Clinical and nutritional management in subjects with different intestinal failure types: characterization of intestinal bacterial communities in a case series

Introduction Short Bowel Syndrome (SBS) is a complex paediatric condition and the primary pathophysiological cause of intestinal failure (IF), resulting from a significant reduction in the length of the small intestine. This reduction in absorptive surface area leads to nutrient malabsorption, impaired digestion, and other clinical complications. Case series This case series explores the clinical aspects of seven paediatric SBS subjects grouped according to IF classification associated with the variation in the intestinal microbiota composition. Blood and urine samples were collected twice a week during hospitalization to evaluate clinical parameters. Faecal samples collected before and after intestinal surgical intervention were analyzed for microbiota composition using a targeted metagenomics sequencing approach, focusing on the V3-V4 region of the 16S rRNA gene on the MiSeq (Illumina) platform. Results We observed specific variations in blood and urinary analytes according to the IF category as well as variations in the diversity and composition of the intestinal bacteria communities. Particularly, variations in the diversity were associated with specific changes in 15 bacterial ASVs abundances among the variables considered ( i.e. IF category, residual colon anatomy and specific clinical history (patient variable)). Conclusions This study provides valuable insights into the clinical history of paediatric cohorts with SBS, expanding the knowledge base for their clinical and nutritional management. Characterizing the intestinal microbiota in these patients plays a crucial role in identifying potential markers of dysbiosis which may provide important insights for developing targeted pharmacological therapies and personalized care for SBS patients. Monitoring specific microorganisms could enable timely pharmacological or clinical intervention, leading to personalized therapies ( e.g. , targeted antibiotic therapy). This case series highlights the complexity of SBS and the necessity of an integrated approach, in which microbiota composition can be leveraged to address dysbiosis, ultimately improving the quality of life of paediatric patients.