Short Bowel Syndrome

Short bowel syndrome is the extreme loss of small intestine or its function due to disease or surgery, to the extent that there isn’t enough of it left to absorb nutrients.

Symptoms of Short Bowel Syndrome

The symptoms of short bowel syndrome are:

  • Diarrhea
  • Pain in the stomach or abdomen, or under the right ribcage
  • Steatorrhea or foul-smelling stool
  • Stool that “floats” or are oily and sticky
  • Indigestion and other symptoms of peptic ulcer
  • Fluid retention
  • Fatigue and weakness
  • Severe weight loss
  • Malnutrition

Because of the body can’t absorb enough nutrients, patients with short bowel syndrome often exhibit symptoms of nutrient and vitamin deficiencies, such as:

  • Anemia due to iron, folic acid, and/or vitamin B12 deficiency
  • Skin rashes and scaling of the skin or hyperkeratosis due to vitamin A deficiency
  • Bruising and blood in urine, due to vitamin K deficiency
  • Muscle spasm and bone pain, due to vitamin D and calcium deficiency
  • Osteoporosis due to calcium deficiency

Children diagnosed with short bowel syndrome are also often slow in growth or development, due to lack of nutrition.

How Is It Diagnosed?

Your doctor would perform the following tests to diagnose this condition:

  • Medical history
    A history of bowel surgery or digestive ailments may point to the cause of short bowel syndrome.

  • Physical examination
    Jaundice, loss of muscle mass and wasting, visible signs of skin scaling and rashes, and diminished sensation in the hands and feet due to vitamin deficiencies are diagnosed by physical examination.

  • Blood tests
    Elevated liver enzymes, abnormal levels of electrolytes and potassium are observed in blood tests.

  • Stool examination

Causes of Short Bowel Syndrome

Short bowel syndrome can be caused by:

  • Surgeries
    These include:

    • Bypass surgery for extremely obese patients
      Here, the small intestine is shortened to reduce its ability to absorb nutrients. It is no longer performed because of potential side effects and complications, such as short bowel syndrome.

    • Surgical removal of the small intestine damaged by disease or cancer.

  • Crohn’s disease
    This digestive disorder is marked by inflammation of the digestive tract (anywhere between the mouth and the anus). If the small intestine walls are inflamed, then it may lead to short bowel syndrome.

  • Necrotising enterocolitis
    Reduced blood supply to the walls of the small intestine lead to dead tissues that have to be surgically removed. This condition commonly affects prematurely-born babies and is the leading cause of short bowel syndrome in infants.

  • Volvulus
    A spontaneous tangling or twisting of the small intestine, where the blood supply to the surrounding tissue is cut off, thus causing damage or death to the intestinal tissue.

  • Tumor and cancer of the small intestine

  • Trauma

How Much Small Intestine Can Be "Lost"?

The small intestine is approximately 20-feet long and in most cases, short bowel syndrome does not appear until it is only 6 feet in length. This means that a person can lose up to about 70% of his small intestine without becoming malnourished.

The lining of the small intestine is covered with millions of finger-like projections called villi. These projections provide a large surface area to absorb nutrients. In a process called intestinal adaptation, when a portion of the small intestine is surgically removed, villi from the remaining part grow larger to compensate for the lost organ. Peristalsis, or the movement of the food through the small intestine, is also slowed to give the bowel more time to absorb nutrients.

Treatment for Short Bowel Syndrome?

short bowel syndrome treatments include:

  • Diarrhea medicine
    In cases of severe diarrhea, intravenous hydration may be required to prevent dehydration.

  • Vitamin, iron, folic acid, and protein supplements
    To treat vitamin and nutrient deficiencies, your doctor may prescribe water-soluble supplements that are easier to absorb.

  • Lactase supplement
    Because the small intestine produces the enzyme that digests lactose, many short bowel syndrome patients also have lactose intolerance.

  • Medications to reduce stomach acid
    In patients with short bowel syndrome, acid-inhibiting peptides normally present in the small intestine are missing. To reduce the amount of stomach acid produced, your doctor may prescribe:

    • Histamine or H2 receptor blocker
      These medicines block the histamine receptors that signal the stomach to make more acid.

    • Proton pump inhibitors
      These are drugs that directly disable the acid pumps in the stomach.

    • Antacids
      Some prescription-strength antacids coat the stomach and promote healing of lesions caused by peptic ulcer.

  • Medications to bind bile-salt

  • Surgery, including small intestine transplant
    Short bowel syndrome caused by intestinal bypass surgery can usually be reversed by further surgery.

    In rare cases, small intestine or small bowel transplant may be required. This procedure has mixed success, and carries with it the risk of organ rejection and infection.

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