Short Bowel Syndrome

The small intestine is the organ that absorbs nutrients from food such as fats, carbohydrates, and vitamins during digestion. Short bowel syndrome means that part or all of the small intestine is missing or has been surgically bypassed, leading to the body being unable to process all of the dietary nutrients it needs to function properly.

Symptoms

The main symptom of short bowel syndrome is diarrhea, which when severe can lead to dehydration, malnutrition and weight loss. Additional signs include:

  • Bloating
  • Cramping
  • Fatigue, feeling tired
  • Foul-smelling stool
  • Heartburn
  • Vomiting
  • Weakness

Severe dehydration, if left untreated, can be life threatening. Contact a health care provider should you notice critical symptoms:

  • Excessive thirst
  • Dark-colored urine
  • Dry skin
  • Infrequent urination
  • Lethargy, dizziness or faintness
  • Muscle cramping

Causes

Short bowel syndrome may be present at birth, or can be caused when a portion of the small intestine is removed during surgery for conditions that may include:

  • Blood clots to the gut
  • Cancer and cancer treatment
  • Congenital birth defects
  • Crohn’s Disease
  • Injuries
  • Internal hernias
  • Surgical jejunoileal bypass – no longer performed

Diagnosis

A gastroenterologist will complete a physical exam, inquire about your medical history, and may order diagnostic tests:

  • Blood Tests: Assess mineral and vitamin levels, anemia and albumin levels.
     
  • CT Scan: Enables physicians to identify bowel obstructions, assess the health of the liver, and changes in the intestines.
     
  • Fecal Fat Tests: The concentration of fat in stool indicates how much fat is absorbed during digestion and can show how well the small intestine is working.
     
  • Upper GI Series: This imaging test uses X-rays and barium sulfate, a substance that coats your digestive tract, to visualize deformities such as strictures, obstructions, or fistulas within the small bowel. Other imagery includes computerized tomographic, and magnetic resonance, which provides enterography of organs, in addition to the intestinal tract. Capsule endoscopy can be used to define acute or chronic inflammation.

Treatment

Options to treat short bowel syndrome can be complex and varied. They are dependent upon a patient’s nutritional needs and case severity, and should be discussed in detail with a physician.

Nutritional Support

  • Diet:
    • Avoid foods high in fat, sugar, protein and fiber, as they can contribute to diarrhea and dehydration
    • Eat small, frequent meals in order to stimulate intestinal absorption
       
  • Enteral Nutrition: Liquid food delivered to the stomach or small intestine through a feeding tube.
     
  • Parenteral Nutrition: An intravenous (IV) tube provides electrolytes and liquid vitamins into the blood stream when solid foods and fluids are unable to be digested.
     
  • Rehydration: Drink fluids that contain salts and minerals to prevent dehydration.

Medications
Medications may assist in improving intestinal absorption, reducing acid production and secretion, decreasing diarrhea, and decreasing bile flow. Your physician will discuss the medication regimen that may work best for you.

Surgery
The overall goal of surgery is to increase the small intestine’s ability to absorb nutrients, and is generally used as a last resort in individuals where therapeutic options have not been effective.

  • Non-Transplant Surgery: A surgeon can artificially lengthen the small intestine or widen a narrow area of the bowel, relieving symptoms and improving absorption.
     
  • Intestinal Transplant: Removal of the diseased or injured small intestine and replacing it with a living donor organ is an option for patients with advanced, persistent short bowel syndrome.
     
  • Historically a jejunoileal bypass was a weight loss option for morbid obesity. But it has been associated with a high incidence of excessive weight loss, electrolyte imbalance and malnutrition - cirrhosis. Surgical connection of this anatomy is usually recommended.

If you would like to consult with a provider, schedule an appointment with Virginia Mason's Gastroenterology Department by calling (206) 223-2319.