Chronic intestinal failure and short bowel syndrome in Crohn’s disease

Table 1 Pathophysiological classification of intestinal failure (adapted from Pironi et al[2], 2015)

Type	Primary cause	Underlying disease
Short bowel type	Quantitative/qualitative loss of resorptive surface	Post-operative, in patients with mesenteric infarction, Crohn’s disease, radiation enteritis, familial polyposis, abdominal traumata, necrotizing enterocolitis1, bariatric obesity surgery (biliopancreatic diversion with or without duodenal switch), gastroileal anastomosis, extensive tumor resection.
		Congenital, in patients with gastroschisis1, intestinal atresia1, intestinal malformation, omphalocele
Fistula type	Bypass of resorptive surface due to jejunocolic fistula	Inflammatory bowel disease (Crohn’s disease2, diverticulitis, radiation enteritis)
		Post-operative3 in patients with neoplasia (colorectal carcinoma, ovarian carcinoma, Crohn’s disease)
		Iatrogenic (post-op, percutaneous drainage)
		Traumata
		Foreign bodies
Dysmotility type	Restricted (insufficient) nutrition intake due to postprandial exacerbation of symptoms, to the point of non-mechanic ileus in severe cases	Ogilvie syndrome (acute non-mechanic obstruction of the colon)
		Chronic intestinal pseudo-obstruction: Primary/idiopathic (neuropathic/myopathic); Secondary (collagenous vascular disease, e.g., PSS, LE, Ehlers-Danlos syndrome; neurological disorders such as Morbus Parkinson, intestinal hypoganglionosis; endocrinopathies)
Obstruction type	Reduced nutrition intake; Increased secretion of liquid and electrolytes in obstructive segments of the intestine; Loss of liquids and nutrients due to recurrent vomiting and/or "overflow sensors"	"Frozen abdomen" in patients with peritoneal carcinomatosis, extensive intestinal adhesion, recurrent peritonitis.
		Neoplastic stenoses and/or strictures
		Incarceration/strangulation of the intestine (hernia)
		Volvulus
Mucosa type	Extensive loss or damage of mucosa results in insufficient resorption of nutrients and pronounced enteral loss	Microvillus inclusion disease1
		Tufting enteropathy (intestinal epithelial dysplasia)
		Tricho-hepato-enteric syndrome
		Autoimmune enteropathy
		Intestinal lymphangiectasia
		Protein-losing enteropathy (Morbus Waldman)
		Radiation enteritis
		Chemotherapy-induced/associated enteritis

¹Causes 70% of pediatric cases[4].

²75%-85% of enterocutaneous fistulae (EF).

³15%-25% of EF[3].

LE: Lupus erythematosus; PSS: Progressive systemic sclerosis.