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Short Bowel Syndrome

Introduction

Short Bowel Syndrome, also known as the short gut syndrome, is a condition in which the intestines cannot absorb nutrients and fluids to meet the body’s daily requirements. It applies to a situation in which small or large intestines become physically shorter due to a surgery or functionally shorter if the portion is non-functional, from sickness, damage, or an illness. The inability of the bowel to absorb fluids, electrolytes, and nutrients in adequate amounts to meet the caloric need causes malnutrition in the body. People with short gut syndrome frequently experience decreased absorption capacity of major and minor nutrients like fluid, carbohydrates, proteins, fat, essential minerals, and vitamins.

Causes

The Cause of this condition may include Crohn’s disease, vascular problems, congenital disabilities, premature births, cancer treatments involving radiations, and surgical removal of a part of the small intestine due to some intestinal disease. Other possible causes may include damage to the intestine due to:

  • Injury ( trauma)
  • Blocking or Narrowing of the intestine
  • Certain Tumors
  • Irregular Blood flow due to blood clots
  • Volvulus ( twisting of the intestine)

Risk Factors

Having conditions such as Crohn's disease that need to be treated by taking part of your small intestine raises your risk of short bowel syndrome. Short bowel syndrome is an uncommon disease, and the epidemiology is still unclear and not fully known. A study conducted in 2020 showed that 53,040 people were hospitalized in the USA. Short bowel syndrome hospitalization was increased 55% between the years 2005-2014. The hospital mortality rate decreased from 40 to 29 in 1000 patients, an overall reduction of 27%.

Signs and Symptoms

The signs and symptoms differ from person to person and mainly depends upon which portion is not functioning normally and often include:

  • Diarrhea is the most common symptom as food is moving too quickly without being absorbed
  • Food intolerances due to the absence of enzymes
  • Dehydration
  • Weight loss
  • Vomiting
  • Loss of appetite
  • Fatigue and weakness
  • Malnutrition
  • Swelling in lower extremities
  • Bloating and gas
  • Steatorrhea (excess fat in stool).

Diagnosis

A detailed patient history, a thorough clinical evaluation, and a variety of specialist tests, including laboratory tests and X-ray scans, are used to diagnose small bowel syndrome.

Basic Blood Tests such as CBC, Albumin, liver enzymes, creatinine, and electrolytes.

Stool Tests: These can tell if you are absorbing enough fat.

X-ray or CT Scan of your Abdomen - This is performed to look for signs of obstruction.

Endoscopy - This test is done to look at your esophagus, stomach, and intestine

Colonoscopy - This test is done to look at your colon (part of the intestine)

Treatment

There is no treatment, but the illness typically can be managed effectively with proper nutritional therapy showing promising results. Therapeutic intervention includes:

  • TPN (Total Parental Nutrition)
  • Nutritional Therapy
  • Enteral Feeding
  • Oral Rehydration Methods
  • Supplementation and Medications.

In some extreme cases, surgical procedure is necessary. In recent studies, incorporating intestinal rehabilitation therapy (IRT), the use of recombinant human growth hormone (r-hGH) along with modified diet and glutamine hormone have shown positive outcomes. This cost-effective recovery method enhances bowel functioning in severe and critical patients, reducing their mobility and giving them hope for a better living.

Medications

  • H2 Blockers or Proton Pump Inhibitors to decrease stomach acid - Examples of such drugs include famotidine, ranitidine, omeprazole, and lansoprazole.
  • Human growth hormones such as Somatropin and Zorbtive have been approved by the Food and Drug Administration (FDA).
  • Antidiarrhoeal Medicines to treat diarrhea such as diphenoxylate, loperamide and, codeine.
  • Some people with short bowel syndrome may benefit from pancreatic enzyme replacement therapy, such as pancrelipase, and bile-acid resins, such as cholestyramine.
  • Extra nutritional supplements
  • Electrolyte solutions. You may take these by mouth (orally) or through an IV (intravenous line).

Procedures

Doctors may recommend surgery for children and adults with short bowel syndrome.  Surgical options for small bowel syndrome are sometimes divided into non-transplant and transplant surgeries. These include procedures to slow the passage of nutrients through the intestine or a system to lengthen the intestine (autologous gastrointestinal reconstruction) and small bowel transplantation (SBT).

Medications

  • Meals should be small and frequent. It's easier to meet a person's caloric and nutrient needs if they eat five to six small meals per day.
  • Instead of drinking with meals, drink between them. Drinking with meals can lengthen transit time and cause diarrhea and appetite by making them feel full.
  • Low in simple sugars, high in protein. Simple sugars, such as juices or sweet foods, can contribute to diarrhea, whereas protein tends to prolong the transit time of food.
  • Low-fat diet (especially for people experiencing steatorrhea or missing their terminal ileum). Supplements of vitamins A, D, E, and K are also indicated if fat malabsorption is present.
  • Low oxalate diet (for people missing their terminal ileum). Strawberry, spinach, rhubarb, chocolate, beets, tea, almonds, and wheat bran are high in oxalate.
  • Foods that can help with diarrhea are also suggested. Bananas, oats, rice, tapioca, applesauce, and yogurt are a few examples.
  • Supplements for magnesium, calcium, and iron (if the duodenum has been removed); vitamin B12 (if terminal ileum removed).