Hypomotor phenotype in short bowel syndrome in infants: a review

Abstract

Short bowel syndrome (SBS) in children in the first year of life is a polyetiological condition in which limitation of the absorptive surface is compounded by complex dysfunction of the motor-evacuation activity of the gastrointestinal tract. One of the clinically significant variants of motor dysfunction in SBS is the hypomotor phenotype, which manifests as vomiting and regurgitation syndrome. This syndrome not only reduces the quality of life of the patient and their family but also serves as a critical barrier to the implementation of enteral rehabilitation programs, impeding the gradual increase in enteral nutrition volume. This review analyzes scientific publications on the pathogenetic features and treatment of SBS in children. The search for articles was performed using the abstract databases Cochrane Central Register of Controlled Trials, PubMed, and the eLibrary electronic library. The search covered the period from 1990 to December 2025. The inclusion criteria included publications on the pathogenetic features, clinical manifestations, and principles of treatment of SBS in children. The exclusion criteria were predominant studies in the adult population in the absence of data applicable to children. Publications involving adult patients were retained in the analysis if the data presented were relevant to understanding the pathophysiological mechanisms potentially applicable to children with SBS. The search identified 164 publications, of which 48 met the selection criteria and were included in the analysis. Vomiting and regurgitation in this patient group are associated with several pathophysiological aspects: a combination of prenatal injury to the enteric nervous system and interstitial cells of Cajal, loss of the ileocecal transition, disruption of the barrier function between the small and large intestine, inflammation of the intestinal wall against the background of bacterial overgrowth, dissociation of motility of the upper and lower gastrointestinal tract, and neurohumoral inhibition of motility against the background of parenteral nutrition. Based on the reviewed pathophysiological mechanisms, the following comprehensive strategy can be proposed, which includes regular decompression of the upper gastrointestinal tract, combined antiemetic and prokinetic therapy, and selective enteroseptic therapy. The proposed approach is based on pathophysiological prerequisites and clinical experience; however, it requires further validation in prospective studies.