Short bowel syndrome Or sometimes known as short gut syndrome develops when a considerable length of the small intestine is surgically removed, resulting in diarrhea and malabsorption.
- Significant shortening of the small intestine by the surgical removal of a large portion from it results in this condition.
- Chronic diarrhea is the most common symptom of short bowel syndrome.
- Fluids and nutrients are administered intravenously following the surgery, but in some cases, it may have to be continued throughout life.
- Drug treatment with cholestyramine and loperamide may provide relief from diarrhea.
Food is partly digested in the stomach but the small intestine is where the major part of the digestive and absorptive processes takes place. When a part of the small intestine is surgically removed, it affects the digestion of food and absorption of nutrients into the blood by varying degrees depending on the location and length of the missing part. When a small portion is removed, the remaining portion may take over its function. For example; the last part of the small intestine called ileum often compensates for the loss of the middle part called jejunum. But when 3 feet or more of ileum is lost, the rest of the intestine is unable to cope. During the period before the remaining intestine adapts, or when it is unable to adapt, absorption of various nutrients such as proteins, fats and vitamins become severely affected. The intestine may be unable to absorb the bile secretion necessary for digestion too.
Inflammatory bowel diseases such as Crohn’s disease, a block in the mesenteric artery supplying to most of the intestine called mesenteric infarction, and blockage caused by volvulus or twisting of an intestinal loop, are some of the usual reasons for the large scale removal of the small intestine. Intestinal cancers as well as radiation enteritis resulting from the damage caused to the intestine by the exposure to radiation during the treatment of cancers, and congenital defects, are a few other reasons.
The first symptom to appear after the surgery is diarrhea due to malabsorption. Subsequently, malnutrition and deficiency diseases develop.
Treatment Of Short Gut Syndrome
Total parenteral nutrition or TPN is administered immediately following the surgery, to provide the patient with complete nutritional support. Carbohydrates, proteins and fats necessary for the body, along with all essential minerals and vitamins, are included in the TPN. Gradually, as the diarrhea subsides, the patient is weaned of parenteral nutrition and oral feeding of fluids is started. Depending on the patient’s tolerance, further additions are made facilitating gradual adjustment to normal diet.
The normal length of the small intestine ranges from around 12 feet to 21 feet. When more than three fourths of the small intestine has been removed, or when large amounts of fluid is being lost through continuing diarrhea, life-long dependence on TPN may be unavoidable. If oral feeding is tolerated, a diet containing less amount carbohydrate, but more of proteins and fats, is advised. Avoiding large meals, and taking several smaller ones frequently, may help in better absorption.
Loperamide is an effective antidiarrheal drug that can be taken an hour prior to meals, to prevent diarrhea which would otherwise occur after meals. If diarrhea is caused by the inability to absorb bile and utilize it for digestion, taking cholestyramine along with meals may help reduce it. Vitamin and mineral supplements have to be taken life-long to prevent deficiencies of magnesium, calcium and vitamins. Vitamin B12 injections may be required every month.
When a patient can neither adapt to the short bowel, nor tolerate TPN for extended periods, transplantation of the small intestine is an option.
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