Dr. Ghulam Fareed
Medical Gastroenterology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I have been suffering from Crohn's disease, and I had two small intestine resections (ileal and terminal ileum area) for a total of 28 inches removed. Recently, I have had blood tests that show low levels of albumin, vitamin D, hemoglobin, calcium, and phosphorus. I usually defecate once or twice a day, and my stools are normal. I am concerned if I have short bowel syndrome. Kindly help.
Thank you.
Hello,
Welcome to icliniq.com.
I can understand your concern.
Small bowel syndrome can occur if the remaining small bowel is only 39 inches along with an intact colon or less than 78 inches without a colon.
As only 28 inches of small intestines have been removed, there are low chances of having small bowel syndrome.
As the distal part of the terminal ileum has been removed, malabsorption of bile acids and Vitamin B12 can occur. Once the levels of bile acids decrease, the levels of fat-soluble vitamins also decrease.
I advise you to follow the below-mentioned instructions.
I hope this information will help you.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
I would like to know the answers to the following questions.
1) Will I have difficulty with vitamins D, A, E, and K absorption?
2) Is a diet low in fat is better for me?
3) Can a high-fat diet lead to diarrhea?
4) Would chronic diarrhea cause low levels of some nutrients such as protein and albumin, zinc, magnesium, copper, selenium, iron, and others, leading to a decrease in weight?
5) Can you suggest the medication to replenish the low levels of nutrients, minerals, and vitamins?
Kindly suggest.
Thank you.
Hello,
Welcome back to icliniq.com.
I can understand your concern.
1) Vitamin B12 and bile acids absorption takes place at the terminal ileum. Bile acids are necessary for the absorption of fat-soluble vitamins including (Vit A, D, E, and K). Relative deficiencies of these vitamins can occur in your case, considering the resection of the terminal ileum.
2) A diet low in fats would be better, because limited bile acids can absorb limited fats, excessive fatty foods should be avoided.
3) As bile acids are necessary for fat absorption, compromised bile acids would not absorb fats altogether, so excessive fatty meals may cause diarrhea but is not advisable to completely avoid fats.
4) Loss of body weight may not be a concern as a very limited small intestine was removed.
5) Chronic diarrhea can cause malabsorption to some extent, but this can happen to anyone. Consume a well-balanced diet like normal individuals with minor variations as mentioned above.
6) Kindly consult a specialist to discuss the specific diet and take the medications with their consent.
I hope this information will help you.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
Hello,
Glad to have you back at icliniq.com.
I hope the information helped you.
Thank you.
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Medical Gastroenterology
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