Short Bowel Syndrome
Short Bowel Syndrome (SBS) is defined as a significant anatomic or functional reduction in small bowel length. This leads to a reduced capacity for the bowel to digest and absorb nutrients including fats. The significant malabsorption manifest itself often as diarrhea, unintentional weight loss, and fluid/electrolyte disturbances.
The exocrine part of the pancreas plays an important role in the digestion of food. It secretes digestive enzymes facilitating the digestion process in the small bowel (Smeets, et al., 1998). This is an important step for digestion of LCTs. In several diseases, the exocrine role of the pancreas might be disrupted. For example, this may arise in acute/chronic pancreatitis, cystic fibrosis and subsequent pancreatic resection.
A deeper dive in Antibiotic-Associated Diarrhea (AAD) including Clostridium difficile associated diarrhea.
Antibiotic-associated diarrhea is defined as diarrhea developing from the beginning of antibiotic treatment to 6-8 weeks after discontinuation (Liao, Chen, Wen, & Zhao, 2021). It may lead to antimicrobial prescription noncompliance and overconsumption of second-line antibiotics.
The prevalence of AAD varies between 5% and 39% in adults. There is a direct effect of the antibacterial agent on the intestinal mucosa and a strong interference on the intestinal flora ecosystem which leads to metabolic dysfunction and overgrowth of pathogens, especially Clostridium difficile.
Clostridium difficile-associated diarrhea (CDAD):
Probiotics supplementation can reduce the risk of CDAD by 64% and is safe (Goldenberg, et al., 2013).
Diarrhea related to chemotherapy: Probiotics could have a preventative effect in the occurrence of diarrhea in patients receiving chemotherapy. It was shown in a meta-analysis that this effect was shown without any adverse events (Rondanelli, et al., 2017). However, caution needs to be taken that probiotics are not given to patients that are suffering from immune suppression or other conditions that could pose additional risks.
Chyle is a fluid that primarily consists of LCT containing chylomicrons and lymphatic fluid. Chyle originates in the small bowel where the chylomicrons are formed and absorbed into the lymphatic system. In a normal condition, Chyle passes through the lymphatic system and enters the venous circulation via the thoracic duct. An obstruction or an injury to the lymphatic system may results in a Chyle leak into the pleural, pericardial, or peritoneal space. The common causes of Chyle leaks include neoplasia, infections, radiation, surgery and trauma.