Short Bowel Syndrome: A Complete Guide
Read on to find out more about short bowel syndrome and its symptoms, causes, and treatment.
Short bowel syndrome, also known as short gut syndrome, is a disease of the intestines whereby the small or large intestine experiences a loss of function. It can affect either intestine or both.
Aside from impeding the absorption of nutrients, short bowel syndrome may cause other adverse effects on health.
As the remaining healthy intestine works to compensate for any missing or nonfunctioning regions, the small intestine may widen to create a higher surface area to draw in more nutrients. This can cause nutrients to move through more slowly. This slow movement means that bacteria have more time to multiply, causing bacterial overgrowth and risking infection.
The severity of symptoms and complications may depend on how much of the intestines do not work as expected, or which sections are impacted.
The condition can be serious and cause disabling or life threatening complications.
How does it happen?
The intestine consists of two main organs: the small intestine and the large intestine.
The small intestine is a tube-shaped organ that lies between the stomach and the large intestine. This is where most food digestion and absorption occur.
In an adult, the expected length of the small intestine will be around 600 centimeters or 235 inches. Certain conditions or surgical shortening of the intestine can reduce this length and the amount of intestine that can function.
When there is a problem with the small intestine, it may not absorb water and important nutrients as it does in an unaffected individual. This is short bowel syndrome.
A particularly common symptom, however, is diarrhea.
Signs and symptoms, which can also result from the complications of having short bowel syndrome, can include:
- unintentional weight loss
- loss of muscle mass or weakening muscles around the temples, giving a hollow appearance
- general feeling of ill health, malaise
- lethargy, fatigue, or weakness
- vitamin deficiency
- cramping and bloating
- stool that contains excess fat, or appears pale or greasy
- swelling of the abdomen, legs, or feet
- dry or flaky skin
Symptoms of vitamin deficiency can vary greatly depending on what vitamins are deficient, and can affect almost all body areas and systems.
The effects and complications of short bowel syndrome can be life threatening, and you should seek immediate care for anyone experiencing severe symptoms of the disease.
Symptoms of dehydration, which can be the result of short bowel syndrome, also need immediate medical attention. These symptoms include:
- excessive thirst
- infrequent urination and urine that is dark in color
- dizziness or faintness
- dry skin, mouth, or tongue
- lack of tears when crying
- in infants, no wet diapers for 3 hours or more
- infants with a sunken soft spot on the body
- children presenting uncharacteristic cranky or drowsy behavior
- sunken eyes or cheeks
Short bowel syndrome happens due to the reduction in the amount of functional small intestine.
Reasons this happens commonly include surgery to remove a part of the small intestine or genetic factors present at birth.
Causes of short bowel syndrome include:
- Surgery: Treatment of another condition may include surgery that deliberately removes part of the small intestine. Conditions that require this may include cancer or damage from cancer treatment, Crohn’s disease, internal hernia, or conditions of malformation or dysfunction of the intestine.
- Intestinal injury: Injury can damage the small intestine. This includes injury from trauma and injury from other causes, such as loss of blood flow from a blocked blood vessel. Injury can also cause short bowel syndrome due to requiring surgery on the intestine.
- Congenital abnormalities: Some people may be born with a particularly short small intestine or part of their bowel missing.
- Disease: Even if an individual has a disease that does not require surgery that shortens the intestines, certain diseases can cause intestinal damage, reducing the amount of functional intestine.
Researchers have not yet found a way to prevent short bowel syndrome as a result of congenital intestinal abnormalities.
However, the successful treatment and management of conditions and risk factors associated with short bowel syndrome may help. For example, techniques that minimize the production of scar tissue during surgery may decrease the chance of a person developing short bowel syndrome.
Who is at risk for short bowel syndrome?
Short bowel syndrome can present in individuals of all ages.
Risk factors may include:
- having a defect present from birth
- experiencing a disease of the small intestine that may possibly require surgery, such as Crohn’s disease or certain cancers
- experiencing injury or disease to the small intestine
To diagnose short bowel syndrome, a doctor will evaluate all available information on your symptoms and their presentation, duration, and history. They may possibly run further tests.
Information or tests a doctor may use to diagnose short bowel syndrome can include:
- medical history
- complete blood count test results
- tests that may reveal nutritional or vitamin deficiencies
- tests that may indicate malnutrition, dehydration, liver cell damage, or kidney dysfunction
- imaging techniques such as X-ray, MRI, or CT scans
- biopsy, for example, of the liver
- stool tests
Treatments for short bowel syndrome will aim to address the particular symptoms that appear according to the individual.
Short bowel syndrome treatments aim to improve a process called intestinal adaptation.
Intestinal adaptation refers to when the remaining functional portion of the small intestine adjusts to the decreased function. It may increase its absorption rate to compensate for any nonfunctioning areas.
Different techniques and medical specialties may be appropriate depending on factors such as symptoms present, the location and extent of the area affected, the patient’s age and medical history, and personal preference.
Therapeutic options for short bowel syndrome
Treatments for short bowel syndrome will depend on the individual’s condition, and doctors may use one or a combination of treatments over varying periods of time.
- Total parenteral nutrition (TPN): TPN is a therapy that administers fluid and nutrition to supply all nutritional requirements and bypass the digestive system, avoiding intestinal stress. With TPN, an IV, or intravenous line, will go into a vein and deliver nutrients directly to the bloodstream. Some may be able to stop TPN with help from other treatments, and some may have to use TPN their whole life.
- Enteral feeding: With this treatment, a tube delivers food directly into the stomach or small intestine. This can form the early stage of treatment that occasionally reintroduces traditional, oral consumption of food. Doctors also use this as a treatment after TPN if the condition improves.
- Dietary adjustments: There is no one specific diet that clinicians recommend for those with short bowel syndrome, but individualized diets may help to tailor treatment and manage potential dietary complications.
- Rehydration treatment: Oral rehydration solutions can help maintain the proper balance of fluids and replenish water, sugar, and salt levels.
- Medication: Many different medications are available and can treat some aspects of short bowel syndrome. These include antidiarrheal medication, enzyme replacement therapy, growth hormones, probiotics or antibiotics, and medication that may rehabilitate the intestinal lining.
- Surgery: Surgery can be a last resort option in patients after trying previous therapeutic options. Non-transplant surgery may include artificially lengthening the intestines, using two procedures called the Bianchi procedure and serial transverse enteroplasty (STEP).
- Transplant: A small intestine transplant may be available, especially for those who experience severe complications or for whom other treatments have not worked. A healthy donor may donate a small intestine to replace the nonfunctioning one. Complications can occur and lifelong medical treatment will be necessary, however, techniques and survival rates are improving.
Complications of small bowel syndrome can relate both to the effects of the disease and the treatment it may require. In some cases, complications can be fatal.
Such complications can include:
- organ transplant infection and rejection
- malnutrition and diet deficiencies
- peptic ulcers, sores on the stomach or intestinal lining which can be the result of too much gastric acid present
- bacterial overgrowth and infection in the small intestine
- kidney stones
- metabolic bone disease
- D-lactic acidosis
- anastomotic ulceration or stricture
Additionally, the long-term use of TPN may result in bacterial infection, blood clots, and intravenous catheter complications. It may also lead to liver, kidney, or pancreatic disease or dysfunction.
Complications of short bowel syndrome can come with their own further risks and complications. For example, malnutrition can have complications including but not limited to heart failure, blood clots, impaired wound healing, impaired immune response, as well as cognitive and mood-related conditions.
Individuals experiencing short bowel syndrome may have many questions surrounding what it is, how it works, and what life might be like with it.
How common is short bowel syndrome?
Short bowel syndrome is rare. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) reports that in any one year, the syndrome affects approximately 3 out of every 1 million people.
Can you recover from short bowel syndrome?
Currently, there is no cure for short bowel syndrome.
However, available treatments can be effective and progressive. Treatments can include surgery, medication, nutrition, and in severe cases, organ transplant.
How long can you live with short bowel syndrome?
The prognosis for those with short bowel syndrome will depend on many factors.
A 2006 study of patients undergoing treatment for short bowel syndrome suggests that survival rates decrease in those with smaller small intestine lengths.
The study also indicates that complications of the disease contribute to the rate of mortality. Complications are more likely in those with shorter intestines.
Can you drink alcohol with short bowel syndrome?
Experts do not recommend consuming alcohol with short bowel syndrome, as it can impede hydration.
Staying hydrated is very important for people with short bowel syndrome as their bodies do not absorb as much water as people with typical bowel function. Complications of dehydration are severe.
Short bowel syndrome is the condition whereby the small intestine experiences a loss of function in a certain area. This can happen due to a missing region of the intestine, or intestinal damage.
Complications of the disease can be life threatening, and commonly include malnutrition, infection, and further bodily disease.
However, treatment can be effective, and your doctor will tailor therapeutic options to the individual patient and their condition.
The outlook of the condition can depend on many factors, including the severity of the nonfunctioning intestine, treatment available to you, and management of complications.
Seek emergency medical care for any symptoms of dehydration, and seek prompt care for any further symptoms of short bowel syndrome.