Short bowel syndrome is a group of problems that can happen if you are not able to absorb many of the nutrients in the foods you eat. They happen to people who have had a large part of their small intestine removed.
The small intestine is a long, curving organ. It connects your stomach to your large intestine. Digestion starts in your stomach. But most digestion takes place in the small intestine. The small intestine also absorbs nutrients. Bowel refers to the small intestine and large intestine together.
You can have problems when half or more of your small intestine is taken out. You may not be able to absorb enough water, vitamins, and other nutrients. This can cause major nutritional problems and symptoms.
This can include a higher risk for short bowel syndrome. The more of the small intestine that has been removed, the greater the chance for severe problems.
Different parts of the small intestine absorb different nutrients. If you have a latter part of the small intestine taken out, you can have nutritional problems. This is because the first part of the small intestine cannot absorb all nutrients. Having the valve between the small and large intestine also makes a big difference in your health. Some people with short bowel syndrome have also had part of their large intestine taken out. This leads to more problems.
This condition can happen after any type of surgery to take out part of your small intestine. The most common reasons for this type of surgery in adults include:
- Crohn’s disease
- When part of the intestine folds over another part (intussusception)
- Small intestine injury from a blocked blood vessel
- Small intestine injury from trauma
- Cancer and damage from cancer treatment
- Certain types of weight-loss surgery
Having conditions that need to be treated by taking out part of your small intestine raises your risk for this issue. These can include Crohn’s disease.
A main symptom of short bowel syndrome is diarrhea. Other symptoms can include:
- Weight loss
- Being sensitive to new foods
If you have had a large part of your small intestine removed, your healthcare provider will look for short bowel syndrome. If you have a history of surgery and symptoms of short bowel syndrome, you are likely to have the condition.
Your healthcare provider may rule out other causes of your symptoms. He or she will do an exam and ask about your symptoms. Your healthcare provider may also do other tests. These can include:
- Basic blood tests. These can check for infection, anemia, and electrolytes.
- Tests to check for nutritional deficiencies
- Stool tests. These can tell if you are absorbing enough fat.
- X-ray of your large and small intestines
- CT scan
- Upper GI series
Treatment depends on how severe the condition is. It also depends on how long it’s been since you had your small intestine removed.
After surgery, your remaining intestine slowly adapts. Over time, it is able to absorb nutrients better. This process can take a year or two. This varies depending on how much and what part of your small intestine was taken out.
You will likely have parenteral feedings after your surgery. This means that you won’t eat anything. Instead, you will get nutrients through a tube placed in your vein.
As you recover, your healthcare provider may slowly start enteral feedings. This gives liquid nutrition directly to your stomach or small intestine through a feeding tube. Over time, your healthcare provider will try to increase your enteral feedings and decrease your parenteral feedings.
Your healthcare provider may eventually move you to oral feedings. You will need to eat small meals often. You will also need to avoid foods that are high in simple carbohydrates, such as juices.
Some people with severe short bowel syndrome will need long-term parenteral nutrition. This can sometimes cause problems. If this happens, you may need a small intestine transplantation. Or your healthcare provider may suggest a non-transplantation surgery. This can improve how you absorb nutrients.
Other treatments for short bowel syndrome include:
- H2 blockers or proton pump inhibitors (PPIs). These are medicines to decrease stomach secretions.
- Medicines to treat diarrhea
- Extra nutritional supplements
- Electrolyte solutions. You may take these by mouth (orally) or through an IV (intravenous line).
- Medicines to prevent liver damage. These are given to people on parenteral nutrition.
- Medicines to help the small intestine adapt
- Medicines to treat too many bacteria (overgrowth) in your small intestine
This condition can cause serious issues. Your healthcare provider will watch you for complications. He or she will also try to treat any problems early on.
If problems aren’t treated well, you can have diarrhea. This can cause dehydration, weight loss, and malnutrition. It may even lead to death.
Other complications can include:
- Liver disease. This can happen from long-term use of parenteral nutrition. In rare cases, this may lead to a liver transplant.
- You may need to have your gallbladder removed.
- Bacterial overgrowth of the small intestine. This can make your symptoms of short bowel syndrome worse.
- Nutrient deficiencies. Specific problems depend on which nutrients are low. For instance, some people show early bone loss. This is because of poor absorption of calcium and other nutrients.
- Kidney stones. This is caused by extra oxalate in your urine.
- Peptic ulcer. This is a sore on the lining of the stomach or duodenum caused by too much stomach acid.
Follow your healthcare provider’s orders about diet and medicines. Doing so will reduce your risk for problems.
Call your healthcare provider if you have severe diarrhea. You may need to go to the hospital to get IV fluids to rehydrate. You should also call your healthcare provider if you have any new symptoms. These can include confusion or bad stomach pain.
- Short bowel syndrome is a group of problems. They happen to people who have had a large part of their small intestine removed.
- The main symptom of short bowel syndrome is diarrhea.
- After surgery, you will get your nutrients through a vein. This is called parenteral nutrition. Then, you will likely get liquid nutrition directly to your stomach or small intestine through a feeding tube. Eventually, you may be able to eat normally.
- Some people with severe short bowel syndrome need parenteral nutrition long-term.
- Short bowel syndrome can cause problems. These are more likely in people who need long-term parenteral nutrition. You may need a small intestine transplant.
Tips to help you get the most from a visit to your health care provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.
May 21, 2018
Management of the short bowel syndrome in adults. UpToDate.
Sather, Rita, RN,Lehrer, Jenifer, MD