What is short bowel syndrome?
Short bowel syndrome is a condition in which some portion of the small or large intestine has been removed or doesn’t function properly. As a result, people with short bowel syndrome can’t properly absorb nutrients, such as:
Some cases of short bowel syndrome are mild, while others cause far more difficulties. Some people have this condition as a complication related to birth defects. Other times it develops in adulthood.
Most commonly, short bowel syndrome develops after surgical removal of a portion of the small intestine. This surgery is done to treat different types of intestinal conditions including:
- being born with a narrowed small intestine, or missing a portion of this part of the digestive system (intestinal atresia)
- injury to the intestines from physical trauma
- sluggish movement within the intestines
- cancer or cancer treatment that impacts the intestines
- scarring of the intestines due to Crohn’s disease, causing obstruction in the digestive tract
- loss of blood flow to the intestines as a result of blood vessel blockage
Other symptoms of short bowel syndrome may include:
- weight loss
- bodily weakness and fatigue
- cramping and bloating in the belly
- swelling in the legs (edema)
- nausea and vomiting
- foul-smelling or pale, greasy stool
- heartburn and gas
The symptoms of short bowel syndrome vary widely depending on how much of the functioning intestine remains.
Other possible symptoms, associated with malabsorption of specific nutrients, include the following:
|dry skin and reduced muscle mass||dehydration and malabsorption of water|
|vision problems||vitamin A deficiency|
|seizures and irregular heartbeat||vitamin B deficiency|
|muscle spasms and osteoporosis (weak bones)||vitamin D deficiency|
|muscle coordination problems||vitamin E deficiency|
|skin discoloration and bruising||vitamin K deficiency|
|pale skin tone, mental fog, and shortness of breath||iron deficiency|
|hair loss and skin rashes||zinc deficiency|
A doctor will diagnose short bowel syndrome based on your medical history, your family’s medical history, a thorough physical examination, and several clinical tests.
Your doctor will ask you about your symptoms and any similar conditions that have occurred in your near family, such as your siblings and parents.
Next, the doctor will perform a complete physical examination, including listening to your abdominal area with a stethoscope, testing your reflexes, and looking for signs of muscle atrophy.
Further diagnostic procedures may include:
- Imaging tests, such as X-rays, CT scans, MRI scan, upper GI series (barium study), and abdominal ultrasound imaging, which may reveal obstructed or narrowed areas in the intestinal tract or bowel, as well as irregularities in other organs.
- Blood tests, to measure vitamin and mineral levels in the bloodstream, as well as blood count (to check for anemia).
- Fecal fat tests, to measure how well the body is absorbing fat. Your doctor will ask you to give a stool sample for this test.
There is currently no cure for short bowel syndrome.
The good news is that the symptoms can usually be managed, improving your quality of life and preventing dangerous complications.
Nutrition and diet
Proper nutrition is the first line of defense for people with short bowel syndrome. The right diet will vary from person to person, depending on what is causing the condition and how severe it is.
However, most people with short bowel syndrome will be advised to:
- Eat frequently to stimulate intestinal absorption of nutrients and accelerate intestinal adaption, which is the process by which the healthy portion of the intestine “learns” to compensate for sections that aren’t working properly or have been removed. The idea is to enjoy healthy snacks throughout the day, foregoing larger meals.
- Drink liquids between meals rather than during meals. Drinking liquids together with meals can increase diarrhea.
- Stay hydrated throughout the day by drinking plenty of water, broth, and non-caffeinated soft drinks. Children should also consume nonprescription rehydration solutions that are sold in most drugstores and food stores.
- Avoid foods that may cause diarrhea such as those high in fiber or sugar, as well as high-fat foods.
- Eat thick, bland foods that can help control diarrhea, such as bananas, rice, oatmeal, applesauce, and toast.
- Take vitamin and mineral supplements according to the guidance of a doctor.
Your diet will usually be supplemented by additional forms of nutritional support. These may include delivery of nutrients via a stomach tube inserted through the nose or mouth, known as enteral nutrition. More commonly, you’ll receive intravenous delivery of fluids and nutrients, known as parenteral nutrition.
Total parenteral nutrition (TPN)involves supplying allof your nutrients directly into the bloodstream, bypassing the digestive system entirely. TPN is normally temporary, other than in the severest cases.
Doctors may also prescribe a variety of medications for short bowel syndrome, including drugs that:
- help prevent diarrhea
- regulate the release of stomach acids
- increase the small intestine’s capacity to absorb nutrients
- inhibit the growth of intestinal bacteria
- stimulate bile flow
- protect the liver
About half of all people with short bowel syndrome will need some form of surgery. The goal of surgery is improving the small intestine’s absorption of nutrients. Types of surgery include:
- Bianchi procedure, a procedure where the bowel is lengthened by cutting the bowel in half and sewing one end to the other
- stricturoplasty, aprocedure that opens up a narrowed part of the intestine while preserving the length of the intestine
- serial transverse enteroplasty, a procedure that creates a zigzag pattern of the intestines to increase the length of the intestine
- an intestinal transplant, in very severe cases
Complications that can — but won’t necessarily — result from short bowel syndrome include:
- gallstones and kidney stones
- intestinal bacterial overgrowth
- peptic ulcers
- any of the conditionsdescribed in the “Symptoms”section above
In addition, treatments may cause complications, such as:
- catheter-related infections, blood clots, and kidney or liver problems developing from TPN
- organ rejection and infections developing after a transplant
In many cases, particularly if the condition occurs as a result of surgery, the symptoms of short bowel syndrome may get better over time. This will depend on factors such as how much healthy intestine remains intact and how well it adapts.
Generally speaking, with proper medical management and self-care, your quality of life can improve.
Meanwhile, clinical trials for new treatments periodically become available. To learn more about clinical trials, visit ClinicalTrials.gov.