Short bowel syndrome is a group of problems related to poor absorption of nutrients. Short bowel syndrome typically occurs in people who have Show
Short bowel syndrome may be mild, moderate, or severe, depending on how well the small intestine is working. People with short bowel syndrome cannot absorb enough water, vitamins, minerals, protein, fat, calories, and other nutrients from food. What nutrients the small intestine has trouble absorbing depends on which section of the small intestine has been damaged or removed. What is the small intestine?The small intestine is the tube-shaped organ between the stomach and large intestine. Most food digestion and nutrient absorption take place in the small intestine. The small intestine is about 20 feet long and includes the duodenum, jejunum, and ileum: duodenum—the first part of the small intestine, where iron and other minerals are absorbed jejunum—the middle section of the small intestine, where carbohydrates, proteins, fat, and most vitamins are absorbed ileum—the lower end of the small intestine, where bile acids and vitamin B12 are absorbed What is the large intestine?The large intestine is about 5 feet long in adults and absorbs water and any remaining nutrients from partially digested food passed from the small intestine. The large intestine then changes waste from liquid to a solid matter called stool. The small intestine is the tube-shaped organ between the stomach and large intestine.What causes Short Bowel Syndrome?The main cause of short bowel syndrome is surgery to remove a portion of the small intestine. This surgery can treat intestinal diseases, injuries, or birth defects. Some children are born with an abnormally short small intestine or with part of their bowel missing, which can cause short bowel syndrome. In infants, short bowel syndrome most commonly occurs following surgery to treat necrotizing enterocolitis, a condition in which part of the tissue in the intestines is destroyed.1 Short bowel syndrome may also occur following surgery to treat conditions such as
Even if a person does not have surgery, disease or injury can damage the small intestine. How common is Short Bowel Syndrome?Short bowel syndrome is a rare condition. Each year, short bowel syndrome affects about three out of every million people.1 What are the signs and symptoms of Short Bowel Syndrome?The main symptom of short bowel syndrome is diarrhea—loose, watery stools. Diarrhea can lead to dehydration, malnutrition, and weight loss. Dehydration means the body lacks enough fluid and electrolytes—chemicals in salts, including sodium, potassium, and chloride—to work properly. Malnutrition is a condition that develops when the body does not get the right amount of vitamins, minerals, and nutrients it needs to maintain healthy tissues and organ function. Loose stools contain more fluid and electrolytes than solid stools. These problems can be severe and can be life threatening without proper treatment. Other signs and symptoms may include
People with short bowel syndrome are also more likely to develop food allergies and sensitivities, such as lactose intolerance. Lactose intolerance is a condition in which people have digestive symptoms—such as bloating, diarrhea, and gas—after eating or drinking milk or milk products. What are the complications of Short Bowel Syndrome?The complications of short bowel syndrome may include
People who have any signs or symptoms of severe dehydration should call or see a health care provider right away:
Infants and children are most likely to become dehydrated. Parents or caretakers should watch for the following signs and symptoms of dehydration:
If left untreated, severe dehydration can cause serious health problems:
How is Short Bowel Syndrome diagnosed?A health care provider diagnoses short bowel syndrome based on
Medical and Family HistoryTaking a medical and family history may help a health care provider diagnose short bowel syndrome. He or she will ask the patient about symptoms and may request a history of past operations. Physical ExamA physical exam may help diagnose short bowel syndrome. During a physical exam, a health care provider usually
Blood TestsA blood test involves drawing a patient's blood at a health care provider's office or a commercial facility and sending the sample to a lab for analysis. Blood tests can show mineral and vitamin levels and measure complete blood count. Fecal Fat TestsA fecal fat test measures the body's ability to break down and absorb fat. For this test, a patient provides a stool sample at a health care provider's office. The patient may also use a take-home test kit. The patient collects stool in plastic wrap that he or she lays over the toilet seat and places a sample into a container. A patient can also use a special tissue provided by the health care provider's office to collect the sample and place the tissue into the container. For children wearing diapers, the parent or caretaker can line the diaper with plastic to collect the stool. The health care provider will send the sample to a lab for analysis. A fecal fat test can show how well the small intestine is working. X-rayAn x-ray is a picture created by using radiation and recorded on film or on a computer. The amount of radiation used is small. An x-ray technician performs the x-ray at a hospital or an outpatient center, and a radiologist—a doctor who specializes in medical imaging—interprets the images. An x-ray of the small intestine can show that the last segment of the large intestine is narrower than normal. Blocked stool causes the part of the intestine just before this narrow segment to stretch and bulge. Upper Gastrointestinal SeriesUpper GI series, also called a barium swallow, uses x rays and fluoroscopy to help diagnose problems of the upper GI tract. Fluoroscopy is a form of x ray that makes it possible to see the internal organs and their motion on a video monitor. An x-ray technician performs this test at a hospital or an outpatient center, and a radiologist interprets the images. During the procedure, the patient will stand or sit in front of an x-ray machine and drink barium, a chalky liquid. Barium coats the esophagus, stomach, and small intestine so the radiologist and a health care provider can see the shape of these organs more clearly on x-rays. A patient may experience bloating and nausea for a short time after the test. For several days afterward, barium liquid in the GI tract causes white or light-colored stools. A health care provider will give the patient specific instructions about eating and drinking after the test. Upper GI series can show narrowing and widening of the small and large intestines. Computerized Tomography ScanComputerized tomography scans use a combination of x-rays and computer technology to create images. For a CT scan, a health care provider may give the patient a solution to drink and an injection of a special dye, called a contrast medium. CT scans require the patient to lie on a table that slides into a tunnel-shaped device that takes x-rays. An x-ray technician performs the procedure in an outpatient center or a hospital, and a radiologist interprets the images. The patient does not need anesthesia. CT scans can show bowel obstruction and changes in the intestines. How is Short Bowel Syndrome treated?A health care provider will recommend treatment for short bowel syndrome based on a patient's nutritional needs. Treatment may include
Nutritional SupportThe main treatment for short bowel syndrome is nutritional support, which may include the following:
MedicationsA health care provider may prescribe medications to treat short bowel syndrome, including
SurgeryThe goal of surgery is to increase the small intestine's ability to absorb nutrients. Approximately half of the patients with short bowel syndrome need surgery.2 Surgery used to treat short bowel syndrome includes procedures that
Long-term treatment and recovery, which for some may take years, depend in part on
Intestinal TransplantAn intestinal transplant is surgery to remove a diseased or an injured small intestine and replace it with a healthy small intestine from a person who has just died, called a donor. Sometimes a living donor can provide a segment of his or her small intestine. Transplant surgeons—doctors who specialize in performing transplant surgery—perform the surgery on patients for whom other treatments have failed and who have life threatening complications from long-term parenteral nutrition. An intestinal-transplant team performs the surgery in a hospital. The patient will need anesthesia. Complications of intestinal transplantation include infections and rejection of the transplanted organ. A successful intestinal transplant can be a life-saving treatment for people with intestinal failure caused by short bowel syndrome. By 2008, transplant surgeons had performed almost 2,000 intestinal transplantations in the United States—approximately 75 percent of which were in patients younger than 18 years of age.3 A health care provider will tailor treatment to the severity of the patient's disease:
Can Short Bowel Syndrome be prevented?People can ask their health care providers about surgical techniques that minimize scar tissue. Scientists have not yet found a way to prevent short bowel syndrome that is present at birth, as its cause is unknown. What is Intestinal Adaptation?Intestinal adaptation is a process that usually occurs in children after removal of a large portion of their small intestine. The remaining small intestine goes through a period of adaptation and grows to increase its ability to absorb nutrients. Intestinal adaptation can take up to 2 years to occur, and during this time a person may be heavily dependent on parenteral or enteral nutrition.1 Eating, Diet, and NutritionResearchers have not found that eating, diet, and nutrition play a role in causing or preventing short bowel syndrome. Clinical TrialsThe National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions. What are clinical trials, and are they right for you?Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you. What clinical trials are open?Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov. References[1] Thompson JS, Rochling FA, Weseman RA, Mercer DF. Current management of short bowel syndrome. Current Problems in Surgery. 2012;49(2):52–115. [2] Thompson JS, Weseman R, Rochling FA, Mercer DF. Current management of the short bowel syndrome. Surgical Clinics of North America. 2011;91(3):493–510. [3] Mazariegos GV, Steffick DE, Horslen S, et al. Intestine transplantation in the United States, 1999–2008. American Journal of Transplantation. 2010;10(4):1020–1034. |