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Short Bowel Syndrome: Symptoms, Causes, & Treatments

Key Takeaways

  • Short bowel syndrome is where a portion of the bowel is physically absent, or there are problems with how the intestine functions. The most common cause is surgical removal of the small bowel.

  • Common symptoms of short bowel syndrome include diarrhea, dehydration, heartburn, bloating, gas, fatigue, lack of energy, weight loss, and sensitivity to new foods. It can also increase the risk of gallbladder disease.

  • There is no cure for short bowel syndrome, but symptoms can be alleviated with oral rehydration solutions, dietary changes, supplements, medications, intravenous nutrition, a feeding tube, or surgery. 

Short bowel syndrome, also called short gut syndrome, is a complex condition of the digestive system. It refers to a group of problems that occur when there is a physical or functional loss of the bowel (small intestine and/or large intestine) by a decrease in the absorption surface area. Please continue reading to learn more about this digestive tract condition, including the causes, symptoms, and treatment options for short bowel syndrome.

What is short bowel syndrome?

The small intestine is a long, tubular structure that measures approximately 600 centimeters (cm), equivalent to 235 inches or 15-20 feet, in healthy individuals. It extends from the stomach to the colon (large intestine). The large intestine is approximately 150 cm (60 inches or 5 feet) long in healthy people.

Short bowel syndrome is a condition in which a portion of the bowel (small intestine or large intestine) is physically absent, or there are problems with how the intestine functions. 

People with short bowel syndrome are unable to absorb nutrients (proteins, carbohydrates, fats, vitamins, minerals) and fluids from the gut due to a reduction in the intestinal absorptive surface area. 

Reduced intestinal absorption can result in intestinal failure, leading to unintended weight loss, malnutrition, electrolyte abnormalities, and other medical problems related to nutritional deficiencies. 

People with severe short bowel syndrome, for example, due to massive small bowel resection for Crohn’s disease, can develop severe, life-threatening complications. 

What causes short bowel syndrome?

The most common cause of short bowel syndrome is resection (surgical removal) of the small bowel. Bowel surgery may be necessary to treat gastrointestinal (GI) tract conditions such as inflammatory bowel disease (Crohn’s disease), traumatic injury, malignancies, mesenteric ischemia (reduced blood flow to the small intestine due to a blocked blood vessel), necrotizing enterocolitis (inflammation of the intestine in newborns), intussusception (a condition in which the intestine folds on itself), fistulas (abnormal passages), and congenital digestive tract anomalies. 

Necrotizing enterocolitis limits blood flow to the intestinal lining, leading to dead tissues that need to be removed by surgery.

Most people have acquired short bowel syndrome due to the removal of the small and large intestines. 

Radiation enteritis (inflammation and damage to the intestines following radiation therapy) is an example of short bowel syndrome from loss of intestinal function. 

Very rarely, infants are born with the small intestine missing (this is called congenital short bowel syndrome). 

What are the symptoms of short bowel syndrome?

The symptoms of short bowel syndrome can vary greatly from person to person, depending on the severity of the condition and the part of the intestine that is missing or non-functional. This is because specific parts of the intestine are responsible for the absorption of specific nutrients. 

Common symptoms of short bowel syndrome include diarrhea, dehydration, heartburn, bloating, gas, fatigue, lack of energy, weight loss, and sensitivity to new foods. In addition, nutritional deficiencies associated with short bowel syndrome can cause a wide range of symptoms. 

Having short bowel syndrome can increase the risk of other health conditions, such as gallbladder disease. It can affect normal growth and development in children.

How is short bowel syndrome diagnosed?

Health care providers can diagnose short bowel syndrome based on the medical history of an underlying disease, physical exam, blood tests, stool tests, and imaging studies of the GI tract, such as X-ray, ultrasound, CT scan, and MRI scan. 

Additional tests, such as an upper and lower endoscopy, may be done to assess the health of the remaining intestine.

What is intestinal adaptation in short bowel syndrome?

Intestinal adaptation is the process by which the remaining bowel is stimulated to function better and absorb more nutrients. Treatments such as enteral nutrition (using a feeding tube) can help this process. 

Medications can be used to stimulate intestinal adaptation or control factors that slow this process. Intestinal adaptation can take anywhere from 6 months to 2-3 years.

Can short bowel syndrome be fixed?

There is no cure for short bowel syndrome. However, symptoms can be managed with medications, nutrition support, and surgery. 

Treatment for short bowel syndrome depends on a number of factors, including the specific symptoms a person is experiencing, the portion of the small intestine that is affected, the presence or absence of colon involvement, a person’s age and overall health status, tolerance to certain medical procedures and medications, and personal preferences.

Given these varying factors, the treatment plan for short bowel syndrome is highly individualized. The goal is to ensure the individual gets enough nutrients. 

Treatment may include oral rehydration solutions, dietary adjustments, supplements, medications, intravenous nutrition called parenteral nutrition, enteral feeding (nutrition delivered directly to the gut with a feeding tube), and/or surgery.

Learn about different tips to help you heal your gut.

What medications are prescribed to people with short bowel syndrome?

The U.S. Food and Drug Administration (FDA) approved teduglutide (Gattex) for adults with short bowel syndrome. Teduglutide is a form of glucagon-like peptide-2 (GLP-2) analog and promotes the amount of nutrients absorbed by the intestines. 

Another drug called somatropin (Zorbtive), a human growth hormone, has also been approved by the FDA for use in people with short bowel syndrome who received specialized nutritional support such as total parenteral nutrition (TPN). Somatropin lessens the need for TPN by improving the ability of the small intestine to absorb nutrients.

Other medications that a healthcare provider may prescribe to people with short bowel syndrome include:

  • Antidiarrheals such as loperamide, diphenoxylate, and codeine. Read our blog to find out the best antidiarrheal medicine.

  • H2 blockers (famotidine) and proton pump inhibitors (omeprazole, lansoprazole) to reduce stomach acid. Learn how to compare proton pump inhibitors.

  • Antibiotics for people with short bowel syndrome who develop small intestinal bacterial overgrowth (SIBO). SIBO develops due to a slowed intestinal transit time, which allows bacteria to breed. It is common in people with short bowel syndrome.

  • In severe cases of short bowel syndrome, a somatostatin analogue called octreotide may be used to reduce diarrhea. However, it can prevent adaptation of the small intestine by preventing the release of certain vital hormones.

  • Pancreatic enzyme replacement therapy, for example, pancrelipase and bile-acid resins like cholestyramine

  • Dietary supplements or medications to correct electrolyte imbalance and vitamin deficiencies, for example, vitamin D deficiency.

  • Probiotics to increase the number of beneficial bacteria in the gut.

Note: People with severe short bowel syndrome may have reduced absorption of medications along with reduced nutrient absorption. They may need to take higher doses of medications or use different delivery systems, such as nasal sprays or skin patches.

What surgeries are done to treat short bowel syndrome?

Surgery is usually the last resort for short bowel syndrome. It is recommended when other treatment options do not work. Surgical options for short bowel syndrome include both transplant and non-transplant procedures, such as:

  • Artificially lengthening the intestines with the Bianchi procedure or STEP procedure. The former involves using a portion of a dilated bowel. The latter involves surgically creating a zig-zag pattern in the small intestine, making it narrower but longer. 

  • Stricturoplasty to widen a narrowed area of the small bowel. 

  • Intestinal tapering to surgically narrow abnormally dilated portions of the small bowel. This is done to prevent the pooling of fluid and bacterial overgrowth. 

  • Procedures to re-establish continuity between the small bowel and colon.

  • Intestinal transplantation in individuals who have complications due to TPN. This involves removing and replacing a portion of the diseased small bowel with an intestine from a healthy donor. 

  • Liver transplant for people who develop liver disease or liver failure.

What is the survival rate for short-bowel syndrome?

The 4-year survival rate for people with short bowel syndrome who are on TPN is approximately 70%. The most common cause of death is liver failure.

What foods should you avoid with short bowel syndrome?

Dietary modifications for people with short bowel syndrome include:

  • Eat 6-8 small meals a day rather than 2-3 large meals.

  • Eat slowly and chew your food well.

  • Stay well hydrated and drink at least 8 glasses of water a day. 

  • Drink liquids between meals and limit fluid intake to 1/2 cup (4 ounces) during meals.

  • Avoid very hot or very cold drinks.

  • Eat high-protein foods like fish, poultry, meat, tofu, dairy, and nut butters.

  • Eat complex carbohydrates like white rice, pasta, cereals, and bread.

  • Eat a moderate amount of healthy fats.

  • Limit the intake of sugary foods like cakes, cookies, candy, and syrups. 

  • Limit the intake of high-oxalate foods like tea, coffee, chocolate, colas, nuts, soy products, leafy green vegetables, beans, celery, sweet potatoes, beetroot, kiwi, berries, wheatgerm, wheat bran, and whole wheat flour.

Note: These are general dietary guidelines for short bowel syndrome. Your doctor will give you more specific instructions on foods to eat and foods to avoid if you have short bowel syndrome.

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  2. https://www.cedars-sinai.org/health-library/diseases-and-conditions/s/short-bowel-syndrome-in-adults.html

  3. https://my.clevelandclinic.org/health/diseases/14725-short-bowel-syndrome-in-children

  4. https://pubmed.ncbi.nlm.nih.gov/27086889/#

  5. https://emedicine.medscape.com/article/193391-overview#a2

  6. https://www.mskcc.org/cancer-care/patient-education/nutrition-guidelines-patients-short-bowel-syndrome