Figure 3.

Physiological changes of a preserved colon in continuity in Short Bowel Syndrome with Intestinal Failure. (A) Increases in crypt depth and epithelial cell count, and an upregulation of Pep1 transporters are part of the colonic adaptation that takes place within the first two years after extensive surgery. (B) L-cells located in the distal ileum and proximal colon secrete GLP-1 and GLP-2 based on nutrient entry in the gut lumen. Both are mediators of the ileal brake and expression is increased when the colon is in continuity. (C) Qualitative and quantitative changes of the microbial flora take place when the colon is in continuity: the colonic microbiota of patients with SBS is mainly comprised of Lactobacillus. (D) The colon serves as an energy-salvaging organ: high levels of undigested carbohydrates and proteins will reach the colon and will be fermented by the microbiota resulting in SCFA production. In addition, MCT absorption is improved. This figure was created with BioRender.com.