Short bowel syndrome is a condition caused by surgery that removes part of the small intestine.
The small bowel carries food from the stomach to the large bowel, which attaches to the rectum and anus. It plays an important role in digestion. Proteins, vitamins, minerals, salts, and important fats are absorbed through the small bowel. Removal of part of the small bowel decreases the area to absorb these nutrients.
Many people can tolerate removal of up to 50% to 60% of the small bowel without having problems. However, when more than this amount or a key part of small bowel is removed, symptoms often occur. These symptoms make up what is called the short bowel syndrome.
The main symptoms of this condition are abdominal pain, or distress, and diarrhea. Malabsorption, or poor absorption, of important nutrients may lead to weight loss, low blood counts including anemia, and vitamin deficiencies.
The cause of this condition is removal of too much of the small bowel. Common reasons for surgery to remove part of the small bowel include: treatment for a condition called Crohn's disease, which causes severe bowel inflammation for unknown reasonsbowel bypass surgery, usually done to help people with severe obesity lose weightremoval of dead bowel, which usually occurs due to poor blood supplyremoval of areas of small bowel damaged by radiation therapy, which is commonly used to treat cancer. The damage to the bowel is known as radiation enteritis.
People who have not had small bowel surgery are not at risk for this condition. Surgeons try to remove as little bowel as possible when doing surgery to prevent this condition.
Short bowel syndrome is suspected if the characteristic symptoms occur in a person who has had small bowel surgery. If diarrhea, malabsorption, or weight loss occurs for long periods of time, the diagnosis can usually be made. There is no single test that confirms the diagnosis.
Short bowel syndrome can lead to weight loss, chronic diarrhea, and vitamin and mineral deficiencies due to malabsorption. Such deficiencies may include vitamin B12, folate, iron, calcium, zinc, and magnesium. This can cause problems throughout the body, such as anemia, skin rashes, and abnormal sensations in the legs.
An individual with short bowel syndrome is also more likely to develop kidney stones and gallstones.
Short bowel syndrome is not contagious and poses no risks to others.
Diet is the primary treatment for short bowel syndrome. A person must take in at least 2500 calories per day through a diet containing mostly complex carbohydrates and protein. A low-fat diet helps reduce diarrhea. Some medications, such as loperamide, also help control the diarrhea.
Some medications, such as loperamide (i.e., Imodium) and diphenoxylate/atropine (i.e., Lomtil), also help control the diarrhea. Vitamin and mineral supplements are often needed, especially vitamin B12 and folate. Calcium and iron supplements may be needed.
A bile salt-binding medication, such as cholestyramine (i.e., Questran), is often given to help control symptoms.
Some people with this condition produce too much stomach acid. This can further decrease digestion. Medications such as cimetidine (i.e., Tagamet), omeprazole (i.e., Prilosec) or ranitidine (i.e., Zantac) can be used to help reduce the amount of stomach acid.
Other medications and supplements may also be needed in some cases. Some people need what is called total parenteral nutrition, or hyperalimentation. This is a procedure in which calories and needed nutrients, including protein and fat, are given through an intravenous line, or IV.
A small bowel transplant is now used in some severe cases.
Most of the dietary changes used to treat this condition have no specific side effects.
The most common side effects of the medications used to reduce stomach acid include: headachediarrheaabdominal distressnauseadizzinessrashcough
Other medications also have possible side effects, which depend on the specific medication used.
The use of an intravenous line to deliver nutrition may cause infection and bleeding. Giving nutritional support through an intravenous line over a long period time increases the risk of death due to liver disease. Severe infection of the blood from an intravenous line contaminated by bacteria may also occur.
Most individuals with short bowel syndrome need lifelong treatment.
There is no specific lab test to monitor short bowel syndrome. Any new or worsening symptoms should be reported to the healthcare provider.
Harrison's Principles of Internal Medicine, Fourteenth edition. 1998. McGraw-Hill, Inc. pp. 1625
Current Medical Diagnosis&Treatment 2000, Lange Medical Books / McGraw -Hill, pp. 618-619.