Short Bowel Syndrome: Causes, Symptoms, and Treatment

24 July,2024

Many people experience gastrointestinal problems that require surgery to remove parts of the intestine. However, if a significant portion (more than 50%) of the small bowel is removed, it can lead to Short Bowel Syndrome (SBS). SBS causes various symptoms, including diarrhea, malnutrition, and dehydration, which can significantly impact a person's quality of life. This blog post will explain the symptoms, causes, diagnosis, and treatment options for Short Bowel Syndrome, helping you make informed health decisions.

What is Short Bowel Syndrome?

Short bowel syndrome, abbreviated as SBS, is a condition in which the size of the small bowel reduces to less than 200 cm. The average length of the small intestine ranges from 300 to 900 cm. Around 9 liters of fluid pass through the small intestine daily, of which 7 liters are reabsorbed.

Short bowel syndrome can be congenital (present since birth) or may develop after the intestines are removed to treat particular conditions. The syndrome can also arise from various diseases, injuries, or conditions that hamper the proper functioning of the small intestine, regardless of whether the length of the bowel is impacted.

What are the Signs and Symptoms of Short Bowel Syndrome?

The small intestine is responsible for taking up nutrients from the food you eat. If the small intestine is damaged or removed, individuals may have trouble absorbing enough fluids, vitamins, and nutrients from food.

The signs, symptoms, and severity of short bowel syndrome can vary widely depending on the length and function of the remaining portion of the organ. Some common symptoms of short bowel syndrome include –

• Diarrhea: It is the primary symptom of short bowel syndrome, which causes further complications such as dehydration, malaise, lethargy, unintended weight loss, and malnutrition.
• Deficiency of vitamins: Deficiency of vitamins like vit. A, D, E, K, and B cause symptoms like glossitis, anemia, irregular heartbeat, peripheral neuropathy, osteoporosis, paresthesias, ataxia, and purpura.
• Malnourishment: Malnourishment is often a result of small bowel syndrome and can lead to swelling of the abdomen, loss of muscle mass, dry, flaky skin, peripheral edema, and wasting away of the temporal muscles.
• Poor growth: Short bowel syndrome can cause poor growth in babies and kids because they don't get the nutrients they need to grow and develop normally.
• Mineral deficiency: Short bowel syndrome also causes a deficiency of essential minerals like zinc and iron. Zinc deficiency leads to alopecia, stomatitis, poor wound healing, and skin rash. Iron deficiency shows symptoms like dyspnea, glossitis, pallor, and abnormally spooned nails.
• Other symptoms: Cramping, weakness, fatigue, heartburn, bloating, and overgrowth of bacteria

What are the Causes of Short Bowel Syndrome?

As the name suggests, short bowel syndrome is the shortening or reduction in the size of the small intestine. Several conditions can lead to it. Depending on the stage of life, short bowel syndrome can be classified as congenital or acquired.

Causes of short bowel syndrome in children are –

• Growth abnormalities at birth
• A part of the bowel is missing
• Bowels did not form entirely at the time of birth
• Interstitial atresia

Various medical conditions warrant the need to remove a part of the intestine surgically. These disorders include –

• Crohn's disease: Painful inflammatory bowed condition
• Bowel cancer: Malignant tumors present in the colon
• Necrotizing enterocolitis: Loss of blood flow to intestines
• Gastroschisis: The infant's intestines extend outside of the abdomen through a hole
• Volvulus: Twisting of intestines
• Intussusception: A portion of the intestine folds into another body part

How is Short Bowel Syndrome Diagnosed?

To diagnose short bowel syndrome, your healthcare professional will conduct a rigorous physical examination to look for symptoms, ask about your medical and family history, and order imaging tests such as X-rays and CT scans. Standard diagnostic procedures for short bowel syndrome include –

• Physical examination: Children with short bowel syndrome often present symptoms of deficiency of vital vitamins and minerals, which doctors can quickly identify during physical examination. Some of the visible physical signs are stomatitis, poor wound healing, alopecia, petechiae, ecchymoses, purpura, temporal wasting, loss of digital muscle mass, peripheral edema, and dry and flaky skin.
• Blood Tests: Laboratory studies such as CBC and LFT are essential in diagnosing short bowel syndrome. Anemia, vitamin B12 deficiency, elevated AST and ALT levels, and high serum creatinine levels suggest short bowel syndrome and its associated complications.
• Imaging Studies: Radiological studies such as barium X-ray, abdominal CT scan, abdominal ultrasound, and MRI are also used to detect short bowel syndrome.

Further tests may be necessary to identify or evaluate potential complications associated with short bowel syndrome. For instance, a liver biopsy may be conducted to assess the liver's health and function. Additionally, upper and lower endoscopic studies can aid in evaluating the function of the remaining intestine.

What are the Complications of Short Bowel Syndrome?

SBS, or Short bowel syndrome, can be a potentially life-threatening condition if not treated. It can cause a variety of complications, such as –

• Deficiency and imbalance of vital minerals, vitamins, and electrolytes
• Fluid imbalance in the body, leading to dehydration
• Weightloss, malnutrition, and inability to maintain or gain weight
• Imbalance in calcium and oxalate reabsorption, leading to kidney stones
• Liver diseases and gallstones due to prolonged use of IV nutrition
• Severe diaper rash due to acidic stools and frequent bowel movements
• Increased bacteria levels in the intestine
• Food intolerances like gluten and lactose intolerance

What are the Treatment Options for Short Bowel Syndrome?

The primary aim of treating short bowel syndrome is to provide the child with accurate nutrients and relieve the symptoms. A multidisciplinary team consisting of gastroenterologists, pediatricians, hepatologists, nutritionists, dieticians, and other healthcare professionals such as phycologists will work together to maximize the treatment outcome.

Common treatment modalities for short bowel syndrome consist of –

Dietary Adjustment and Nutritional Changes

Children with short bowels need careful nutrition monitoring. Modifying your child's food intake and nutrition can help treat short bowel syndrome. The recommended dietary adjustments may vary depending on the severity of the condition.

• Total Parenteral Nutrition (TPN): After bowel surgery, your child may need special liquid nutrition called total parenteral nutrition (TPN) through a central line in their vein. This liquid contains nutrients like carbohydrates, protein, fats, sugars, and essential vitamins and minerals. TPN provides these nutrients directly to your child's body, bypassing their digestive system. Children receiving TPN need to be carefully monitored to make sure they get the right amount of calories and nutrients.
• Enteral Nutrition: Enteral nutrition, also known as tube feeding, enables your child to receive nutrients through a flexible gastric tube that is inserted directly into their stomach or small intestine or through their nose. This method allows for supplemental nutrition without having to eat by mouth or as a complement to oral feeding.
• Dietary Changes: A healthcare provider might suggest that your child eat smaller, more frequent meals and follow a high-calorie meal plan. This plan should include enough carbohydrates, protein, vitamins, and minerals to support your child's growth. They may also recommend multivitamin and mineral supplements and advise on avoiding high-fat, sugary, and high-fiber foods. This can help prevent problems like malnutrition and dehydration and support your child in gaining weight.

Medications

US FDA has approved a variety of drugs to treat and manage symptoms of short bowel syndrome. These medications include –

• Antidiarrheal Drugs: Medications such as diphenoxylate, loperamide, codeine, and opium tincture work by slowing down peristalsis (the contraction and relaxation of the intestines), which in turn increases the time it takes for food to pass through the intestines. This allows for a longer duration of food staying in the intestines, leading to increased absorption and reduced diarrhea.
• Proton Pump Inhibitors and Histamine-2 Receptor Blockers: Excessive stomach acid secretion can hinder intestinal adaptation. Medications such as famotidine, ranitidine, omeprazole, and lansoprazole help prevent or reduce stomach acid release. These drugs are typically administered early in the postoperative period when there is an increased risk of excessive acid secretion.
• Human Growth Hormone: Injectable somatropin (rDNA origin) is an FDA-approved drug for treating short bowel syndrome. It is similar to the growth hormone produced by the pituitary gland and can enhance the small intestine's capacity to absorb nutrients. As a result, the need for TPN may be reduced.
• Pancreatic Enzyme Replacement Therapy: Food moves through the digestive system more quickly in short bowel syndrome, reducing the time it has to mix with the normal pancreatic and biliary secretions that help in digestion. Hence, pancreatic enzyme replacement therapy consisting of pancrelipase and bile-acid resins such as cholestyramine is necessary for such conditions.
• Antibiotics: Bacterial overgrowth is a common complication in patients with short bowel syndrome. Doctors prescribe antibiotics to destroy or inhibit the growth of these harmful microorganisms. They may also prescribe probiotics to maintain the levels of good bacteria in the gut.

Surgery

Short bowel syndrome can be treated using various surgical techniques. Surgery is typically a last resort for SBS when other treatments have failed. However, as the techniques advance, it may become a primary option. Different surgeries have different roles in treating short bowel syndrome and can –

• Lengthen the small intestine to increase its effectiveness
• Narrow the diameter of the intestine to reduce the risk of bacterial overgrowth
• Prevent blockages in the intestine
• Slow down the digestion of food in the intestine

Surgical options are divided into non-transplant and transplant surgeries.

Non-transplant Surgeries

• The Bianchi procedure and the serial transverse enteroplasty (STEP) can artificially lengthen the intestines.
• Stricturoplasty can help widen a narrowed area of the bowel. It is often performed on individuals with Crohn's disease.
• Intestinal tapering is done to narrow abnormally widened segments of the intestine. It helps prevent bacterial overgrowth.
• Surgical procedures that reconnect the small bowel and the colon have also proven beneficial in treating individuals with short bowel syndrome.

Transplant Surgery

• Some people with short bowel syndrome may need a small bowel transplant, especially if they have problems from TPN, like liver failure, or if they can't get enough nutrition with other treatments.
• In a small bowel transplant, doctors remove the diseased small bowel and replace it with a healthy one from a donor.
• A liver or kidney transplant can also be performed if short bowel syndrome has significantly deteriorated the condition of these organs.

To Conclude

Short bowel syndrome can be a challenging condition, but with proper care and lifestyle adjustments, many people with SBS can lead fulfilling lives. A multidisciplinary treatment approach that combines dietary management, medications, and sometimes surgery is crucial for optimizing the health and well-being of individuals. If you or someone you know might have short bowel syndrome, it's essential to consult a healthcare professional for prompt evaluation and to discuss the best course of treatment.

Remember, you are not alone. With proper management, short bowel syndrome can be effectively controlled, allowing you to live a healthy and active life.