# Pre-, Pro-, Post- and Synbiotics in Pediatric Short Bowel Syndrome: A Narrative Review of Current Evidence

## TL;DR

This review evaluates how pre-, pro-, and synbiotics can help children with short bowel syndrome, highlighting benefits and risks based on the patient's nutritional status.

## Contribution

The paper provides a critical assessment of biotic interventions in pediatric short bowel syndrome, emphasizing the need for personalized and safer therapeutic strategies.

## Key findings

- Long-term synbiotic treatments improve growth and nutritional status via SCFA production and mucosal adaptation.
- Proteobacteria overgrowth in PN-dependent patients increases infection risk, while weaned patients face D-lactic acidosis risk.
- Serious adverse events like Lactobacillus sepsis and D-lactic acidosis are linked to CVC use and malabsorption.

## Abstract

Background: Pediatric Short bowel syndrome (SBS) is the leading cause of intestinal failure and is characterized by persistent dysbiosis that negatively impacts intestinal adaptation and growth. Although microbiota modulation via pre-, pro-, and synbiotics represents a promising strategy, current evidence remains fragmented. This narrative review aims to critically assess the efficacy and safety of such interventions in the management of pediatric SBS. Methods: A structured literature search was conducted on PubMed up to November 2025. Fourteen relevant studies were included, comprising clinical trials, preclinical animal models, and significant case reports regarding the use of biotics in SBS. Results: The analysis reveals a microbiological dichotomy based on nutritional status: parenteral nutrition (PN)-dependent patients exhibit an excess of Proteobacteria associated with infectious risk, whereas weaned patients present a metabolic risk of D-lactic acidosis due to carbohydrate fermentation. Regarding efficacy, long-term synbiotic treatments (>12 months) demonstrated significant improvements in growth and nutritional status, likely mediated by increased production of short-chain fatty acids (SCFAs) and mucosal adaptation, unlike short-term probiotic cycles. However, serious adverse events (Lactobacillus sepsis and D-lactic acidosis) were reported, predominantly in patients with central venous catheters or malabsorption. Conclusions: Biotics offer therapeutic potential for intestinal failure, but their use cannot be empirical. The safety profile should be carefully selected, especially in central venous catheter (CVC) carriers. Future strategies must evolve towards precision medicine, prioritizing non-D-lactate-producing strains and personalized protocols based on the patient’s nutritional phase.