Short Bowel Syndrome
Short Bowel Syndrome, also known as SBS, is a rare, but longterm condition where patients are unable to absorb enough nutrients and fluids from the food they eat due to the surgical removal of a large part of their intestines. It only occurs in a minority of babies who have surgery for NEC, but can be lifelong in a very few cases.
What is Short Bowel Syndrome (SBS)
Short bowel syndrome describes the malabsorption that occurs when there is not enough intestine to absorb milk or food. Mostly, this happens because the bowel was removed at an operation for NEC, but can happen due to other problems. SBS happens if more than 50-70% of the small intestine is removed, or if less than 100 cm of small intestine is left. But some babies who have large parts removed do not develop SBS. It can be difficult to measure accurately how much bowel is remaining after an operation, and in small babies the bowel may continue to grow and lengthen.
SBS causes inadequate digestion and malabsorption and may result in malnutrition if nutrients are not given intravenously. Short bowel syndrome can be mild, moderate, or severe, depending on how well the small intestine is working and what sections have been removed.
People with short bowel syndrome may not absorb enough water and nutrients (vitamins, minerals, proteins, fat etc.) from food due to a lack of intestine (too short) resulting in less surface area for absorption. Which nutrients the intestine has trouble absorbing also depends on which section of the small intestine has been damaged or removed. This means each baby may tolerate milk differently.
The main cause of short bowel syndrome (SBS) is surgery where sections of the intestine has been removed, but some children are born with an abnormally short small intestine or with part of their bowel missing. Adults may develop SBS later in life due to accident, illness or disease.
There are many causes of SBS in both adults and children including:
Volvulus (twisting of the bowel)
Accidents or injury
The main symptom of short bowel syndrome is diarrhoea—loose, watery stools - which can lead to dehydration, malnutrition, and weight loss. Dehydration means the body lacks enough fluid and electrolytes which are chemicals such as sodium, potassium, and chloride.
In children, malnutrition means the body does not get enough vitamins, minerals, and nutrients to stay healthy and grow normally. Some children with SBS may develop food allergies and sensitivities, such as lactose or gluten intolerance. Your doctors can tell you whether your baby or child as SBS. Signs and symptoms may include:
· Stomach bloating or cramps, passing a lot of wind
· Feeling tired or exhausted
· Loose and/or foul-smelling stool
· Heartburn, vomiting or reflux
The complications of short bowel syndrome may include
· Peptic ulcers-sores caused by too much gastric acid
· Bacterial overgrowth
You should closely monitor for signs of dehydration, if you have any signs or symptoms of severe dehydration you should call or see a health care provider right away.
Lookout for any of the following symptoms:
· Excessive thirst
· Dark-coloured urine
· Infrequent urination
· Feeling lethargic, dizziness, or faintness
· Dry skin
Infants and children are most likely to become dehydrated. Parents or carers should watch for the following signs and symptoms of dehydration:
· Dry mouth and tongue
· Lack of tears when crying
· No wet diapers for 3 hours or more
· Sunken soft spot
· Cranky or drowsy behaviour
· Sunken eyes or cheeks
If left untreated severe dehydration can cause serious health problems including organ damage, the body going into shock when low blood pressure prevents blood and oxygen from getting to organs. The body may also go in to a sleep like state ‘coma’ were a person is not conscious.
Depending on the circumstances and reasoning for examination the individual’s health care provider will diagnose short bowel syndrome. This will be based on their medical and family history, a physical exam, blood tests, facal fat tests, an x-ray of the small and large intestines, upper gastrointestinal (GI) series or via a computerized tomography (CT) scan.
Treatment for Mild short bowel syndrome involves eating small, frequent meals; drinking fluid; taking nutritional supplements; and using medications to treat diarrhoea. Special diet. A health care provider can recommend a specific diet plan for the patient that may include small, frequent feedings avoiding foods that can cause diarrhoea, such as foods high in sugar, protein, and fibre avoiding high-fat foods
Treatment for Moderate short bowel syndrome is similar to that for mild short bowel syndrome, with the addition of parenteral nutrition as needed.
Treatment for Severe short bowel syndrome involves use of parenteral nutrition and oral rehydration solutions. Patients may receive enteral nutrition or continue normal eating, even though most of the nutrients are not absorbed.
Both enteral nutrition and normal eating stimulate the remaining intestine to work better and may allow patients to discontinue parenteral nutrition. Some patients with severe short bowel syndrome require parenteral nutrition indefinitely or may require an intestinal transplant.
This treatment delivers fluids, electrolytes, and liquid vitamins and minerals into the bloodstream through an intravenous (IV) tube—a tube placed into a vein.
Enteral nutrition: This treatment delivers liquid food to the stomach or small intestine through a feeding tube—a small, soft, plastic tube placed through the nose or mouth into the stomach.
Vitamin and mineral supplements: A person may need to take vitamin and mineral supplements during or after parenteral or enteral nutrition.
A health care provider may prescribe medications to treat short bowel syndrome, including:
Antibiotics to prevent bacterial overgrowth
H2 blockers to treat too much gastric acid secretion
Proton pump inhibitors to treat too much gastric acid secretion
Choleretic agents to improve bile flow and prevent liver disease
Bile-salt binders to decrease diarrhoea
Anti-secretin agents to reduce gastric acid in the intestine
Hypomotility agents to increase the time it takes food to travel through the intestines, leading to increased nutrient absorption
Growth hormones to improve intestinal absorption
Teduglutide to improve intestinal absorption
The aim of surgery is to increase the small intestine's ability to absorb nutrients. Approximately half of the patients with short bowel syndrome need surgery to prevent blockage and preserve the length of the small intestine. To remove any Narrowing, dilated segment of the small intestine that may have occurred. Two of the following procedures maybe considered.
Bianchi procedure: The surgeon divides the bowel in half and sews one end to the other. The goal is to convert the intestine from one short tube with a large diameter to a longer tube with a smaller diameter. This allows more time for food to travel and be absorbed into the body.
Serial Transverse Enteroplasty Procedure (STEP). The surgeon divides the bowel and staples it in a zigzag pattern. The accordion-like pattern allows food to spend more time in the intestine where it can be absorbed naturally.
The health care provider will recommend treatment for short bowel syndrome based on a patient's nutritional needs.
The prognosis is dependent on the underlying cause, the severity of SBS, the adaptation in the remaining bowel, the nature of any comorbidities and the effectiveness of management provided. Scientists have not yet found a way to prevent short bowel syndrome that is present at birth, as its cause is unknown.
It is possible for the intestines to adapt however this is not certain for all individuals with short bowel syndrome. The process is call Intestinal adaptation this usually occurs in children after removal of a large portion of their small intestine. The remaining small intestine goes through a period of adaptation and grows to increase its ability to absorb nutrients. Intestinal adaptation can take up to 2 years to occur, and during this time a person may be heavily dependent on parenteral or enteral nutrition.
Head over to our Video Channel to view a short clip on Short Bowel Syndrome created by Osmosis.org
References & Resources
BruceBlaus (2017) An illustration of the digestive system in an adult [Online]. Available at https://commons.wikimedia.org/wiki/File:Adult_Digestive_System.png (Accessed 9 September 2018)
BruceBlaus (2013) The Colon [Online]. Available at https://commons.wikimedia.org/wiki/File:Blausen_0603_LargeIntestine_Anatomy.png (Accessed 9 September 2018)
BruceBlaus (2013) Small Intestine [Online]. Available at https://commons.wikimedia.org/wiki/File:Blausen_0817_SmallIntestine_Anatomy.png (Accessed 9 September 2018)
National Institute of Diabetes and Digestive and Kidney Disease (2015) Short Bowel Syndrome [Online]. Available at https://www.niddk.nih.gov/health-information/digestive-diseases/short-bowel-syndrome (Accessed 9 September 2018)
Tidy,C. (2015) Short Bowel Syndrome [Online]. Available at https://patient.info/doctor/short-bowel-syndrome (Accessed 9 September 2018)
Royal Manchester Children's Hospital (n.d) Short Bowel Syndrome (Online). Available at http://www.cmft.nhs.uk/childrens-hospitals/our-services/intestinal-failure/short-bowel-syndrome (Accessed 9 September 2018)
DK (2016) ‘In and Out’ in DK. (ed) How The Body Works, London, Dorling Kindersley Limited, pp. 140-142.
Useful Online Support:
Short Bowel Syndrome Foundation Families Group (Support Group)