Intestinale Adaptation - Ein wichtiges Therapiekonzept beim Kurzdarmsyndrom

Intestinal adaptation in short bowel syndrome depends on morphological changes of the remaining small bowel such as longitudinal growth, thickening of the mucosa and increase in activity of mucosal digestive enzymes. During the process of adaptation absorptive capacity increases and tolerance of enteral nutrition improves. The extent of adaptation depends on anatomical structures of the remaining small bowel. Proximal small bowel has already reached maximum absorptive capacity and is not capable of net fluid absorption. Distal small bowel has a much higher potential for adaptation. Complex enteral nutrients such as triglycerides and intact proteins stimulate the process of adaptation. Humoral factors such as growth hormone and glucagons-like peptide 2 (GLP) have been shown to improve tolerance of enteral nutrition in adults but long term benefit has not been demonstrated consistently. Until now, clinical studies in children have not been published. With respect to possible side effects treatment with these potent growth factors they cannot be recommended for children at this point.