Chronic intestinal failure and short bowel syndrome in Crohn’s disease

Table 7 Pathophysiological characteristics of short bowel syndrome with and without colon in continuity (adapted from Pironi et al[46], 2016)

Characteristic	End-jejunostomy	Jejunocolic or jejunoileal anastomosis
Structural and functional adaptation, to increase nutrient absorption	No evidence thereof at any time after surgery	Possible up to 2 yr after surgery
Gastric hypersecretion (up to 6 mo after resection)	Present	Present
Gastric emptying and small bowel transit	Accelerated gastric emptying for liquids	Slowed
	Accelerated small bowel transit
GI hormone secretion (PYY, GLP-1, GLP-2)	Decreased/absent	Increased
Energy absorption from microbiota SCFA, production in the colon	Absent	Increased up to 1000 kcal (4.2 MJ) per day
Water and sodium absorption in the remnant small bowel	Possible “net secretion” when jejunum length < 100 cm (more fluid and sodium lost than ingested)	Colon adaptation can increase the absorption of water up to 6 liters and sodium up to 800 mmol per day
Vitamin B12 and bile salt absorption	Absent	Partially conserved or absent
Magnesium absorption	Decreased	Decreased
Remnant small bowel cut-off length for HPN weaning	> 115 cm	Jejunocolic anastomosis > 60 cm
		Jejunoileal anastomosis with ICV and entire colon
		> 35 cm

GI: Gastrointestinal; GLP: Glucagon-like peptide; HPN: Home parenteral nutrition; IVC: Ileocecal valve; PYY: Peptide tyrosine-tyrosine; SCFA: Short chain fatty acid.