Dietary and Parenteral Nutritional Management of Short Bowel Syndrome with Intestinal Failure in Adults: A Narrative Review

Abstract

Short bowel syndrome (SBS) is the leading cause of chronic intestinal failure in adults, arising when the residual small bowel can no longer absorb the macronutrients, water, and electrolytes needed to sustain health without intravenous supplementation. Its management is, at its core, a nutritional problem. This narrative review summarises and critically appraises current evidence and guideline recommendations on the two pillars of that management: dietary (oral/enteral) therapy and parenteral nutritional support. We frame both around the two variables that dominate clinical behaviour, namely residual intestinal anatomy and the phase of intestinal adaptation, and translate them into anatomy-tailored dietary strategies, rational fluid and electrolyte replacement, micronutrient surveillance, and the composition, delivery, and complications of (home) parenteral nutrition. We also position the pharmacological adjuncts, culminating in glucagon-like peptide-2 (GLP-2) analogues, within a stepwise strategy to reduce parenteral support dependence. The goal throughout is a practical, physiology-anchored approach that maximises enteral autonomy and quality of life while preventing the metabolic, hepatic and catheter-related complications of long-term intravenous feeding. The literature was identified through structured but non-systematic searches of PubMed/MEDLINE, Embase and the Cochrane Library, and the nature of the evidence supporting each recommendation, ranging from randomised trials to expert consensus, is indicated throughout the text.