Short Bowel Syndrome

What is Short Bowel Syndrome?

The main organ responsible for digestion and absorption of the food we eat is the small intestine. As food passes in the part of the small bowel, certain nutrients are being absorbed into the body. For instance, vitamin B₁₂ is absorbed in the third section of the intestine, which is the ileum. For this reason, resection of parts of the intestine can have a great impact in our effective dietary intake. When a large portion of the small intestine has been cut-off (due to surgery, for example), short bowel syndrome ensues. In these cases, the small intestine is not able to sustain its main function of absorbing water, other important nutrients and vitamins such as calcium, folate, iron, magnesium, vitamin B₁₂ and zinc.

Short bowel syndrome tends to occur in neonatal patients with small intestines due to congenital anomalies and people that underwent resection of the small bowel. The condition does not usually develop unless a person has lost more than two thirds of his or her small intestine. Per year, about 10,000 to 20,000 Americans have reportedly suffered the condition.

What Causes Short Bowel Syndrome?

The two major causes of short bowel syndrome are neonatal defects of the small intestine and surgical resection among adults as a result of other digestive problems. Some of the conditions that require small bowel surgery include necrotizing enterocolitis and Crohn's disease. Some other conditions that require cutting some portion of the intestine are volvulus or twisting of the intestine, malignant tumors, injury or trauma to the small intestine, bypass surgery to treat obesity, or removal of diseased or damaged portions of the small intestine.

Symptoms of Short Bowel Syndrome

Initial symptoms include:

• Diarrhea
• Weight loss
• Abdominal pain
• Steatorrhea – presence of fat in stool

Many symptoms are related to malnutrition:

• Anemia
• Fatigue
• Dehydration
• Poor skin turgor
• Stunted growth for children

Short bowel syndrome is often associated with deficiencies in vitamins A, D, E, K, and B₁₂, calcium, magnesium, iron, folic acid, and zinc. These may appear as anemia, hyperkeratosis (scaling of the skin), easy bruising, muscle spasms, poor blood clotting, and bone pain.

Diagnosis of Short Bowel Syndrome

Diagnosis of short bowel syndrome is easily foreseen by its symptoms, especially if it occurs after surgical resection. and it is obtained primarily through physical examination and reports of medical history. Combination of blood tests and other imaging studies would be helpful in confirming the disease and other related conditions.

Since anemia is very common due to malabsorption of iron and other nutrients, a complete blood count is needed to measure the level of hemoglobin, red, and white blood cells. Stool examinations are also tested to investigate whether the fat necessary for the body's energy is absorbed by the body. X-ray studies, barium swallow, CT scan and endoscopy are other relevant procedures to collect information regarding internal structures of the entire small intestine.

Treatment of Short Bowel Syndrome

For patients suffering with short bowel syndrome, the goal of treatment is to correct the nutritional deficiencies and help the body absorb nutrients from foods. In order to do this, additional supplements of vitamins and minerals are given in addition to a special, high nutrient diet that is low in fat. Medications to slow the movements of the gastrointestinal tract (peristalsis) are also given to make the food stay longer, and give more time for the small intestine to absorb the nutrients from them.

Other medications to address the symptoms are also given such as anti-diarrheal medication to relieve bouts of diarrhea, and proton pump inhibitors such as omeprazole to inhibit production of stomach acids. In severe cases where the small intestine is not able to absorb nutrients, intravenous injection of nutrient containing fluid is necessary.

Prognosis of Short Bowel Syndrome

Short bowel syndrome has a very good prognosis if the condition is caused by surgery, there is very good chance of recovery. It may only take a while for the small intestine to adapt in its new form or size and eventually, it will be able to absorb nutrients as before.

On the other hand, there is small chance of recovery for newborn infants who had this condition. A 4 to 5 year survival rate was observed with treatment directed at parenteral nutrition. A good chance of recovery is anticipated for those patients who had undergone transplant.

Living with Short Bowel Syndrome

Close monitoring by a multi-disciplinary team is needed to address different issues of short bowel syndrome. The gastroenterologist is the main person to handle the overall assessment and screening, treatment care and evaluation of the condition. Nutritionist(s) and pharmacist (s) are directly involved in nutrient and parenteral nutrition needed by the patient. Subsequent tests to identify the nutrients that are lacking in the body are done to support this issue. Continuous care, nutritional and emotional support by family is needed to avoid the risk for complications and prevent treatment failure due to non-compliance.

Current Research of Short Bowel Syndrome

The most recent advances in management of this condition are related to small bowel transplant to lengthen the small intestine.However, the patient should be healthy and fully prepared to handle such operation since there is a chance that the transplant will be rejected by the body.