Impact of Gut Dysbiosis (Microbial Imbalance) on Complications in Infants with Short Bowel Syndrome
Adebisi Benjamin Temidayo
ABSTRACT
Pediatric Intestinal Failure (IF), often manifesting as Short Bowel Syndrome, represents a complex clinical condition necessitating long-term parenteral nutrition and frequent management of systemic morbidities. While historical therapeutic approaches have primarily emphasized the optimization of parenteral nutrient formulations, recent evidence underscores the critical, yet often overlooked, role of gut dysbiosis and Small Intestinal Bacterial Overgrowth (SIBO) in disease progression. By synthesizing clinical, endoscopic, and metagenomic data from 2015 to 2026, this research establishes gut dysbiosis as a foundational “second hit” in the pathogenesis of secondary complications. The study delineates how anatomical disruptions—such as the loss of the ileocecal valve and surgical bypasses—alongside the use of proton pump inhibitors, facilitate bacterial translocation and compromise the intestinal barrier. This dysbiosis permits the systemic infiltration of microbial products, including lipopolysaccharides (LPS), which function as potent agonists for hepatic Toll-like receptor 4 (TLR4) pathways, thereby accelerating the development of Intestinal Failure-Associated Liver Disease (IFALD) and systemic inflammatory responses. Furthermore, the analysis reveals that abnormal carbohydrate fermentation by specific taxa drives the systemic accumulation of D-lactic acid, predisposing vulnerable infants to severe metabolic neurotoxicity. Proposing a paradigm shift from reactive symptom management to proactive, mechanism-based care, this study advocates for the integration of routine epithelial brush swabs and mucosal biopsies into longitudinal monitoring protocols. By targeting the gut-liver and gut-brain axes through evidence-based trophic feeding and precise antibiotic stewardship, clinicians can significantly improve the long-term clinical trajectories of children affected by intestinal failure.
