Short bowel syndrome (SBS) occurs when a significant proportion of the small intestine has been removed or damaged and does not function adequately to absorb nutrients from the diet.
The severity of the syndrome can vary significantly in patients, depending on the extent of the damage to the intestine and the remaining utility. It is considered to be a rare condition, with three in a million people affected each year.
Symptoms
A patient with short bowel syndrome may experience a range of symptoms related to the insufficient function of the intestine, including:
- Diarrhea
- Dehydration
- Weight loss
- Malnutrition
- Abdominal pain
- Bloating or cramping
- Fatigue and weakness
- Heartburn
- Vomiting
It is common for patients with SBS to have a deficiency of vitamins, which may lead to specific signs such as anaemia, hyperkeratosis, bruising, muscular spasms, poor blood clotting or pain of the bones. Additionally, affected patients have a greater risk of being affected by food allergies or sensitivities.
Cause
The most common cause of short bowel syndrome is surgical removal of part of the small intestine, which can be performed as part of the treatment for several health conditions. These include:
- Crohn’s disease
- Volvulus
- Tumor growth
- Physical trauma
- Necrotizing enterocolitis
- Bypass surgery for obesity
- Birth defects – gastroschisis, omphalocele, meconium ileus, intussusception, intestinal atresia, internal hernia
In some cases, infants may be born with a short small intestine or a missing section of the bowel, which can lead to short bowel syndrome.
Necrotizing enterocolitis is the main cause for infants with the syndrome, involving destroyed tissue in the intestines and inadequate function and absorption of nutrients as a result.
Treatment
The treatment for someone with short bowel syndrome depends on the specific needs of the individual but often involves a multidisciplinary team with nutritional support, pharmacological treatment and surgery.
Dehydration is a common complication of diarrhoea experienced by many patients with SBS and can usually be managed with oral rehydration. Pharmacological rehydration solutions, which contain the physiological levels of salts and minerals, are ideal for children that have lost a significant volume of fluid due to diarrhoea.
Diet changes to adapt to the insufficiency of the intestine are an important step in the management of the condition. Small, frequent meals are usually preferred and problematic foods, such as those that cause diarrhoea, should be avoided.
Parenteral or enteral nutrition can help some patients to receive the nutrients they need when the intestine is not sufficient. Parenteral involves administration of fluids, electrolytes, vitamins and mineral via an intravenous tube, whereas enteral uses a feeding tube into the stomach. Supplementation of vitamins or minerals may be required for the duration of these treatments.
Some medications may be useful in the treatment of some individuals, including:
- Antibiotics to prevent bacterial growth
- Anti-heartburn drugs to reduce gastric acid secretion
- Choleretic agents to prevent liver disease, due to better bile flow
- Hypomotility agents to increase travel time and nutrient absorption in intestine
- Growth hormones or teduglutide to improve intestinal absorption
Surgery
Approximately half of all patients with short bowel syndrome require surgery to improve the absorption of the intestine. The specific procedure may vary, including:
- Prevention of blockage in the intestine
- Narrowing of dilated segments of the intestine
- Increasing travel time (and, therefore, nutrient absorption)
- Lengthening of the intestine
The post-surgery outcomes and recovery depends on the procedure and the extent of invasion involved.
Some patients may require an intestinal transplant, which involves replacement of missing or malfunctioned tissue with healthy small intestinal tissue. The healthy tissue can be sourced from a person that has recently died, or a living donor. This can be life saving for an individual with intestinal failure.
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