There are a number of gastrointestinal conditions that only develop after a previous medical intervention causes a change to the body. Such is the case with short bowel syndrome (SBS), a condition that is almost always linked with a prior surgery that involved removing part of the small intestine. Although fairly rare in the population at large, short bowel syndrome can be a major concern for bowel resection patients and, even more rarely, in some pediatric patients.

What Is Short Bowel Syndrome?

Short bowel syndrome, also sometimes referred to simply as short gut, refers to the collection of symptoms that can arise when a significant portion of the small intestine is either congenitally absent or surgically removed. For most people, there are a variety of post-surgical techniques and medications that can mitigate this loss of intestinal length, but for others the symptoms are highly disruptive and can greatly affect the person’s quality of life. It is estimated that between 10,000 and 20,000 people suffer from SBS in the United States.

When the gastrointestinal system is functioning normally, food enters the digestive tract through the mouth and esophagus before it is broken down in the stomach into a substance called chyme. This mostly liquid substance then moves into the duodenum, the first part of the small intestine; this is where pancreatic juices and other digestive enzymes are added in preparation for the journey through the intestines. From there, it travels through the jejunum and ileum to the large intestine where stool is formed and expelled.

The jejunum is the longest section of the small intestine and the site where most of the absorption of nutrients takes place. Apart from rare cases of newborn babies having congenitally short small intestines (atresia), this condition only develops after the surgical removal of a significant section of the small intestine. Below are some of the conditions that might warrant bowel resection surgery:

  • Crohn’s disease: Crohn’s disease is one of the principal types of inflammatory bowel disease (IBD) that can cause severe inflammation, strictures, or other problems in the small intestine. When the symptoms are severe enough, a bowel resection is the final option for providing long term relief.
  • Trauma: Severe traumatic injuries to the abdomen, such as a serious car accident, may require bowel resection if there is damage to the intestine.
  • Cancer: In some later stages of small bowel cancer, resection may be the only remaining option to remove cancerous tumors.
  • Bowel obstruction: The presence of strictures, tumors, or excessive scar tissue are just some of the ways the small intestine can become obstructed. An obstruction can also occur when a loop of the small intestines gets twisted around itself (volvulus). In cases where the obstruction cannot be resolved through less invasive means, a bowel resection may be necessary.
  • Ischemic bowel disease: Reduced blood flow (ischemia) to the intestine, known as ischemic bowel disease, can potentially cause enough tissue damage that a bowel resection may be needed to remove it.
  • Necrotizing enterocolitis: This rare intestinal disease primarily affects newborns who are either premature or very low weight.

Signs and Symptoms of Short Bowel Syndrome

The symptoms of short bowel syndrome can vary greatly from person to person based largely on how much of the remaining intestine is left after bowel resection. It also makes a difference which part of the small intestine is involved; the duodenum absorbs minerals like magnesium and calcium while the jejunum absorbs amino acids and water soluble vitamins, for instance. Below are some examples of potential signs and symptoms:

  • Diarrhea: Chronic diarrhea is one of the most common symptoms of short bowel syndrome simply because the absorptive ability of the small intestine is impaired. This changes bowel motility and leads to frequent, watery, loose stools.
  • Dehydration: Over time, persistent diarrhea and problems with absorption can cause dehydration and the loss of electrolytes, leading to increased thirst, dry mouth, and reduced urine output.
  • Abdominal pain: Other common gastrointestinal symptoms like abdominal pain, bloating, and cramping are also part of the typical experience with short bowel syndrome.
  • Malnutrition: One of the biggest concerns with short bowel syndrome is malabsorption not providing enough nutrients for the body to function properly. Problems with nutrient absorption from the food we eat can easily lead to deficiencies in important nutrients like vitamin B12, folate, iron, and zinc. Such deficiencies in enteral nutrition often manifest as weight loss, fatigue, or weakness.
  • Liver problems: Short bowel syndrome can cause intestinal failure-associated liver disease (IFALD), a condition that typically occurs when receiving nutritional support from an intravenous feeding tube over a long period of time. This and other liver problems can also increase the chances of developing gallstones in the gallbladder.
  • Osteoporosis: One of the potential additional effects of malnutrition is a deficiency in the compounds that maintain bone density.
  • SIBO: SIBO, short for small intestinal bacterial overgrowth, is a common complication of short bowel syndrome because of the slowdown in bowel motility; this slower movement essentially makes the intestines a more effective breeding ground for some types of harmful bacteria.

Diagnosis and Treatment Options

Because the symptoms of short bowel syndrome are relatively common, diagnosing the condition usually involves ruling out other gastrointestinal conditions. Diagnosing SBS starts with a healthcare provider performing a thorough physical exam as well as an evaluation of the various symptoms. Blood tests are then often used to assess nutritional deficiencies and overall health, while imaging studies such as X-rays and CT scans visualize the digestive tract; if necessary, endoscopy can also be used to directly visualize the interior of the small intestine.

In most cases, the treatment of SBS is multifaceted with nutritional support forming a core component; this can range from taking dietary supplements to total parenteral nutrition (TPN). Below are the most common treatment options:

  • Nutritional support: In addition to dietary supplements aimed at correcting deficiencies, nutritional support also involves adopting new habits like eating smaller meals at more frequent intervals. It also may require a diet with more easily digestible foods.
  • Medication: Various medications may also be prescribed to manage specific symptoms like easing diarrhea or reducing the production of stomach acid. A medication called teduglutide is specifically prescribed for SBS in order to promote mucosal growth along the gastrointestinal tract.
  • Bowel rest: In some acute cases, a period of bowel rest may be recommended in order to give the digestive tract time to heal. This kind of rest is typically accomplished through temporary parenteral nutrition.
  • Intestinal adaptation: Intestinal adaptation is a long-term process by which the structure and function of the intestines can be modified to increase the amount of nutrients that can be absorbed.
  • Surgery: Surgery is usually reserved for the most severe cases. One option is to lengthen the intestines through autologous gastrointestinal reconstruction. Another option is intestinal transplantation.

Gastroenterology Help from Cary Gastro

Short bowel syndrome is a relatively rare condition that generally only affects people who have already had a surgical procedure to remove part of the small intestine. Like other gastrointestinal conditions, though, the symptoms can mimic other illnesses. At Cary Gastro, our highly qualified team of healthcare professionals is dedicated to helping our patients get the treatment they need regardless of the symptoms. If you’d like to speak with one of our staff, please contact us to request an appointment.