failure in pediatric patients.
epidemiologicalPaul Wales4:50 ↗
Causes of short bowel syndrome include congenital anomalies (intestinal atresia, malrotation, volvulus, gastroschisis, long segment Hirschsprung disease) and acquired neonatal diseases (necrotizing enterocolitis).
clinicalPaul Wales5:06 ↗
Motility disorders occur when abnormalities of intestinal muscle or the nerves controlling that muscle prevent coordinated propulsion of food and stool.
clinicalPaul Wales5:45 ↗
Congenital enteropathies are conditions where patients have all their bowel but the mucosal lining does not digest or absorb properly.
clinicalPaul Wales6:17 ↗
Mucosal defects in enteropathies lead to hypersecretion and profuse fluid losses, preventing nutrient absorption.
host_summaryEllen Encisco6:30 ↗
Some patients have elements of two or all three categories of intestinal failure in their presentation.
clinicalPaul Wales7:11 ↗
Gastroschisis can involve all three categories: short bowel from nonviable tissue, inflammation affecting absorption, and motility issues.
host_summaryEllen Encisco7:22 ↗
Most intestinal failure patients are infants or babies, but some older pediatric patients develop intestinal failure from inflammatory bowel disease, Crohn disease complications, trauma, malignancy, or vascular thrombosis.
epidemiologicalPaul Wales7:45 ↗
Access and availability to intestinal rehabilitation programs is still very rare.
host_summaryRod Gerardo8:41 ↗
Three time points exist for diagnosis and referral to intestinal rehab: prenatal diagnosis (atresia with cystic fibrosis, gastroschisis), postnatal acquired problems (volvulus, NEC), and later presentations after discharge when patients fail to progress.
clinicalMichael Helmrath8:53 ↗
Innovation in intestinal rehabilitation comes from multiple approaches to problems and different visions, with more expertise leading to better outcomes.
opinionMichael Helmrath10:15 ↗
Transitioning older children with intestinal failure into their late teen years and beyond is a major obstacle currently not being adequately addressed.
clinicalMichael Helmrath10:51 ↗
The intestinal rehabilitation team includes dietitians (for nutritional needs), social workers, nurse practitioners, pharmacy, interventional radiology, pathology, endocrinology, and nephrology.
clinicalMichael Helmrath11:52 ↗
Overall long-term survival in major intestinal rehabilitation programs is usually over 90%.
host_summaryRod Gerardo12:34 ↗
Long-term survivors now develop chronic comorbidities not previously seen to the same extent because patients did not live long enough, including renal dysfunction, metabolic bone disease, neurocognitive issues, and quality of life problems.
clinicalPaul Wales12:46 ↗
Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?
Until recently, there was no standardized definition for intestinal failure.
guidelinePaul Wales1:56 ↗
Intestinal failure is a functional problem where gut function is insufficient to absorb enough nutrients, fluids, and calories to support survival and, in children, growth.
clinicalPaul Wales2:03 ↗
New guidelines define intestinal failure as inadequate intestinal function requiring parenteral support for at least 60 days.
host_summaryRod Gerardo2:24 ↗
Earlier recognition and taking advantage of the gut's adaptive biology are time dependent.
clinicalMichael Helmrath2:40 ↗
An intestinal rehabilitation program is a multidisciplinary collaborative patient care paradigm that brings coordinated care for children with intestinal failure through comprehensive management of their specialized nutrition and other associated needs, as defined in recent ASPEN guidelines.
guidelinePaul Wales3:03 ↗
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