title: Increased intestinal absorption by segmental reversal of the small bowel in adult patients with short-bowel syndrome: a case-control study.
abstract: BACKGROUND
  Segmental reversal of the small bowel (SRSB) is proposed in patients with short-bowel syndrome (SBS) as a rehabilitative therapy, but its effects on absorption have not been studied.
  
  
  OBJECTIVE
  We aimed to determine intestinal macronutrient absorption and home parenteral nutrition (HPN) dependence in SBS patients with intestinal failure.
  
  
  METHODS
  We included in a retrospective study all consecutive patients who had an SRSB between 1985 and 2010 and underwent a study of macronutrient absorption. Patients were matched to SBS controls with the same digestive characteristics. Energy and macronutrient absorption were measured. The dependence on HPN was expressed by the number of infusions per week and by the calories infused daily divided by the basal energy expenditure multiplied by 1.5.
  
  
  RESULTS
  Seventeen patients who had an SRSB were matched to 17 control patients. Intestinal absorption was higher in the SRSB group for total calories (69.5% compared with 58.0%), fat (48.4% compared with 33.2%), and protein (62.7% compared with 53.4%) (P < 0.05). Median oral autonomy was 100% ± 38.4% in the SRSB group, whereas it was 79% ± 39.6% in the control group (P < 0.05). The number of calories infused was lower in the SRSB group (500 ± 283 compared with 684 ± 541; P < 0.05), as was HPN dependence (33% ± 20% compared with 48% ± 38%; P < 0.05) at the time of the study.
  
  
  CONCLUSIONS
  SRSB allows a gain in macronutrient absorption, which is associated with a lower HPN dependence. To our view, SRSB should be integrated in intestinal rehabilitative adult programs.
authors.affiliation: Departments of Gastroenterology and Nutrition Support, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and the Denis Diderot University, Paris, France.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Layec
authors.forename: Laura
authors.initials: L
authors.lastname: Beyer
authors.forename: Olivier
authors.initials: O
authors.lastname: Corcos
authors.forename: Arnaud
authors.initials: A
authors.lastname: Alves
authors.forename: Xavier
authors.initials: X
authors.lastname: Dray
authors.forename: Aurélien
authors.initials: A
authors.lastname: Amiot
authors.forename: Carmen
authors.initials: C
authors.lastname: Stefanescu
authors.forename: Benoit
authors.initials: B
authors.lastname: Coffin
authors.forename: Frédéric
authors.initials: F
authors.lastname: Bretagnol
authors.forename: Yoram
authors.initials: Y
authors.lastname: Bouhnik
authors.forename: Bernard
authors.initials: B
authors.lastname: Messing
authors.forename: Yves
authors.initials: Y
authors.lastname: Panis
authors.forename: Nathalie
authors.initials: N
authors.lastname: Kapel
authors.forename: Francisca
authors.initials: F
authors.lastname: Joly
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002149:Energy Intake; D004734:Energy Metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007408:Intestinal Absorption; D007421:Intestine, Small / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D016331:Parenteral Nutrition, Home; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000473:pathology* / Q000628:therapy*; D055815:Young Adult