Intestinal microbiome in short bowel syndrome: diagnostic and therapeutic opportunities

Purpose of reviewThe intestinal microbiome plays a strong, complementary role in the development and integrity of the intestinal epithelium. This biology is crucial for intestinal adaptation, particularly after the mucosal insults that lead to short bowel syndrome (SBS). The purpose of this review is to discuss relationships between the intestinal microbiota and the physiology of intestinal adaptation.We will address interactions between the intestinal microbiome and nutritional metabolism, factors leading to dysbiosis in SBS, and common compositional differences of the gut microbiome in SBS patients as compared to healthy controls. We will also discuss novel opportunities to expand diagnostic and therapeutic interventions in this population, by using our knowledge of the microbiome to manipulate luminal bacteria and study their resultant metabolites. As microbial therapeutics advance across so many fields of medicine, this review is timely in its advocacy for ongoing research that focuses on the SBS population.Our review will discuss 4 key areas: 1) physiology of the intestinal microbiome in SBS, 2) clinical and therapeutic insults that lead to a state of dysbiosis, 3) currently available evidence on microbiome-based approaches to SBS management, and 4) opportunities and innovations to inspire future research.The clinical implications of this review are both current, and potential. Understanding how the microbiome impacts intestinal adaptation and host physiology may enhance our understanding of why we experience such clinical variability in SBS patients' outcomes. This review may also expand clinicians' understanding of what 'personalized medicine' can mean for this patient population, and how we may someday consider our nutritional, therapeutic, and prognostic recommendations based on our patients' host, and microbial physiology.Papers of particular interest, published within the annual period of review, have been highlighted as:The role of the gut microbiome has been described across a range of intestinal, and extraintestinal disorders [1]. The contributions of the microbiota to the development of immune regulation, structural integrity of the gut mucosal barrier, and resistance to enteric pathogens is well described and its roles in nutritional metabolism of host dietary intake is emerging [2]. Host-microbiota interactions may have particular relevance in short-bowel syndrome (SBS) where intestinal adaptation is a central goal. Available literature suggests that the intestinal microbiome may impact intestinal failure-associated liver disease (IFALD), small intestinal bacterial overgrowth (SIBO), bile acid metabolism and the achievement of enteral autonomy [2]. These data offer novel diagnostic and therapeutic opportunities.In children, the most common cause of intestinal failure (defined as requiring parenteral nutrition [PN] support) is SBS, with a prevalence of 24.5 out of 100,000 live births [3]. Causes of SBS vary and may include necrotizing enterocolitis (NEC), midgut volvulus (or other vascular insults that lead to ischemia), or progressive inflammation (such as Crohn's disease) [4]. The microbiome has been implicated in the pathogenesis of several of these conditions, including NEC [5,6], Crohn's disease [7], and dysmotility syndromes (which may lead to a functional SBS) [8].Available data is limited and affected by the anatomic heterogeneity of SBS patients and limited availability of microbial data. Nevertheless, current evidence suggests a role for further study that may enhance our understanding of the biology of SBS, as well as opportunities for novel therapeutics. This review will summarize our understanding of the interactions of the gut microbiome in the management of SBS, its associated complications, and propose opportunities for future study. no caption availableThe intestinal microbiota affects host physiology via multiple mechanisms that have relevance to SBS (Fig. 1). Intestinal microbiota metabolize host nutrients to generate bioactive metabolites with intestinal and extraintestinal effects. Microbiota may also have direct effects on mucosal receptors along the gastrointestinal epithelia.Factors contributing to dysbiosis in short bowel syndrome. (Original submission).Purpose of reviewThe intestinal microbiome plays a strong, complementary role in the development and integrity of the intestinal epithelium. This biology is crucial for intestinal adaptation, particularly after the mucosal insults that lead to short bowel syndrome (SBS). The purpose of this review is to discuss relationships between the intestinal microbiota and the physiology of intestinal adaptation.We will address interactions between the intestinal microbiome and nutritional metabolism, factors leading to dysbiosis in SBS, and common compositional differences of the gut microbiome in SBS patients as compared to healthy controls. We will also discuss novel opportunities to expand diagnostic and therapeutic interventions in this population, by using our knowledge of the microbiome to manipulate luminal bacteria and study their resultant metabolites. As microbial therapeutics advance across so many fields of medicine, this review is timely in its advocacy for ongoing research that focuses on the SBS population.Our review will discuss 4 key areas: 1) physiology of the intestinal microbiome in SBS, 2) clinical and therapeutic insults that lead to a state of dysbiosis, 3) currently available evidence on microbiome-based approaches to SBS management, and 4) opportunities and innovations to inspire future research.The clinical implications of this review are both current, and potential. Understanding how the microbiome impacts intestinal adaptation and host physiology may enhance our understanding of why we experience such clinical variability in SBS patients' outcomes. This review may also expand clinicians' understanding of what 'personalized medicine' can mean for this patient population, and how we may someday consider our nutritional, therapeutic, and prognostic recommendations based on our patients' host, and microbial physiology.Papers of particular interest, published within the annual period of review, have been highlighted as:The role of the gut microbiome has been described across a range of intestinal, and extraintestinal disorders [1]. The contributions of the microbiota to the development of immune regulation, structural integrity of the gut mucosal barrier, and resistance to enteric pathogens is well described and its roles in nutritional metabolism of host dietary intake is emerging [2]. Host-microbiota interactions may have particular relevance in short-bowel syndrome (SBS) where intestinal adaptation is a central goal. Available literature suggests that the intestinal microbiome may impact intestinal failure-associated liver disease (IFALD), small intestinal bacterial overgrowth (SIBO), bile acid metabolism and the achievement of enteral autonomy [2]. These data offer novel diagnostic and therapeutic opportunities. In children, the most common cause of intestinal failure (defined as requiring parenteral nutrition [PN] support) is SBS, with a prevalence of 24.5 out of 100,000 live births [3]. Causes of SBS vary and may include necrotizing enterocolitis (NEC), midgut volvulus (or other vascular insults that lead to ischemia), or progressive inflammation (such as Crohn's disease) [4]. The microbiome has been implicated in the pathogenesis of several of these conditions, including NEC [5,6], Crohn's disease [7], and dysmotility syndromes (which may lead to a functional SBS) [8].Available data is limited and affected by the anatomic heterogeneity of SBS patients and limited availability of microbial data. Nevertheless, current evidence suggests a role for further study that may enhance our understanding of the biology of SBS, as well as opportunities for novel therapeutics. This review will summarize our understanding of the interactions of the gut microbiome in the management of SBS, its associated complications, and propose opportunities for future study. no caption availableThe intestinal microbiota affects host physiology via multiple mechanisms that have relevance to SBS (Fig. 1). Intestinal microbiota metabolize host nutrients to generate bioactive metabolites with intestinal and extraintestinal effects. Microbiota may also have direct effects on mucosal receptors along the gastrointestinal epithelia.Factors contributing to dysbiosis in short bowel syndrome. (Original submission).Purpose of reviewThe intestinal microbiome plays a strong, complementary role in the development and integrity of the intestinal epithelium. This biology is crucial for intestinal adaptation, particularly after the mucosal insults that lead to short bowel syndrome (SBS). The purpose of this review is to discuss relationships between the intestinal microbiota and the physiology of intestinal adaptation.We will address interactions between the intestinal microbiome and nutritional metabolism, factors leading to dysbiosis in SBS, and common compositional differences of the gut microbiome in SBS patients as compared to healthy controls. We will also discuss novel opportunities to expand diagnostic and therapeutic interventions in this population, by using our knowledge of the microbiome to manipulate luminal bacteria and study their resultant metabolites. As microbial therapeutics advance across so many fields of medicine, this review is timely in its advocacy for ongoing research that focuses on the SBS population.Our review will discuss 4 key areas: 1) physiology of the intestinal microbiome in SBS, 2) clinical and therapeutic insults that lead to a state of dysbiosis, 3) currently available evidence on microbiome-based approaches to SBS management, and 4) opportunities and innovations to inspire future research.The clinical implications of this review are both current, and potential. Understanding how the microbiome impacts intestinal adaptation and host physiology may enhance our understanding of why we experience such clinical variability in SBS patients' outcomes. This review may also expand clinicians' understanding of what 'personalized medicine' can mean for this patient population, and how we may someday consider our nutritional, therapeutic, and prognostic recommendations based on our patients' host, and microbial physiology.Papers of particular interest, published within the annual period of review, have been highlighted as:The role of the gut microbiome has been described across a range of intestinal, and extraintestinal disorders [1]. The contributions of the microbiota to the development of immune regulation, structural integrity of the gut mucosal barrier, and resistance to enteric pathogens is well described and its roles in nutritional metabolism of host dietary intake is emerging [2]. Host-microbiota interactions may have particular relevance in short-bowel syndrome (SBS) where intestinal adaptation is a central goal. Available literature suggests that the intestinal microbiome may impact intestinal failure-associated liver disease (IFALD), small intestinal bacterial overgrowth (SIBO), bile acid metabolism and the achievement of enteral autonomy [2]. These data offer novel diagnostic and therapeutic opportunities.In children, the most common cause of intestinal failure (defined as requiring parenteral nutrition [PN] support) is SBS, with a prevalence of 24.5 out of 100,000 live births [3]. Causes of SBS vary and may include necrotizing enterocolitis (NEC), midgut volvulus (or other vascular insults that lead to ischemia), or progressive inflammation (such as Crohn's disease) [4]. The microbiome has been implicated in the pathogenesis of several of these conditions, including NEC [5,6], Crohn's disease [7], and dysmotility syndromes (which may lead to a functional SBS) [8].Available data is limited and affected by the anatomic heterogeneity of SBS patients and limited availability of microbial data. Nevertheless, current evidence suggests a role for further study that may enhance our understanding of the biology of SBS, as well as opportunities for novel therapeutics. This review will summarize our understanding of the interactions of the gut microbiome in the management of SBS, its associated complications, and propose opportunities for future study. no caption availableThe intestinal microbiota affects host physiology via multiple mechanisms that have relevance to SBS (Fig. 1). Intestinal microbiota metabolize host nutrients to generate bioactive metabolites with intestinal and extraintestinal effects. Microbiota may also have direct effects on mucosal receptors along the gastrointestinal epithelia.Factors contributing to dysbiosis in short bowel syndrome. (Original submission).Purpose of reviewThe intestinal microbiome plays a strong, complementary role in the development and integrity of the intestinal epithelium. This biology is crucial for intestinal adaptation, particularly after the mucosal insults that lead to short bowel syndrome (SBS). The purpose of this review is to discuss relationships between the intestinal microbiota and the physiology of intestinal adaptation.We will address interactions between the intestinal microbiome and nutritional metabolism, factors leading to dysbiosis in SBS, and common compositional differences of the gut microbiome in SBS patients as compared to healthy controls. We will also discuss novel opportunities to expand diagnostic and therapeutic interventions in this population, by using our knowledge of the microbiome to manipulate luminal bacteria and study their resultant metabolites. As microbial therapeutics advance across so many fields of medicine, this review is timely in its advocacy for ongoing research that focuses on the SBS population.Our review will discuss 4 key areas: 1) physiology of the intestinal microbiome in SBS, 2) clinical and therapeutic insults that lead to a state of dysbiosis, 3) currently available evidence on microbiome-based approaches to SBS management, and 4) opportunities and innovations to inspire future research.The clinical implications of this review are both current, and potential. Understanding how the microbiome impacts intestinal adaptation and host physiology may enhance our understanding of why we experience such clinical variability in SBS patients' outcomes. This review may also expand clinicians' understanding of what 'personalized medicine' can mean for this patient population, and how we may someday consider our nutritional, therapeutic, and prognostic recommendations based on our patients' host, and microbial physiology.Papers of particular interest, published within the annual period of review, have been highlighted as:The role of the gut microbiome has been described across a range of intestinal, and extraintestinal disorders [1]. The contributions of the microbiota to the development of immune regulation, structural integrity of the gut mucosal barrier, and resistance to enteric pathogens is well described and its roles in nutritional metabolism of host dietary intake is emerging [2]. Host-microbiota interactions may have particular relevance in short-bowel syndrome (SBS) where intestinal adaptation is a central goal. Available literature suggests that the intestinal microbiome may impact intestinal failure-associated liver disease (IFALD), small intestinal bacterial overgrowth (SIBO), bile acid metabolism and the achievement of enteral autonomy [2]. These data offer novel diagnostic and therapeutic opportunities.In children, the most common cause of intestinal failure (defined as requiring parenteral nutrition [PN] support) is SBS, with a prevalence of 24.5 out of 100,000 live births [3]. Causes of SBS vary and may include necrotizing enterocolitis (NEC), midgut volvulus (or other vascular insults that lead to ischemia), or progressive inflammation (such as Crohn's disease) [4]. The microbiome has been implicated in the pathogenesis of several of these conditions, including NEC [5,6], Crohn's disease [7], and dysmotility syndromes (which may lead to a functional SBS) [8].Available data is limited and affected by the anatomic heterogeneity of SBS patients and limited availability of microbial data. Nevertheless, current evidence suggests a role for further study that may enhance our understanding of the biology of SBS, as well as opportunities for novel therapeutics. This review will summarize our understanding of the interactions of the gut microbiome in the management of SBS, its associated complications, and propose opportunities for future study. no caption availableThe intestinal microbiota affects host physiology via multiple mechanisms that have relevance to SBS (Fig. 1). Intestinal microbiota metabolize host nutrients to generate bioactive metabolites with intestinal and extraintestinal effects. Microbiota may also have direct effects on mucosal receptors along the gastrointestinal epithelia.Factors contributing to dysbiosis in short bowel syndrome. (Original submission).Purpose of reviewThe intestinal microbiome plays a strong, complementary role in the development and integrity of the intestinal epithelium. This biology is crucial for intestinal adaptation, particularly after the mucosal insults that lead to short bowel syndrome (SBS). The purpose of this review is to discuss relationships between the intestinal microbiota and the physiology of intestinal adaptation.We will address interactions between the intestinal microbiome and nutritional metabolism, factors leading to dysbiosis in SBS, and common compositional differences of the gut microbiome in SBS patients as compared to healthy controls. We will also discuss novel opportunities to expand diagnostic and therapeutic interventions in this population, by using our knowledge of the microbiome to manipulate luminal bacteria and study their resultant metabolites. As microbial therapeutics advance across so many fields of medicine, this review is timely in its advocacy for ongoing research that focuses on the SBS population.Our review will discuss 4 key areas: 1) physiology of the intestinal microbiome in SBS, 2) clinical and therapeutic insults that lead to a state of dysbiosis, 3) currently available evidence on microbiome-based approaches to SBS management, and 4) opportunities and innovations to inspire future research.The clinical implications of this review are both current, and potential. Understanding how the microbiome impacts intestinal adaptation and host physiology may enhance our understanding of why we experience such clinical variability in SBS patients' outcomes. This review may also expand clinicians' understanding of what 'personalized medicine' can mean for this patient population, and how we may someday consider our nutritional, therapeutic, and prognostic recommendations based on our patients' host, and microbial physiology.Papers of particular interest, published within the annual period of review, have been highlighted as:The role of the gut microbiome has been described across a range of intestinal, and extraintestinal disorders [1]. The contributions of the microbiota to the development of immune regulation, structural integrity of the gut mucosal barrier, and resistance to enteric pathogens is well described and its roles in nutritional metabolism of host dietary intake is emerging [2]. Host-microbiota interactions may have particular relevance in short-bowel syndrome (SBS) where intestinal adaptation is a central goal. Available literature suggests that the intestinal microbiome may impact intestinal failure-associated liver disease (IFALD), small intestinal bacterial overgrowth (SIBO), bile acid metabolism and the achievement of enteral autonomy [2]. These data offer novel diagnostic and therapeutic opportunities.In children, the most common cause of intestinal failure (defined as requiring parenteral nutrition [PN] support) is SBS, with a prevalence of 24.5 out of 100,000 live births [3]. Causes of SBS vary and may include necrotizing enterocolitis (NEC), midgut volvulus (or other vascular insults that lead to ischemia), or progressive inflammation (such as Crohn's disease) [4]. The microbiome has been implicated in the pathogenesis of several of these conditions, including NEC [5,6], Crohn's disease [7], and dysmotility syndromes (which may lead to a functional SBS) [8].Available data is limited and affected by the anatomic heterogeneity of SBS patients and limited availability of microbial data. Nevertheless, current evidence suggests a role for further study that may enhance our understanding of the biology of SBS, as well as opportunities for novel therapeutics. This review will summarize our understanding of the interactions of the gut microbiome in the management of SBS, its associated complications, and propose opportunities for future study. no caption availableThe intestinal microbiota affects host physiology via multiple mechanisms that have relevance to SBS (Fig. 1). Intestinal microbiota metabolize host nutrients to generate bioactive metabolites with intestinal and extraintestinal effects. Microbiota may also have direct effects on mucosal receptors along the gastrointestinal epithelia. Factors contributing to dysbiosis in short bowel syndrome. (Original submission).Purpose of reviewThe intestinal microbiome plays a strong, complementary role in the development and integrity of the intestinal epithelium. This biology is crucial for intestinal adaptation, particularly after the mucosal insults that lead to short bowel syndrome (SBS). The purpose of this review is to discuss relationships between the intestinal microbiota and the physiology of intestinal adaptation.We will address interactions between the intestinal microbiome and nutritional metabolism, factors leading to dysbiosis in SBS, and common compositional differences of the gut microbiome in SBS patients as compared to healthy controls. We will also discuss novel opportunities to expand diagnostic and therapeutic interventions in this population, by using our knowledge of the microbiome to manipulate luminal bacteria and study their resultant metabolites. As microbial therapeutics advance across so many fields of medicine, this review is timely in its advocacy for ongoing research that focuses on the SBS population.Our review will discuss 4 key areas: 1) physiology of the intestinal microbiome in SBS, 2) clinical and therapeutic insults that lead to a state of dysbiosis, 3) currently available evidence on microbiome-based approaches to SBS management, and 4) opportunities and innovations to inspire future research.The clinical implications of this review are both current, and potential. Understanding how the microbiome impacts intestinal adaptation and host physiology may enhance our understanding of why we experience such clinical variability in SBS patients' outcomes. This review may also expand clinicians' understanding of what 'personalized medicine' can mean for this patient population, and how we may someday consider our nutritional, therapeutic, and prognostic recommendations based on our patients' host, and microbial physiology.Papers of particular interest, published within the annual period of review, have been highlighted as:The role of the gut microbiome has been described across a range of intestinal, and extraintestinal disorders [1]. The contributions of the microbiota to the development of immune regulation, structural integrity of the gut mucosal barrier, and resistance to enteric pathogens is well described and its roles in nutritional metabolism of host dietary intake is emerging [2]. Host-microbiota interactions may have particular relevance in short-bowel syndrome (SBS) where intestinal adaptation is a central goal. Available literature suggests that the intestinal microbiome may impact intestinal failure-associated liver disease (IFALD), small intestinal bacterial overgrowth (SIBO), bile acid metabolism and the achievement of enteral autonomy [2]. These data offer novel diagnostic and therapeutic opportunities.In children, the most common cause of intestinal failure (defined as requiring parenteral nutrition [PN] support) is SBS, with a prevalence of 24.5 out of 100,000 live births [3]. Causes of SBS vary and may include necrotizing enterocolitis (NEC), midgut volvulus (or other vascular insults that lead to ischemia), or progressive inflammation (such as Crohn's disease) [4]. The microbiome has been implicated in the pathogenesis of several of these conditions, including NEC [5,6], Crohn's disease [7], and dysmotility syndromes (which may lead to a functional SBS) [8].Available data is limited and affected by the anatomic heterogeneity of SBS patients and limited availability of microbial data. Nevertheless, current evidence suggests a role for further study that may enhance our understanding of the biology of SBS, as well as opportunities for novel therapeutics. This review will summarize our understanding of the interactions of the gut microbiome in the management of SBS, its associated complications, and propose opportunities for future study. no caption availableThe intestinal microbiota affects host physiology via multiple mechanisms that have relevance to SBS (Fig. 1). Intestinal microbiota metabolize host nutrients to generate bioactive metabolites with intestinal and extraintestinal effects. Microbiota may also have direct effects on mucosal receptors along the gastrointestinal epithelia.Factors contributing to dysbiosis in short bowel syndrome. (Original submission).Purpose of reviewThe intestinal microbiome plays a strong, complementary role in the development and integrity of the intestinal epithelium. This biology is crucial for intestinal adaptation, particularly after the mucosal insults that lead to short bowel syndrome (SBS). The purpose of this review is to discuss relationships between the intestinal microbiota and the physiology of intestinal adaptation.We will address interactions between the intestinal microbiome and nutritional metabolism, factors leading to dysbiosis in SBS, and common compositional differences of the gut microbiome in SBS patients as compared to healthy controls. We will also discuss novel opportunities to expand diagnostic and therapeutic interventions in this population, by using our knowledge of the microbiome to manipulate luminal bacteria and study their resultant metabolites. As microbial therapeutics advance across so many fields of medicine, this review is timely in its advocacy for ongoing research that focuses on the SBS population.Our review will discuss 4 key areas: 1) physiology of the intestinal microbiome in SBS, 2) clinical and therapeutic insults that lead to a state of dysbiosis, 3) currently available evidence on microbiome-based approaches to SBS management, and 4) opportunities and innovations to inspire future research.The clinical implications of this review are both current, and potential. Understanding how the microbiome impacts intestinal adaptation and host physiology may enhance our understanding of why we experience such clinical variability in SBS patients' outcomes. This review may also expand clinicians' understanding of what 'personalized medicine' can mean for this patient population, and how we may someday consider our nutritional, therapeutic, and prognostic recommendations based on our patients' host, and microbial physiology.Papers of particular interest, published within the annual period of review, have been highlighted as:The role of the gut microbiome has been described across a range of intestinal, and extraintestinal disorders [1]. The contributions of the microbiota to the development of immune regulation, structural integrity of the gut mucosal barrier, and resistance to enteric pathogens is well described and its roles in nutritional metabolism of host dietary intake is emerging [2]. Host-microbiota interactions may have particular relevance in short-bowel syndrome (SBS) where intestinal adaptation is a central goal. Available literature suggests that the intestinal microbiome may impact intestinal failure-associated liver disease (IFALD), small intestinal bacterial overgrowth (SIBO), bile acid metabolism and the achievement of enteral autonomy [2]. These data offer novel diagnostic and therapeutic opportunities. In children, the most common cause of intestinal failure (defined as requiring parenteral nutrition [PN] support) is SBS, with a prevalence of 24.5 out of 100,000 live births [3]. Causes of SBS vary and may include necrotizing enterocolitis (NEC), midgut volvulus (or other vascular insults that lead to ischemia), or progressive inflammation (such as Crohn's disease) [4]. The microbiome has been implicated in the pathogenesis of several of these conditions, including NEC [5,6], Crohn's disease [7], and dysmotility syndromes (which may lead to a functional SBS) [8].Available data is limited and affected by the anatomic heterogeneity of SBS patients and limited availability of microbial data. Nevertheless, current evidence suggests a role for further study that may enhance our understanding of the biology of SBS, as well as opportunities for novel therapeutics. This review will summarize our understanding of the interactions of the gut microbiome in the management of SBS, its associated complications, and propose opportunities for future study. no caption availableThe intestinal microbiota affects host physiology via multiple mechanisms that have relevance to SBS (Fig. 1). Intestinal microbiota metabolize host nutrients to generate bioactive metabolites with intestinal and extraintestinal effects. Microbiota may also have direct effects on mucosal receptors along the gastrointestinal epithelia.Factors contributing to dysbiosis in short bowel syndrome. (Original submission).Purpose of reviewThe intestinal microbiome plays a strong, complementary role in the development and integrity of the intestinal epithelium. This biology is crucial for intestinal adaptation, particularly after the mucosal insults that lead to short bowel syndrome (SBS). The purpose of this review is to discuss relationships between the intestinal microbiota and the physiology of intestinal adaptation.We will address interactions between the intestinal microbiome and nutritional metabolism, factors leading to dysbiosis in SBS, and common compositional differences of the gut microbiome in SBS patients as compared to healthy controls. We will also discuss novel opportunities to expand diagnostic and therapeutic interventions in this population, by using our knowledge of the microbiome to manipulate luminal bacteria and study their resultant metabolites. As microbial therapeutics advance across so many fields of medicine, this review is timely in its advocacy for ongoing research that focuses on the SBS population.Our review will discuss 4 key areas: 1) physiology of the intestinal microbiome in SBS, 2) clinical and therapeutic insults that lead to a state of dysbiosis, 3) currently available evidence on microbiome-based approaches to SBS management, and 4) opportunities and innovations to inspire future research.The clinical implications of this review are both current, and potential. Understanding how the microbiome impacts intestinal adaptation and host physiology may enhance our understanding of why we experience such clinical variability in SBS patients' outcomes. This review may also expand clinicians' understanding of what 'personalized medicine' can mean for this patient population, and how we may someday consider our nutritional, therapeutic, and prognostic recommendations based on our patients' host, and microbial physiology.Papers of particular interest, published within the annual period of review, have been highlighted as:The role of the gut microbiome has been described across a range of intestinal, and extraintestinal disorders [1]. The contributions of the microbiota to the development of immune regulation, structural integrity of the gut mucosal barrier, and resistance to enteric pathogens is well described and its roles in nutritional metabolism of host dietary intake is emerging [2]. Host-microbiota interactions may have particular relevance in short-bowel syndrome (SBS) where intestinal adaptation is a central goal. Available literature suggests that the intestinal microbiome may impact intestinal failure-associated liver disease (IFALD), small intestinal bacterial overgrowth (SIBO), bile acid metabolism and the achievement of enteral autonomy [2]. These data offer novel diagnostic and therapeutic opportunities.In children, the most common cause of intestinal failure (defined as requiring parenteral nutrition [PN] support) is SBS, with a prevalence of 24.5 out of 100,000 live births [3]. Causes of SBS vary and may include necrotizing enterocolitis (NEC), midgut volvulus (or other vascular insults that lead to ischemia), or progressive inflammation (such as Crohn's disease) [4]. The microbiome has been implicated in the pathogenesis of several of these conditions, including NEC [5,6], Crohn's disease [7], and dysmotility syndromes (which may lead to a functional SBS) [8].Available data is limited and affected by the anatomic heterogeneity of SBS patients and limited availability of microbial data. Nevertheless, current evidence suggests a role for further study that may enhance our understanding of the biology of SBS, as well as opportunities for novel therapeutics. This review will summarize our understanding of the interactions of the gut microbiome in the management of SBS, its associated complications, and propose opportunities for future study. no caption availableThe intestinal microbiota affects host physiology via multiple mechanisms that have relevance to SBS (Fig. 1). Intestinal microbiota metabolize host nutrients to generate bioactive metabolites with intestinal and extraintestinal effects. Microbiota may also have direct effects on mucosal receptors along the gastrointestinal epithelia.Factors contributing to dysbiosis in short bowel syndrome. (Original submission).Purpose of reviewThe intestinal microbiome plays a strong, complementary role in the development and integrity of the intestinal epithelium. This biology is crucial for intestinal adaptation, particularly after the mucosal insults that lead to short bowel syndrome (SBS). The purpose of this review is to discuss relationships between the intestinal microbiota and the physiology of intestinal adaptation.We will address interactions between the intestinal microbiome and nutritional metabolism, factors leading to dysbiosis in SBS, and common compositional differences of the gut microbiome in SBS patients as compared to healthy controls. We will also discuss novel opportunities to expand diagnostic and therapeutic interventions in this population, by using our knowledge of the microbiome to manipulate luminal bacteria and study their resultant metabolites. As microbial therapeutics advance across so many fields of medicine, this review is timely in its advocacy for ongoing research that focuses on the SBS population.Our review will discuss 4 key areas: 1) physiology of the intestinal microbiome in SBS, 2) clinical and therapeutic insults that lead to a state of dysbiosis, 3) currently available evidence on microbiome-based approaches to SBS management, and 4) opportunities and innovations to inspire future research.The clinical implications of this review are both current, and potential. Understanding how the microbiome impacts intestinal adaptation and host physiology may enhance our understanding of why we experience such clinical variability in SBS patients' outcomes. This review may also expand clinicians' understanding of what 'personalized medicine' can mean for this patient population, and how we may someday consider our nutritional, therapeutic, and prognostic recommendations based on our patients' host, and microbial physiology.Papers of particular interest, published within the annual period of review, have been highlighted as:The role of the gut microbiome has been described across a range of intestinal, and extraintestinal disorders [1]. The contributions of the microbiota to the development of immune regulation, structural integrity of the gut mucosal barrier, and resistance to enteric pathogens is well described and its roles in nutritional metabolism of host dietary intake is emerging [2]. Host-microbiota interactions may have particular relevance in short-bowel syndrome (SBS) where intestinal adaptation is a central goal. Available literature suggests that the intestinal microbiome may impact intestinal failure-associated liver disease (IFALD), small intestinal bacterial overgrowth (SIBO), bile acid metabolism and the achievement of enteral autonomy [2]. These data offer novel diagnostic and therapeutic opportunities.In children, the most common cause of intestinal failure (defined as requiring parenteral nutrition [PN] support) is SBS, with a prevalence of 24.5 out of 100,000 live births [3]. Causes of SBS vary and may include necrotizing enterocolitis (NEC), midgut volvulus (or other vascular insults that lead to ischemia), or progressive inflammation (such as Crohn's disease) [4]. The microbiome has been implicated in the pathogenesis of several of these conditions, including NEC [5,6], Crohn's disease [7], and dysmotility syndromes (which may lead to a functional SBS) [8].Available data is limited and affected by the anatomic heterogeneity of SBS patients and limited availability of microbial data. Nevertheless, current evidence suggests a role for further study that may enhance our understanding of the biology of SBS, as well as opportunities for novel therapeutics. This review will summarize our understanding of the interactions of the gut microbiome in the management of SBS, its associated complications, and propose opportunities for future study. no caption availableThe intestinal microbiota affects host physiology via multiple mechanisms that have relevance to SBS (Fig. 1). Intestinal microbiota metabolize host nutrients to generate bioactive metabolites with intestinal and extraintestinal effects. Microbiota may also have direct effects on mucosal receptors along the gastrointestinal epithelia.Factors contributing to dysbiosis in short bowel syndrome. (Original submission).Purpose of reviewThe intestinal microbiome plays a strong, complementary role in the development and integrity of the intestinal epithelium. This biology is crucial for intestinal adaptation, particularly after the mucosal insults that lead to short bowel syndrome (SBS). The purpose of this review is to discuss relationships between the intestinal microbiota and the physiology of intestinal adaptation.We will address interactions between the intestinal microbiome and nutritional metabolism, factors leading to dysbiosis in SBS, and common compositional differences of the gut microbiome in SBS patients as compared to healthy controls. We will also discuss novel opportunities to expand diagnostic and therapeutic interventions in this population, by using our knowledge of the microbiome to manipulate luminal bacteria and study their resultant metabolites. As microbial therapeutics advance across so many fields of medicine, this review is timely in its advocacy for ongoing research that focuses on the SBS population.Our review will discuss 4 key areas: 1) physiology of the intestinal microbiome in SBS, 2) clinical and therapeutic insults that lead to a state of dysbiosis, 3) currently available evidence on microbiome-based approaches to SBS management, and 4) opportunities and innovations to inspire future research.The clinical implications of this review are both current, and potential. Understanding how the microbiome impacts intestinal adaptation and host physiology may enhance our understanding of why we experience such clinical variability in SBS patients' outcomes. This review may also expand clinicians' understanding of what 'personalized medicine' can mean for this patient population, and how we may someday consider our nutritional, therapeutic, and prognostic recommendations based on our patients' host, and microbial physiology.Papers of particular interest, published within the annual period of review, have been highlighted as:The role of the gut microbiome has been described across a range of intestinal, and extraintestinal disorders [1]. The contributions of the microbiota to the development of immune regulation, structural integrity of the gut mucosal barrier, and resistance to enteric pathogens is well described and its roles in nutritional metabolism of host dietary intake is emerging [2]. Host-microbiota interactions may have particular relevance in short-bowel syndrome (SBS) where intestinal adaptation is a central goal. Available literature suggests that the intestinal microbiome may impact intestinal failure-associated liver disease (IFALD), small intestinal bacterial overgrowth (SIBO), bile acid metabolism and the achievement of enteral autonomy [2]. These data offer novel diagnostic and therapeutic opportunities.In children, the most common cause of intestinal failure (defined as requiring parenteral nutrition [PN] support) is SBS, with a prevalence of 24.5 out of 100,000 live births [3]. Causes of SBS vary and may include necrotizing enterocolitis (NEC), midgut volvulus (or other vascular insults that lead to ischemia), or progressive inflammation (such as Crohn's disease) [4]. The microbiome has been implicated in the pathogenesis of several of these conditions, including NEC [5,6], Crohn's disease [7], and dysmotility syndromes (which may lead to a functional SBS) [8].Available data is limited and affected by the anatomic heterogeneity of SBS patients and limited availability of microbial data. Nevertheless, current evidence suggests a role for further study that may enhance our understanding of the biology of SBS, as well as opportunities for novel therapeutics. This review will summarize our understanding of the interactions of the gut microbiome in the management of SBS, its associated complications, and propose opportunities for future study. no caption availableThe intestinal microbiota affects host physiology via multiple mechanisms that have relevance to SBS (Fig. 1). Intestinal microbiota metabolize host nutrients to generate bioactive metabolites with intestinal and extraintestinal effects. Microbiota may also have direct effects on mucosal receptors along the gastrointestinal epithelia. Factors contributing to dysbiosis in short bowel syndrome. (Original submission).Purpose of reviewThe intestinal microbiome plays a strong, complementary role in the development and integrity of the intestinal epithelium. This biology is crucial for intestinal adaptation, particularly after the mucosal insults that lead to short bowel syndrome (SBS). The purpose of this review is to discuss relationships between the intestinal microbiota and the physiology of intestinal adaptation.We will address interactions between the intestinal microbiome and nutritional metabolism, factors leading to dysbiosis in SBS, and common compositional differences of the gut microbiome in SBS patients as compared to healthy controls. We will also discuss novel opportunities to expand diagnostic and therapeutic interventions in this population, by using our knowledge of the microbiome to manipulate luminal bacteria and study their resultant metabolites. As microbial therapeutics advance across so many fields of medicine, this review is timely in its advocacy for ongoing research that focuses on the SBS population.Our review will discuss 4 key areas: 1) physiology of the intestinal microbiome in SBS, 2) clinical and therapeutic insults that lead to a state of dysbiosis, 3) currently available evidence on microbiome-based approaches to SBS management, and 4) opportunities and innovations to inspire future research.The clinical implications of this review are both current, and potential. Understanding how the microbiome impacts intestinal adaptation and host physiology may enhance our understanding of why we experience such clinical variability in SBS patients' outcomes. This review may also expand clinicians' understanding of what 'personalized medicine' can mean for this patient population, and how we may someday consider our nutritional, therapeutic, and prognostic recommendations based on our patients' host, and microbial physiology.Papers of particular interest, published within the annual period of review, have been highlighted as:The role of the gut microbiome has been described across a range of intestinal, and extraintestinal disorders [1]. The contributions of the microbiota to the development of immune regulation, structural integrity of the gut mucosal barrier, and resistance to enteric pathogens is well described and its roles in nutritional metabolism of host dietary intake is emerging [2]. Host-microbiota interactions may have particular relevance in short-bowel syndrome (SBS) where intestinal adaptation is a central goal. Available literature suggests that the intestinal microbiome may impact intestinal failure-associated liver disease (IFALD), small intestinal bacterial overgrowth (SIBO), bile acid metabolism and the achievement of enteral autonomy [2]. These data offer novel diagnostic and therapeutic opportunities.In children, the most common cause of intestinal failure (defined as requiring parenteral nutrition [PN] support) is SBS, with a prevalence of 24.5 out of 100,000 live births [3]. Causes of SBS vary and may include necrotizing enterocolitis (NEC), midgut volvulus (or other vascular insults that lead to ischemia), or progressive inflammation (such as Crohn's disease) [4]. The microbiome has been implicated in the pathogenesis of several of these conditions, including NEC [5,6], Crohn's disease [7], and dysmotility syndromes (which may lead to a functional SBS) [8].Available data is limited and affected by the anatomic heterogeneity of SBS patients and limited availability of microbial data. Nevertheless, current evidence suggests a role for further study that may enhance our understanding of the biology of SBS, as well as opportunities for novel therapeutics. This review will summarize our understanding of the interactions of the gut microbiome in the management of SBS, its associated complications, and propose opportunities for future study. no caption availableThe intestinal microbiota affects host physiology via multiple mechanisms that have relevance to SBS (Fig. 1). Intestinal microbiota metabolize host nutrients to generate bioactive metabolites with intestinal and extraintestinal effects. Microbiota may also have direct effects on mucosal receptors along the gastrointestinal epithelia.Factors contributing to dysbiosis in short bowel syndrome. (Original submission).