Forms of SBS and Long-Term Intestinal Adaptation

SBS is a complex condition that can be classified into two forms with different severities:1–3

  • Intestinal insufficiency is when patients are able to compensate for malabsorption through oral intake of nutrients, or drug therapies (this can include enteral feeding or tube feeding)1–3
  • Intestinal failure (SBS-IF) occurs when patients are unable to compensate for malabsorption with diet and drug therapies, and require intravenous nutritional and/or fluid support (this is known as parenteral support, parenteral nutrition (PN), IV nutrition or fluids (IV), or home parenteral nutrition (HPN).1–3 


SBS-IF can be either: 

where sufficient intestinal function can be restored to remove the need for parenteral support3

where parenteral support is required over months or years3


Can SBS improve over time?
The small intestine does have some ability to adapt to its severely reduced length. In some patients, this natural adaptation of the remaining bowel may reach a stage where they are no longer dependent on parenteral support and are able to maintain adequate nutrition enterally. Other patients though, do not experience that level of intestinal adaptation and continue to require parenteral support for their chronic IF.4–6

How well the intestine adapts to its new form and improves its ability to absorb fluids and nutrients depends on factors such as:2,4,6

  • How much intestine was left behind after surgery; the more intestine that is left, the less adaptation is required2,4,6
  • The ability of the remaining intestine to work properly; sometimes intestine that is left may still be damaged and not functioning as well as it could be (see Causes of SBS)2,4,6
  • The age of the individual when SBS started; adaptation of the remaining intestine occurs more easily in younger patients2,4,6
  • The presence of comorbidities, including Crohn's disease, radiation enteritis, carcinoma, or pseudo-obstruction of the bowel2





  1. Jeppesen PB. Spectrum of short bowel syndrome in adults: intestinal insufficiency to intestinal failure. JPEN J Parenter Enteral Nutr 2014;38(1 Suppl): 8S–13S.
  2. Buchman AL. Etiology and initial management of short bowel syndrome. Gastroenterology 2006;130(2 Suppl 1):S5–S15.
  3. Pironi L, Arends J, Baxter J, et al. Home Artificial Nutrition & Chronic Intestinal Failure; Acute Intestinal Failure Special Interest Groups of ESPEN. ESPEN endorsed recommendations. Definition and classification of intestinal failure in adults. Clin Nutr 2015;34(2):171–180.
  4. Buchman AL, Scolapio J, Fryer J. AGA technical review on short bowel syndrome and intestinal transplantation. Gastroenterology2003;124(4):1111–1134.
  5. Hofstetter S, Stern L, Willet J. Key issues in addressing the clinical and humanistic burden of short bowel syndrome in the US. Curr Med Res Opin 2013;29(5):495–504.
  6. Matarese LE. Nutrition and fluid optimization for patients with short bowel syndrome. JPEN J Parenter Enteral Nutr 2013;37(2):161–170.



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