After the 1-to 2-year period of greatest intestinal adaptation following massive resection, a homeostatic/maintenance stage begins where no further spontaneous intestinal adaptation is thought to occur. Intestinal failure is frequently considered permanent when parenteral nutrition (PN) is required beyond this stage. This is exemplified by the <6% probability of eliminating PN use if not successfully accomplished in the first 2 years after the individual’s last bowel resection . Fortunately, >50% of adults with SBS are able to be weaned completely from PN within 5 years of diagnosis [1,2]. Despite the life-saving nature of PN and advances in its provision, it is associated with significant risks to the patient, such as catheter-related sepsis, venous thrombosis, and liver disease; notably, it also impairs quality of life and is very costly. Therefore, an important goal when treating the SBS patient who requires PN is to reduce dependency on it and, whenever possible, eliminate its use altogether. As such, there has been intense investigation to identify treatments that maximize intestinal adaptation and absorption.
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