Short bowel syndrome

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at March 15, 2016
StartDiseasesShort bowel syndrome

Short bowel syndrome (sometimes called short gut, short gut syndrome, or SBS) is a malabsorption disorder that results from the surgical removal of a person's small intestine, but it may sometimes be caused by dysfunction of a large bowel section. Short bowel can also be a congenital disorder.

Contents

Definition & Facts

Short bowel syndrome is actually of group of issues related to poor nutrient absorption. This condition is usually found in people with poor motility in the intestines, those with damage to the small intestine, and those who have had at least 50% of their small intestine and/or part of the large intestine removed.

The small intestine is located between the large intestine and stomach and it's where most digestion and nutrient absorption occurs. This 20-foot-long organ contains three sections: the duodenum absorbs iron and minerals; the jejunum absorbs carbohydrates, fat, protein, and most vitamins; and the ileum absorbs bile acids and vitamin B12.

People with SBS are unable to absorb enough calories, protein, fat, water, or other nutrients from food. The nutrients that cannot be absorbed depends on which section of the intestine is gone or damaged.

Symptoms & Complaints

Depending on how well the small intestine works, symptoms may be very mild to severe. The classic symptoms of SBS include abdominal pain, diarrhea, steatorrhea (sticky or oily stool), low fluid levels, weight loss, fatigue, and malnutrition. Diarrhea is a common symptom of the disorder and it may have many causes.

Improper absorption of fats and carbohydrates is a major cause of SBS-related diarrhea as the colon is responsible for absorbing water during digestion. Malabsorption of mineral and vitamins can lead to many complications such as hyperkeratosis (skin scaling), anemia, bruising, muscle spasms, bone pain, and poor blood clotting.

People with SBS may also develop small bowel bacteria overgrowth with bloating and gas, particularly if the ileocecal valve is missing. Improper absorption of calcium, bile salts, and fats may lead to kidney stones, which may or may not have symptoms.

Electrolyte imbalance from improper absorption of minerals can lead to headache, nausea, muscle weakness, and irregular heartbeat. Some patients develop acidosis, or a high level of lactic acid in the blood. This can cause confusion, slurred speech, and vision problems.

Causes

Short bowel syndrome can happen for many reasons. Some children are born with bowel problems that damage the intestine or shorter bowels that can lead to SBS. Most people with small bowel syndrome develop the condition after surgical removal of a significant portion of the small intestine.

There are several reasons part of the small intestine may be removed, including treatment for Crohn's disease (an inflammatory bowel disease), gastroschisis (intestine sticking out of the body through the umbilical cord), internal hernia (small intestine is displaced in the abdominal lining), intestinal atresia (intestines did not form properly), cancer, or injury to the intestine from lost blood flow or trauma.

Some cancer treatments may also damage the bowel. Not all people who lose significant amounts of their small intestine will develop short bowel syndrome. Many factors determine who will develop the syndrome, including the segment that is lost or damaged, the age of the patient when the loss occurs, the remaining length of the colon and small intestine, and whether the ileocecal valve remains.

Diagnosis & Tests

When someone has symptoms of short bowel syndrome after a portion of his or her intestine has been removed, a physician will likely begin with a physical examination and run one or several tests. The physical exam typically includes an exam of the body to check for weight loss, muscle loss, and signs of mineral and vitamin deficiencies (such as skin problems or nail problems) and the use of a stethoscope to listen to the abdomen.

A number of tests may be used to diagnosis short bowel syndrome including: an X-ray of the large and small intestines, fecal fat tests to check for fat malabsorption, blood chemistry tests to check for vitamin and mineral deficiencies, an upper gastrointestinal series (an x-ray examination of the gastrointestinal tract), and/or a CT scan of the intestines. A patient's family and medical history can also help diagnose short bowel syndrome, especially in the case of surgery-related SBS.

Treatment & Therapy

There is no cure for SBS except intestine transplantation, which is not common and has a mixed success rate. The symptoms of short gut syndrome are typically treated with medication. Anti-diarrheal medicine, vitamin and mineral supplements, proton-pump inhibitors and H2 blockers for stomach aid, and lactase supplements to treat bloating and diarrhea.

Some patients benefit from medication that slows down the movement of the intestine to help food remain in the intestines longer to increase nutrient absorption. A high-calorie diet may be prescribed to boost the amount of nutrients, vitamins, and minerals that enter the body. Nutritional support is an especially important part of managing short bowel syndrome as the body has higher nutritional needs. Avoiding filler foods that are low in nutrients is also important.

In some cases, surgery is recommended to lengthen dilated portions of the bowel. These procedures are generally used to lengthen the bowel in children to avoid the need for transplantation surgery. About 50% of all people with short bowel syndrome require surgery to prevent blockages, preserve the length of the small intestine, narrow dilated segments, and/or lengthen the small intestine.

Prevention & Prophylaxis

There is no known way to prevent short bowel syndrome, as researchers have not found that nutrition or diet play a role. The best way to prevent SBS is to manage any existing conditions that may lead to removal of the small intestine. For example, Crohn's disease can be managed by avoiding red meat, smoking, and other triggers that can lead to flare-ups and worsen symptoms.