Short Bowel Syndrome – Causes, Symptoms and Treatment

Short bowel syndrome, also known as SBS, is a complex disease condition that usually occurs due to the physical loss of the small intestine resulting from the surgical removal of a portion of the small intestine or due to the loss of function of a part of the small intestine, sometimes including a portion of the large intestine as well.
The bowels are made of two parts, the large intestine, most often known as the colon, and the small intestine. The main function of the small intestine is to absorb the nutrients from the food you eat, and when a part of the small intestine is surgically removed or loses its function due to a disease, injury or trauma, the individual may suffer from malabsorption and show symptoms such as diarrhea, unintended and sudden weight loss, and dehydration.

What is Short Bowel Syndrome?

As mentioned earlier, short bowel syndrome is a condition characterized by the body’s inability to absorb nutrients from the food eaten due to the physical removal of a part of the small intestine or due to the loss of function of the small intestine resulting from any injury or trauma to it.

Individuals suffering from short bowel syndrome have a reduced ability to absorb nutrients such as fats, carbohydrates, vitamins, minerals, and fluids from the food they take in, and this is called malabsorption. The symptoms of short bowel syndrome vary from one individual to another, and these include diarrhea, weight loss with no known cause, and other symptoms occurring due to the loss of essential vitamins and minerals from the body. Sometimes, diarrhea may be severe and can lead to life-threatening dehydration if medical attention is not sought on time.

There is no permanent cure for the short bowel syndrome, but the symptoms can be treated effectively. Doctors can ensure that you get the right nutrition, and you will be able to lead an active life. The body will learn to adjust to having a short small intestine over time, and eventually you will be able to wean of the medications. The most important factor for people with SBS is to properly adhere to the treatment plan, and seek medical advice whenever it is needed. This will prevent individuals from developing life-threatening complications that may be caused by SBS.

Short Bowel Syndrome Causes

The normal length of the small intestine in healthy individuals is approximately 20 feet. Individuals with short bowel syndrome have at least half of the small intestine either missing or removed.

The short bowel syndrome is either acquired during a person’s life or it may be a congenital disorder, meaning some children are born with short or damaged small intestines.
The most common cause for the surgical removal of a part of the small intestine in infants and newborns is necrotizing enterocolitis. This is a common condition seen in premature babies, and it is characterized by the death and falling off of the intestinal walls, thus hindering the proper functioning of the small intestine. Sometimes, children are born with a short small intestine without any specific cause.

In adults, the Disorders that Prompt the Surgical Resection of the Small Intestine Include:

• Chron’s disease, which is a chronic inflammatory disease of the digestive tract that causes symptoms such as abdominal pain, bloody diarrhea, and sometimes weight loss
• The damage of the small intestine caused by trauma or injury such as gunshots
• Cancer of the small intestine
• The damage of the small intestine caused by cancer treatments like radiation therapy, which is referred to as radiation enteritis and is characterized by the damage to the lining of both the large and small intestines
• Damage to the small intestines caused by the lack of blood flow due to the blockage of a blood vessel
• Small intestine obstruction caused by strangulated hernia, malignancy, or adhesions

Short Bowel Syndrome Symptoms

The symptoms of the short bowel syndrome vary from one individual to another, and they usually depend on the length and function of the remaining part of small intestine after surgical resection has been performed.
Since SBS causes malabsorption, children and infants with this disorder experience poor growth due to the lack of the proper building blocks needed for normal growth and development.

In adults, Diarrhea is the most Common Symptom and it Causes:

• Dehydration
• Malaise or a general feeling of poor health and lethargy
• Unintended weight loss
• Malnutrition that develops over time

The Additional Symptoms of Short Bowel Syndrome Include:

• Abdominal cramping
• Weakness and fatigue
• Bloating
• Heart burn
• Steatorrhea or the presence of fat in stools
• Pale, greasy stools

The Malnutrition Resulting from the Short Bowel Syndrome Causes Symptoms that Include:

• The swelling of the abdomen
• Dry, flaky skin
• Abundant loss of muscle mass
• Peripheral edema, i.e. the swelling of the legs and feet
• Hollow appearance of the temples
• Gallstones
• Kidney stones
• Fatty liver

Since the short bowel syndrome is associated with the failure to absorb adequate amounts of vitamins and minerals, the lack of sufficient amounts of vitamins and minerals may lead to the following symptoms:

• Night blindness
• Irregular heartbeats
• Anemia
• Peripheral neuropathy
• Osteoporosis
• Tetany or intermittent muscle spasms
• Parasthesia or abnormal sensation on the skin
• Ataxia or loss of coordination
• Skin pallor
• Shortness of breath
• Poor wound healing
• Hair loss leading to alopecia, which appears as patchy areas of hair loss

Since the short bowel syndrome causes different symptoms in different individuals, it is very important for patients to discuss their specific symptoms with their doctors, and review the prognosis of the disease.

Short Bowel Syndrome Diagnosis

Doctors use a thorough physical examination, the patient’s medical history, and a few specialized tests to make a diagnosis of the short bowel syndrome when they suspect a patient to be suffering from it.
Once the doctor has finished the physical examination and noted down the symptoms stated by the patient, he may order one or more of the following tests:

• Blood tests that include a complete blood count (CBC), a test for albumin levels, creatinine and liver enzymes in the blood
• Stool examination
• Imaging tests that include: X-rays of the chest and abdomen, a barium X-ray to check for abnormalities in the upper gastrointestinal tract, CT scans of the abdomen, and ultrasound of the abdomen to check for any abnormalities in the abdominal organs.
• Bone density test to check for vitamin deficiencies that may be causing weakness of the bones and increasing the risk for osteoporosis
• Liver biopsy in which a piece of liver tissue is removed to check for the health and function of the liver
• Upper and lower endoscopic tests to evaluate the function of the remaining part of the small intestine

Short Bowel Syndrome Treatment

The treatment for short bowel syndrome is usually done by a team of gastroenterologists, surgeons, dietitians, and nutritionists. The treatment is specific to individual patients depending on the symptoms they are experiencing, their age, overall health, and the function of the remaining part of the small intestine. The treatment for SBS consists of a combination of medication, diet, and surgery if required.

Maintaining proper nutritional intake is a must for patients with SBS, and doctors may include Total Parenteral Nutrition (TPN) which is intravenous fluid and nutrition therapy in patients who require it. The treatment for nutritional support for patients with short bowel syndrome includes one of the following methods:

• Oral Rehydration:

  Adults are encouraged to drink large amounts of water, and include sports drinks, decaffeinated sodas, and salty broths in their diet while children are recommended oral rehydration solutions, which are special drinks containing salts and minerals that help prevent dehydration. The most common oral rehydration drink is Pedialyte that is available in most grocery stores and drugstores.

• Parenteral Nutrition:

  This treatment is recommended for patients who do not get enough nutrition from oral intake of food. In this treatment, the required fluids, electrolytes, and liquid vitamins and minerals are delivered directly into the bloodstream through an intravenous (IV) tube.

• Enteral Nutrition:

  In this treatment, liquid food is directly delivered to the stomach or small intestine through a small, soft, plastic tube passed into the stomach through the nose or the mouth.

• Vitamin and Mineral Supplements:

  These supplements are given to a patient during the parenteral or enteral nutrition program or after these programs have ended.

• Special Diet:

  A gastroenterologist may recommend a special diet program depending on a patient’s symptoms and health condition. The diet recommendations may include small, frequent meals for patients with mild to moderate SBS, avoiding foods that increase chances of diarrhea such as those that are high in protein, fiber, and sugar, and avoiding high-fat foods.

The medications usually prescribed by doctors for SBS patients to help increase the small intestine’s ability to absorb nutrients and fluids include:

• Teduglutide: This is a hormone prescribed by doctors for adult patients suffering from severe SBS who need parenteral nutrition.
• L-glutamine: This is a medication that comes in the powder form that increases the small intestine’s capacity to absorb nutrients from food.
• Somatropin: This is a human growth hormone that is given through an injection, and it helps intestines to work better on their own, without much outside support.

Some SBS patients may require nutritional and medical support only for a short period as they may go through a process called intestinal adaptation wherein the small intestine adapts to its short length and increases its ability to absorb nutrients as well as a normal small intestine. However, this process usually takes about 2 years, and during this time the patient will have to depend on parenteral or enteral nutrition.

In case of short bowel syndrome in children, the parents need to make sure that their child is getting enough daily calories and nutrition to help him grow. It is advisable to visit a pediatric gastroenterologist or a dietician on a regular basis to help change the diet from time to time and ensure the child is getting the right nutrition.
Doctors may suggest surgery for some patients with SBS to help increase the small intestine’s ability to absorb nutrients, and surgical procedures may be done to remove any blockage to the small intestine, to make any dilated segment of the small intestine narrower, or lengthen the small intestine.

When all the above treatment options have failed for a patient with short bowel syndrome, the doctors may recommend a transplant surgery to replace a part of the remaining small intestine or the entire small intestine. The transplant surgery is a major surgery, and it requires the patient to wait until a suitable donor is found. The aftercare of the transplant surgery involves the hospitalization of the patient for 6 weeks or more and requires the regular intake of immunosuppressive drugs to prevent the body from rejecting the new organ. Also, patients with short bowel syndrome who undergo transplant surgery will be required to take certain drugs and have regular follow-ups with the transplant surgeon to prevent any dangerous complications that might develop after the surgery.