Short Bowel Syndrome
You can also view Dr. Buchman's review of Short Bowel Syndrome and Intestinal Failure, published by the American Gastroenterological Association, by clicking here. (requires adobe acrobat reader)
Definition:
Short bowel syndrome is condition of nutritional malabsorption related to the surgical removal or disease of a significant portion of the small intestine.
Alternative Names:
Small intestine insufficiency
Causes, incidence, and risk factors:
When areas of the small intestine are removed surgically, there may not be enough surface area left in the remaining bowel to adequately absorb nutrients from food.
This condition is particularly likely to develop when one-half or more of the bowel is removed during surgery. Risk factors include diseases of the small intestine that may require surgical intervention such as Crohn's disease or trauma, a twist in the intestine that cuts off the blood supply (volvulus), or blood clot or embolism in the artery that supplies the small intestine or the vein that drains it.. Necrotizing enterocolitis is a common cause of this syndrome in infants. Short bowel syndrome can also be a congenital problem.
Symptoms:
Treatment of Short Bowel Syndrome and Intestinal Failure
We are one of the few centers in the world that offers a comprehensive program aimed at medical, psychological, non-transplant surgical, and transplant surgical management of short bowel syndrome and intestinal failure. It is important to recognize that not all patients with short bowel syndrome have intestinal failure (require specialized intravenous nutrition or fluid/electrolyte support), and still other patients may not have short bowel syndrome, but may have intestinal failure (radiation enteritis, various malabsorptive disorders including refractory sprue for example, or motility disorders such as pseuoobstruction).
Our philosophy for the management of patients with short bowel syndrome is to first and foremost, improve your quality of life. That may require medication adjustments, IV fluid or parenteral nutrition adjustments, nutritional supplements, dietary intervention, addressing psychological, stress, and sleep issues, or surgical issues (including treatment of fistulas, obstructions, or nonfunctional intestine). Our goal is to improve your nutrient and fluid absorption, and to reduce or hopefully in some cases, eliminate your PN and remove your central venous catheter. This may involve a regimen of anti-diarrheal medications that include diphenoxylate, loperamide, tincture of opium, codeine, clonidine, and/or octreotide. We may consider you for treatment with growth hormone, as well as investigational growth factors. You diet may be adjusted to include more complex carbohydrates and soluble fiber, and in some cases, restricted to avoid too much oxalate. You will be taught the concept of oral rehydration solutions and instructed in their use. You will be instructed how to monitor your hydration status and how to help your clinicians wean your PN. You will be taught appropriate care of your catheter to prevent infections. We will develop a comprehensive strategy to taper your PN gradually using all medical means available. You will be evaluated for intestinal tapering procedures if you are found to have one or more dilated segments of your intestine that are not functioning as they should.
We believe all of these options should be maximized prior to consideration of intestinal transplantation. However, some patients may require more immediate evaluation for transplantation. Options for transplantation include isolated intestinal transplantation (the best survival), as well as combined intestine-liver transplantation in those who have developed significant and irreversible liver disease, and multivisceral transplantation (preferred for very specific circumstances where additional organs are required).
We refer the interested patient or clinician to a technical review and position paper written by Northwestern clinicians and others, for the American Gastroenterological Association for a more indebt review of the medical and surgical management of short bowel syndrome and intestinal failure. Please also see the following review references:
Signs and tests:
Expectations (prognosis):
The bowel adapts over time by increasing in length slighlty, but more importantly increasing in diameter, which leads to increased surface area. Absorption can be improved by changing the diet, slowing intestinal transit, and other medical therapies, including the use of investigational medications. Surgery to re-anastomose the colon to the remaining small intestine, to taper abnormally dilated segments of intestine, or intestinal transplantation may all improve absorption and decrease the need for TPN.
Complications:
Calling your health care provider:
Call for an appointment with your health care provider if symptoms suggestive of short bowel syndrome develop, particularly if you have recently had bowel surgery.