Short bowel syndrome
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Short bowel syndrome is a malabsorption disorder caused by either the surgical removal of the small intestine or the loss of its absorptive function due to diseases.
In healthy adults, the small intestine has an average length of approximately 6 meters (20 feet). Short bowel syndrome usually appears when there is less than 1.8 meters (6 feet) of the small intestine left to absorb sufficient nutrients.
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Symptoms
The symptoms of short bowel syndrome include:
- Abdominal pain
- Diarrhea
- Steatorrhea or particularly foul-odored feces
- Oily or sticky stool
- Fluid retention
- Weight loss and malnutrition
- Fatigue
Patients with short bowel syndrome may have complications caused by malabsorption of vitamins and mineral, such as deficiencies in vitamin A, E, D, and B12, calcium, magnesium, iron, folic acid, and zinc. These may appear as anemia, scaling of the skin or hyperkeratosis, easy bruising, muscle spasm, and bone pain.
Causes
Short bowel syndrome in adults is usually caused by:
- Crohn's disease, an inflammatory disorder of the digestive tract
- Volvulus, a spontaneous twisting of the small intestine that cuts off the blood supply and leads to necrosis or tissue death.
- Small intestine cancer
- Injury or trauma to the small intestine
- Bowel bypass surgery to treat obesity, now a rarely performed surgical procedure to remove a portion of the small intestine.
- Surgery to remove diseases or damaged portion of the small intestine.
This condition can also develop in premature infants who has necrotizing enterocolitis, a serious disease where dead tissues in the lining of the small intestine needs to be surgically removed.
Treatments
Symptoms of short bowel syndrome are usually addressed by prescription medicine. These include:
- Anti-diarrheal medicine
- Vitamin and mineral supplements
- H2 blocker and proton pump inhibitors to reduce stomach acid
- Lactase supplement
- Surgery, including intestinal lengthening, tapering, and organ transplant.
Newborn infants may require parenteral nutrition (or nutrition administered via intravenous line).
Intestinal Adaptation
Short bowel syndrome caused by the surgical removal of a portion of the bowel may be a temporary condition, due to the remarkable adaptive property of the small intestine.
In a process called intestinal adaptation, physiological changes to the remaining portion of the small intestine occur to increase its absorptive capacity. These changes include:
- Enlargement and lenghtening of the villi found in the lining
- Increase in the diameter of the small intestine
- Slow down in peristalsis or movement of food through the small intestine
Prognosis
There is no cure for short bowel syndrome. In newborn infants, the 4-year survival rate on parenteral nutrition is approximately 70%.
Although promising, small intestine transplant has a mixed success rate, with postoperative mortality rate of up to 30%. One-year and 4-year survival rate are 90% and 60%, respectively.
