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

What Is a Short Bowel Syndrome?

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

What Is a Small Intestine and 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 (chronic inflammation of the gastrointestinal tract), cancer, traumatic injuries, and blood clots in the arteries require surgical removal of a large portion of the small intestine. Approximately 15 percent 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-foot small intestine remains.

What Are the Risk Factors for Short Bowel Syndrome?

The risk factors for short bowel syndrome are as follows:

• Congenital abnormalities, such as intestinal atresia (defect of small intestine).

• Crohn’s disease (chronic inflammatory bowel disease).

• Intestinal injury.

• Intestinal obstruction.

• Intestinal cancers.

• Side effect of radiation therapy.

• Gastrointestinal infections.

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 (deficiency of hemoglobin).

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 to Diagnose Short Bowel Syndrome?

The diagnosis of short bowel syndrome is as follows:

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

• Medical History: Complete medical and family history is taken, and a history of previous surgeries is noted.

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

• 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 takes X-rays. 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 combines 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.

When to Visit the Healthcare Provider In the Case of Short Bowel Syndrome?

The situations indicating it is time to seek medical attention are as follows:

• Persistent diarrhea.

• Severe abdominal pain.

• Unintended weight loss.

• Signs of dehydration, such as dry mouth, dizziness, dark-colored urine, and reduced urination.

• Nutritional deficiencies, such as fatigue, muscle weakness, and skin changes.

• Blood or mucus in stool.

• Fever.

• Vomiting.

• Difficulty in drinking and eating.

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 avoid 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, and 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 a major surgery.

What Is the Prognosis of Short Bowel Syndrome?

The prognosis of short bowel syndrome is based on the portion of the intestine removed, the extent of intestinal loss, and the underlying cause. However, short bowel syndrome presents significant challenges. The prognosis of the condition can be favorable with proper medical and nutritional treatment.

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 that occurs due to the loss of a portion of the small intestine causing challenges in nutrient absorption. 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. Appropriate diagnosis and treatment strategies may improve the health of the affected person.