The small intestine is the part of the digestive tract where most nutrients are digested and absorbed.
Food that has been turned into a smoothie-like texture in the stomach mixes
with more digestive enzymes in the small intestine, which help to break the food down into absorbable components.
Short bowel syndrome occurs in individuals who don’t have enough functioning
small intestine to absorb nutrients from food properly.
Short bowel syndrome typically arises after surgery to remove damaged intestine. Any surgery
that removes more than 50% of the small intestine will likely result in short bowel syndrome,
but your physician will still use other measures, including blood tests, stool tests, and physical
examinations to look for other signs that you have this condition.
There are several reasons why someone might have part of their intestine removed.
These include blocked or restricted blood flow to the gut, a strangulated intestinal hernia,
Crohn’s disease, gastrointestinal cancer, radiation therapy, a perforated bowel, a twisting
or tangling of the small intestine, injury, congenital defects, necrotizing enterocolitis,
and other rare diseases. The greatest consequences of short bowel syndrome
are malnutrition and dehydration. Chronic diarrhea, fatigue, bloating, cramping, and
weight loss are common symptoms. Complications and specific nutrient deficiencies can vary
depending on which part of the intestine is removed. The small intestine has three distinct
sections: the duodenum, which is the part that connects to the stomach, the jejunum,
which is the middle section, and the ileum, which connects to the large intestine. The
duodenum absorbs iron, calcium, and magnesium. The jejunum absorbs fatty acids, amino acids,
monosaccharides, and water-soluble vitamins. The ileum absorbs fat-soluble vitamins, A,
D, E, and K, vitamin B12, and bile acids. Complications of short bowel syndrome include
vitamin and mineral deficiencies, electrolyte imbalances, too much lactic acid in the bloodstream,
fatty stools, and kidney stones. You might also produce too much stomach acid, which
can enter the small intestine and interfere with nutrient absorption.
While short bowel syndrome is a complex, serious condition with complications, there are ways
to help manage it. Treatment includes medications, along with nutritional modifications, and
significant supplementation, but can sometimes involve surgery as well.
If you have recently had surgery to remove part of your intestine, you will initially not be able
to eat food. You will receive your dietary needs through total parenteral nutrition,
which involves delivery of nutrients directly into the bloodstream through an intravenous,
or IV, tube. Some individuals might be able to start eating food within a few weeks, but
for others it could take several months or even a year or more.
Once your digestive tract is at least partially functional, you will move on to having a liquid
food mixture administered through a feeding tube via your nose or directly into your stomach
or small intestine. This is known as enteral nutrition.
Even as you begin to reintroduce food, you will need to make ongoing adaptations to your
diet and eating schedule. It is best to work with a registered dietitian to design a meal
plan that will help you avoid malnutrition. Typically, you will need to make your meals
small, but eat more often aiming for around 5-7 meals per day. Avoid large, greasy meals,
as these can be more difficult to digest. It is also important to drink plenty of fluids,
but to do so between meals instead of with them. Base your meals around high protein foods
and complex carbohydrates, and avoid eating too much fat, especially if you are missing
your terminal ileum. Alcohol and caffeinated beverages can increase diarrhea, so it is
best to avoid or reduce your intake of these.
Remarkably, in many individuals, the remaining intestinal villi will grow in length and thickness
to make up for the loss of intestine, which increases the surface area for nutrient absorption.
However, some individuals might struggle to eat normally, and could therefore need to
be on enteral nutrition or TPN long-term.
Those who use TPN for a long time are at risk of central line infections, bone disease,
and liver disease. Most medications used to treat short bowel
syndrome focus on relieving specific symptoms. These include anti-diarrheal medications,
gastric acid reducers such as proton pump inhibitors, glutamine supplements, and medications
that help remove bile acids from the body. One medication, helps the intestine
absorb nutrients and fluid by regenerating intestinal lining cells, improving intestinal
absorption of fluids and nutrients, and promoting growth in the surface area of the small intestine lining.
In severe cases where medication and nutritional
therapy do not work, you might need surgery, but these are uncommon. Sometimes a surgeon
is able to change the shape or length of the intestine surgically, which can help improve
absorption. Small bowel transplantation, in which a surgeon removes your small intestine
and replaces it with the small intestine from a donor, is an option, but only in rare cases.
A diagnosis of short bowel syndrome can be very difficult, as it requires lifelong management.
Treatment involves getting adequate nutrition with minimal symptoms. While there is no cure
for short bowel syndrome, working closely with your healthcare team, including your
physician, gastroenterologist, and dietitian, can help reduce your risk of malnutrition,
dehydration, and diarrhea, while improving your quality of life.
I’m Dr. James Gray, a gastroenterologist. On behalf of the Medical Advisory Council
of the Gastrointestinal Society, thanks for watching. Learn more about short bowel syndrome
at badgut dot org.