Role of the Microbiota in Intestinal Adaptation During Short Bowel Syndrome (AdMIR)

Role of the Microbiota in Intestinal Adaptation During Short Bowel Syndrome: a Longitudinal Follow-up

During the first years following intestinal resection, spontaneous physiological adaptations occur in patients with short bowel syndrome (SBS), allowing improvement of the absorptive capacity of the remaining intestine. This adaptation is particularly effective in SBS patients with the colon in continuity. The specific relationship between this intestinal adaptation and changes in the gut microbiota has not been studied in these patients. We hypothesize that there is a specific relationship between the microbiota and its metabolites and intestinal adaptive capacity, and that certain gut bacteria may promote this spontaneous adaptation.

Study Overview

• Status: Not yet recruiting
• Conditions: Short Bowel Syndrome (SBS)
• Intervention / Treatment: Other: collection of blood and stool/chyme and intestinal biopsy

Detailed Description

We know that spontaneous adaptation, including weaning from parenteral nutrition, is more likely in patients with short bowel syndrome (SBS) who have the colon in continuity. However, the underlying mechanisms remain unclear. We have shown that the gut microbiota is altered in patients with SBS, with an overabundance of lactic acid bacteria (bacteria responsible for fermentation). It is therefore possible that some of these bacteria may promote spontaneous adaptation and improved absorption in patients with SBS with a colon in continuity, thereby enabling weaning from parenteral nutrition.

In the proposed research, we will study changes in the composition of the gut microbiota in adults with SBS before and at the beginning of the restoration of colonic continuity within the digestive tract (new type 2 SBS patients). To this end, we will compare changes in fecal bacterial populations with the intestine's capacity to adapt and absorb nutrients.

This will make it possible to identify specific factors within the microbiota or in the substances they produce (microbial biomarkers) that could become future targets for improving energy absorption. To address the research question, it is planned to include 15 individuals with SBS, followed in the gastroenterology and nutritional support department at Beaujon Hospital in Clichy

Primary Objective:

To study the relationship between intestinal absorptive capacity in adults with type 2 short bowel syndrome (jejuno-colic anastomosis) and the composition of the fecal microbiota after the restoration of colonic continuity.

• Study Type: Interventional
• Enrollment (Estimated): 15
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Francesca Joly, MD; Phone Number: +33 1 40 87 53 32; Email: francisca.joly@aphp.fr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age ≥18 years
• Diagnosis of short bowel syndrome with a jejunostomy and a plan to restore jejuno-colic continuity within 3 months
• Remaining post-duodenal small intestine (after the ligament of Treitz) < 200 cm
• Remaining colon > 14%
• Remaining small intestine and colon are healthy (no residual inflammatory, post-radiation, or ischemic disease)
• Patient enrolled in a social security system or entitled to coverage

Exclusion Criteria:

• Pregnancy
• Patient unable to provide consent:
• Due to a disability preventing consent
• Does not understand French
• Patient deprived of liberty, or under legal protection (guardianship or curatorship)
• Participation in another interventional study

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Patient	Other: collection of blood and stool/chyme and intestinal biopsy; The only procedures added by the study are the collection of an additional volume of blood and stool/chyme during samples taken as part of routine care, as well as an intestinal biopsy

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Correlation between intestinal absorptive capacity in adults with type 2 short bowel syndrome after restoration of digestive continuity and changes in the fecal microbiota	Analysis of Intestinal Absorptive Function: Absorptive capacity is assessed through a stool analysis measuring macronutrients (NIR spectrometry) and energy (bomb calorimetry) excreted in chyme or stool. This assessment is performed on chyme and stool samples collected over a 48-hour period. Microbiota Analysis: At inclusion, an intestinal chyme sample (from the jejunostomy pouch) and colonic lumen content are collected. Stool samples are also collected for microbiota analysis.	from inclusion until 12 months post surgery

Collaborators and Investigators

• Sponsor: Assistance Publique - Hôpitaux de Paris

Study record dates

Study Major Dates

• Study Start (Estimated): April 1, 2026
• Primary Completion (Estimated): November 1, 2028
• Study Completion (Estimated): February 1, 2029

Study Registration Dates

• First Submitted: April 8, 2026
• First Submitted That Met QC Criteria: April 8, 2026
• First Posted (Actual): April 15, 2026

Study Record Updates

• Last Update Posted (Actual): April 15, 2026
• Last Update Submitted That Met QC Criteria: April 8, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Gastrointestinal Microbiome; Short Bowel Syndrome; Intestinal Adaptation
• Additional Relevant MeSH Terms: Postoperative Complications; Pathologic Processes; Intestinal Diseases; Digestive System Diseases; Gastrointestinal Diseases; Malabsorption Syndromes; Pathological Conditions, Signs and Symptoms; Short Bowel Syndrome; Digestive System Physiological Phenomena; Digestive System and Oral Physiological Phenomena; Defecation
• Other Study ID Numbers: APHP221024; IDRCB: 2025-A01399-40 (Other Identifier: ANSM)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No