Short Bowel Syndrome - Causes, Symptoms, Diagnosis, and Treatment

Introduction:

Short bowel syndrome is a condition in which the body cannot absorb enough nutrients because of the absence of part of a small intestine. Short bowel syndrome may be mild, moderate, or severe, depending on how well the remaining portion of the intestine is working. It is also known as a short gut syndrome.

What Does the Small Intestine Do?

The small intestine is the part of the digestive system where the majority of the nutrients are absorbed into the body during the process of digestion. It is a tube-shaped organ about 20 feet long. The small intestine has three sections: duodenum, jejunum, and ileum.

• The Duodenum: It is the first part of the small intestine. It is the shortest section next to the stomach, where iron and other minerals are absorbed.

• The Jejunum: It is the middle section that lies between the duodenum and the ileum. Carbohydrates, proteins, fats, and most vitamins are absorbed here.

• The Ileum: It is the lower end of the small intestine. It is the longest section connecting to the large intestine, where bile acids and vitamin B12 are absorbed.

What Are the Causes of Short Bowel Syndrome?

Short bowel syndrome can occur when:

• A Portion of the Small Intestine Is Surgically Removed: Conditions like Crohn's disease, cancer, traumatic injuries, and blood clots in the arteries require surgical removal of a large portion of the small intestine. Approximately 15 % of the people who undergo intestinal resection develop short bowel syndrome.

• A Portion of the Small Intestine That Is Missing or Damaged at Birth: Some babies are born with a short small intestine or damaged small intestine, which has to be removed. Children are born with abnormally short small intestines. This is known as congenital small bowel.

Short bowel syndrome does not develop until less than 6.6 feet of the normal 20 feet small intestine remains.

What Are the Symptoms of Short Bowel Syndrome?

Common signs and symptoms of short bowel syndrome include:

• Diarrhea.

• Greasy foul-smelling stools.

• Weight loss.

• Fatigue.

• Abdominal bloating.

• Cramping.

• Heartburn.

• Vomiting.

• Malnutrition.

• Swelling.

• Anemia.

People with short bowel syndrome cannot absorb enough vitamins, minerals, water, proteins, fats, and carbohydrates. The malabsorption of nutrients depends upon which portion of the small intestine is missing or removed. People with short bowel syndrome are also likely to develop food allergies and lactose intolerance.

How Can We Diagnose Short Bowel Syndrome?

• Physical Exam: The doctor will do a physical exam and look for signs of vitamin, and mineral deficiencies and weight loss.

• Complete medical and family history is taken and history of previous surgeries is noted down.

• Blood Tests: Blood tests are done to check nutrition levels and a complete blood count is also tested.

• Stool Tests: Stool samples are collected and sent to the lab. The fecal fat test measures the ability of the small intestine to break down and absorb fat.

• Barium Study: The patient drinks a special liquid containing barium and x-rays are taken. Barium coats the esophagus, stomach, and small intestine, and the doctor can view the inside of the intestine. Barium swallow study can show narrowing and widening of the small and large intestines.

• Computed Tomography (CT) Scan: This imaging technique uses a combination of x-rays and computers to create clear images. This can show bowel obstruction and changes in the intestines.

• Magnetic Resonance Imaging (MRI) Scan: This uses a magnetic field to create clear images of the inside of the body.

What Is the Treatment of Short Bowel Syndrome?

The treatment depends on which part of the small intestine is missing. The treatment for short bowel syndrome includes nutritional support, medications, surgery, and intestinal transplant.

1. Nutritional Therapy: Adults should drink water, and drinks without caffeine and salty broth. Children should drink oral rehydration solutions to prevent dehydration. Nutritional supplements are given to patients with short bowel syndrome. Some people need nutrition supplements through a vein (parenteral) or a feeding tube (enteral) to prevent malnutrition. Parenteral nutrition delivers fluids, electrolytes, vitamins, and minerals into the bloodstream and enteral nutrition delivers liquid food into the stomach or small intestine directly. A special diet is given to patients which includes small, frequent feedings, avoiding foods that are high in sugar, protein, fat, and fiber.

2. Medications: Medications are given to improve intestinal absorption after surgery, and reduce diarrhea and stomach acids. The following are given:

• Antibiotics to prevent bacterial overgrowth.

• H2 blockers and proton pump inhibitors to treat too much gastric acid secretion.

• Growth hormones are given to improve intestinal absorption.

• Hypomotility drugs are given to increase the time the food takes to travel through the intestine to increase absorption.

• Antidiarrheal medications like Loperamide are given to reduce the frequency of diarrhea.

3. Surgery: The goal of the surgery is to improve the small intestine’s ability to absorb nutrients. The surgical procedures done include:

• Prevent blockage and preserve the length of the small intestine.

• Narrow the dilated segment of the intestine.

• Surgery is done to slow the passage of nutrients through the intestine or a procedure to lengthen the intestine.

4. Intestinal Transplant: Short bowel transplantation is also done in some cases. It is a surgery in which a damaged small intestine is removed and replaced with a healthy small intestine from a donor. This surgery is done when other treatment methods have failed. It is done under general anesthesia. It is major surgery.

What Are the Complications of Short Bowel Syndrome?

The complications of short bowel syndrome include:

• Malnutrition - Due to poor absorption of nutrients.

• Peptic Ulcers - Sores on the lining of the digestive tract due to high levels of gastric acid.

• Kidney Stones - Hard deposits in the kidneys.

• Small Intestinal Bacterial Overgrowth - A condition in which large amounts of bacteria grow in the small intestine.

Conclusion:

Short bowel syndrome is a rare condition. The condition is not fatal but may lead to serious life-threatening complications if untreated. Patients can live a normal life without a portion of the small intestine.