What Is Short Bowel Syndrome? Symptoms, Causes and Treatment Methods

The intestines, an important part of the digestive system, consist of two main parts: the small intestine and the large intestine. The small intestine, which plays a role in the breakdown and absorption of nutrients, is a structure made up of blood and lymph vessels, nerves and muscles. Its main function is to break down food coming from the stomach into its building blocks and deliver the nutrients the body needs into the bloodstream. In addition, it is responsible for sending undigested and unneeded food residues to the large intestine. The small intestine, which houses bacterial colonies called “microbiota” or “flora,” plays a role in the development of the immune system. In conditions such as congenital bowel diseases and extensive resection (removal of part or all of an organ from the body), when the small intestine is shorter than it should be, this is defined as “short bowel syndrome.” The remaining length of the small intestine can usually be 180-200 cm or less. When the area of the small intestine that carries out the absorption of macro and micronutrients is shortened, various symptoms and risks may appear in individuals. Short bowel syndrome can often create a need for nutritional and fluid supplementation. The body exposed to inadequate nutritional intake may show signs such as weight loss, electrolyte imbalance, diarrhea and steatorrhea (fatty diarrhea), dehydration (the body losing water), etc. The severity of the syndrome can present as mild or severe. Treatment options may include continuous parenteral nutrition and intestinal transplantation.

What Is Short Bowel Syndrome?

Short bowel syndrome is the condition that results from a significant reduction in the surface area of the small intestine. This condition, which brings with it loss of fluid, nutrients and weight, is known as a malabsorption disorder. In adults, the small intestine is 275-850 cm long. The small intestine consists of 3 parts: the duodenum, ileum and jejunum. Various nutrients are absorbed from these sections:

The duodenum is the first part of the small intestine and begins to break down the chyme coming from the stomach. In this section, bile acids and pancreatic enzymes enable the breakdown and absorption of lipids (fats).

The jejunum is the section where carbohydrates, amino acids and fatty acids are absorbed.

The ileum is the section where bile acids to be recycled, vitamin B12 and other micronutrients that are not absorbed elsewhere are absorbed.

Because the intestines affected by short bowel syndrome are 200 cm or shorter, the transit rate of food through the intestine may increase. This can lead to a range of uncomfortable symptoms. Since the jejunum is the first absorption area for nutrients, jejunal resection may reduce nutrient absorption. Ileal resection can lead to inadequate absorption of bile acids and severe diarrhea. In addition, failure to absorb fat-soluble vitamins and important micronutrients such as B12 may cause nutritional deficiency in short bowel syndrome.

What Are the Symptoms of Short Bowel Syndrome?

Short bowel syndrome can occur in individuals with varying severity. Generally presenting with similar symptoms, the syndrome can be life-threatening if left untreated. Common symptoms of short bowel syndrome may include the following:

Malabsorption,

Diarrhea,

Greasy, foul-smelling stools,

Involuntary weight loss,

Fatigue,

Abdominal pain,

Gas and bloating,

Dark-colored urine,

Decreased skin elasticity,

Dizziness or fainting,

Excessive thirst and dry mouth,

Swelling (edema) in the feet and legs.

The absence of nutrients, fluids and electrolytes necessary for the body to function normally can lead to disruptions in tissue and organ functions. Failure to intervene medically can trigger serious health problems such as organ damage, shock and coma. It is especially important to monitor signs of dehydration, described as fluid loss from the body, and to ensure rehydration therapy. In infants and children, the absence of tears, no urine in the diaper for 3 hours or longer, abdominal swelling and crying spells may be among the symptoms that require attention. Low calcium, zinc, magnesium, iron, and vitamin B12, A, D, E and K levels may be seen in blood values. In addition, lactose intolerance, kidney stone formation, metabolic acidosis and weight loss may be clearly observed.

How Does Short Bowel Syndrome Develop?

The main conditions that give rise to the short bowel syndrome picture:

Cancer,

Crohn's disease,

Congenital (present from birth) anomalies,

Mesenteric infarction,

Radiation enteritis,

Severe injuries and trauma,

Lack of blood flow in the intestines

Surgical resection can also be listed.

Resection is the procedure of removing the damaged parts of the small intestine, used in the treatment of some diseases. However, this procedure may contribute to the development of short bowel syndrome. In young children and infants, it tends to occur mostly after surgical treatments. Diseases in children that may require surgical treatment may include:

Necrotizing enterocolitis,

Intestinal atresia,

Malrotation,

Gastroschisis.

Narrowing in the area of the small intestine where food is mostly digested and absorbed may cause nutrients to reach the large intestine without being absorbed. In this case, the small intestinal villi cannot carry out absorption normally and deficiencies may occur. When nutrients that cannot be broken down or absorbed reach the large intestine, in short bowel syndrome they may cause effects such as diarrhea, bloating and cramps. The large intestine is generally not the area where food is digested and absorbed. Here, some of the water and electrolytes are reabsorbed, and food residues form the stool.

How Is Short Bowel Syndrome Diagnosed?

A medical history of the patient, physical examination, family history and laboratory tests may be needed for diagnosis. In addition, diagnosis can be supported with the help of imaging techniques and special tests. Clinical tests may include:

Complete blood count: Enables measurement of levels of albumin, liver enzymes, creatinine, iron, vitamins and minerals.

An abdominal computed tomography scan can be used to detect ileus and intestinal obstruction.

Imaging of gallstones that may be associated with the syndrome can be performed with abdominal ultrasound.

MRI can enable detection of narrowed areas in the intestines, evaluation of the presence of fistulas, and monitoring of the integrity of the small intestinal wall.

In addition, an abdominal X-ray may help detect symptoms of intestinal muscle paralysis and obstructions.

Additional tests may be necessary to diagnose or identify possible complications. Other examinations such as liver biopsy and lower and upper endoscopic examinations may be recommended.

How Is Short Bowel Syndrome Treated?

Short bowel syndrome cases can be managed by applying different treatment methods. Main treatment methods may include nutritional support, fluid and electrolyte therapy, medication use and surgical procedures. Nutritional and fluid support are necessary interventions for patients. These interventions are important for preventing or slowing down possible complications. In individuals, short bowel syndrome nutritional treatment is planned by taking into account the stage and severity of the syndrome and the length of the intestine. In cases where the small intestinal area has decreased significantly, parenteral nutrition may be necessary for a period of time or for life. Parenteral nutrition is defined as feeding through a vein and may be recommended over the long term. After nutritional and fluid support is provided during the acute period, covering the first 3-4 weeks, some individuals may transition to enteral feeding.

Enteral nutrition is the direct placement of a tube into the stomach or small intestine and provision of nutrition through the tubes. Compared with parenteral nutrition, oral and enteral nutrition may contribute more quickly to the improvement of intestinal health. The remaining part of the intestines begins to adapt to nutritional and fluid support in the adaptation phase. The adaptation period may last 1-2 years in adults. For intestines whose adaptive capacity has developed, a transition from parenteral nutrition to oral and enteral nutrition can be achieved. According to the needs of the individual, under the guidance of a doctor and dietitian, supplements, alternative treatments and medications may be used along with a short bowel diet. When nutritional insufficiency develops despite the implementation of priority treatment plans, one may speak of “chronic intestinal failure.” Surgery may be applied for patients with chronic intestinal failure. Catheter placement, intestinal resection and intestinal transplantation are generally the recommended surgical methods for ensuring nutrition.

Frequently Asked Questions

When the small intestinal area, which governs the health of the digestive system, shortens, short bowel syndrome may occur. The possible risks of the syndrome may affect the musculoskeletal system, nervous system and digestive system. In this context, you can read the rest of the article to find frequently asked questions and answers about short bowel syndrome and its treatment.

If short bowel syndrome is not treated, a number of complications may tend to develop. Short bowel is one of the main factors causing nutritional and fluid insufficiency. Excessive fluid loss from the body and electrolyte imbalances can disrupt the activity of hormones, muscles and some organs. Changes in hormone production and release, deterioration in muscle and skeletal health, some symptoms on the skin and face, and dysfunction of nervous system tissues may be among the risky situations. As a result of an untreated syndrome, the likelihood of lactose intolerance, bacterial overgrowth and chronic inflammation in the small intestine, peptic ulcers, osteoporosis, and gallstones and kidney stones is high. As a result of the removal of part or all of the intestines, congenital intestinal anomalies, and trauma and injuries, the small intestine may have a length below 200 cm. Therefore, after surgical treatments and in individuals with intestinal diseases, symptoms can be expected to develop. Since short bowel syndrome causes a deficiency of substances necessary for the body, medical treatment must be applied without fail. Patients who are not treated may be exposed to life-threatening outcomes. Identification and monitoring of the syndrome are important steps. Individuals suspected of having short bowel syndrome are advised to access urgent diagnosis and treatment. Commonly, the removal of approximately half or more of the small intestine is the main factor that triggers the prognosis. This surgical intervention may be preferred in the presence of intestinal injury and trauma, congenital anomalies, and intestinal diseases such as Crohn's disease. At the same time, large intestine problems and their resection may also play a role in the development of short bowel syndrome. Factors affecting the prognosis are generally actions that disrupt intestinal integrity. Therefore, intestinal diseases and surgical treatments may be a risk factor. In these patients, serious health problems caused especially by malabsorption may be seen. These can generally be listed as follows:

Weight loss and diarrhea,

Vitamin deficiencies,

Hyponatremia (low sodium),

Hypokalemia (low potassium),

Hypomagnesemia (low magnesium),

Kidney and gallstones,

Kidney failure,

Secondary cholestasis,

Intestinal failure.

Compared with adults, liver fibrosis and cholestasis may occur more frequently in infants. In addition, intestinal failure may lead to the development of liver diseases that can be life-threatening.

Short bowel syndrome is a serious condition that can affect quality of life. At Hisar Hospital, we offer personalized diagnosis and treatment options for this condition. We are here to support your health with our teams of gastroenterology specialists.

To make an appointment, you can fill out our online appointment form or contact us directly. For more information, you can visit our Gastroenterology Department.