Updates on intestinal failure management

INTRODUCTION: Chronic intestinal failure (CIF) is a rare condition characterized by inadequate intestinal absorption requiring long-term parenteral nutrition (PN). Given etiological shifts and expanding therapeutic options, we provide an updated review covering CIF definitions, epidemiology and multidisciplinary management in adults, based on recently published studies (2012-2025). AREAS COVERED: We conducted a scoping review of recent literature, registry data and guideline recommendations to summarize contemporary trends in CIF.Short bowel syndrome remains the leading cause of CIF, though the etiological profile has shifted toward surgical complications and active malignancy. Advances in the multidisciplinary and multimodal management with safer PN formulations, chyme reinfusion therapy, and disease-modifying pharmacotherapies such as glucagon-like peptide-2 analogues have transformed outcomes, while intestinal transplantation is reserved for selected cases. Preventing complications and focusing on quality of life (QoL) are central to long-term management. EXPERT OPINION: CIF prevalence continues to rise worldwide, though accurate data remain inconsistent. As patient complexity rises, long-term outcomes increasingly depend on complication prevention and centralized, multidisciplinary care delivered by expert centers. In the next five years, the convergence of pharmacological, surgical, digital and organizational innovations will enhance enteral autonomy, reduce PN-related complications and improve patients' QoL, providing a more equitable and effective model of CIF care worldwide.