Short bowel syndrome
What is it?
Short Bowel Syndrome is a malabsorption disorder caused by a lack of functional small intestine which leads to poor absorption of nutrients i.e. malnutrition.
It is a rare disorder as there are approximately 3-4 million cases recorded per year in India and around 3 people in a million are affected worldwide.
- Bloating (gas)
- Heartburn (burning pain in the chest caused by stomach acid entering the throat i.e. acid reflux)
- Feeling tired and lethargic
- Steatorrhea (Foul smelling oily and bulky stool)
- Diarrhea which caused dehydration and weight loss
- Abdominal pain and cramps
- Dark colored urine
How does it happen?
It is caused by malabsorption by villi present in the small intestine which results in severe deficiencies i.e. malnutrition.
Complications associated with SBS are:
- Peptic ulcers
- Kidney stones
- Malnutrition which may lead to
- Bone pain and osteoporosis
- Poor clotting
- Muscle spasm
- Hyperkeratosis (scaling of skin)
Normal bowel (part or division of intestines, usually large intestine) in adults ranges from 9-26 feet (i.e. 300-800 cm). When 2/3rd or more of it is lost it results in SBS. Also the functional capacity of remaining bowel matters.
How is Short Bowel Syndrome diagnosed?
A health care provider diagnoses short bowel syndrome based on
- a medical and family history
- blood tests
- fecal fat tests
- an x-ray of the small and large intestines
- upper gastrointestinal (GI) series
- CT scan
What are its causes?
Short bowel syndrome is generally seen in persons with significant damage to the small intestine or those who have undergone intestinal surgeries.
Short bowel syndrome may also be a result of poor or movement inside the intestines.
Malabsorption of nutrients depends on which section of the small intestine has been damaged or removed.
SBS may be present by birth as some children may have short small intestine since birth.
Short bowel syndrome may also occur following surgery to treat conditions such as
- damage to the intestines caused by cancer treatment
- Enterocolitis (part of the tissue in the intestines is destroyed).
- Crohn’s disease (inflammation, or swelling, and irritation of any part of the digestive tract).
- Gastroschisis ( intestines stick out of the body through one side of the umbilical cord)
- internal hernia ( small intestine is displaced into pockets in the abdominal lining)
- intestinal atresia (a part of the intestines doesn’t form completely)
- intestinal injury from loss of blood flow due to a blocked blood vessel
- intestinal injury from trauma
- intussusceptions ( one section of either the large or small intestine folds into itself)
- meconium ileus ( meconium, a newborn’s first stool, is thicker and stickier than normal and blocks the ileum)
- midgut volvulus ( blood supply to the middle of the small intestine is completely cut off)
- omphalocele ( the intestines, liver, or other organs stick out through the navel or belly button)
Even if a person does not have surgery, disease or injury can damage the small intestine.
Short bowel syndrome may be categorized as mild, moderate or severe depending on the stages of the condition.
What are the dietary guidelines?
As there is no permanent cure for this, only dietary modifications will help in its management. Also, short bowel syndrome cannot be prevented with diet.
- High protein diet
- Low sugar intake (reduce simple carbohydrates intake and increase complex carbohydrates in diet). Sources of simple sugar include candies, jams, cookies, pies, lollies, etc as the contain sucrose and lactose.
Complex carbohydrate-rich foods are oatmeal, brown rice, multigrain rotis.
- Take liquids between meals e.g. soups like lemon coriander; herbal teas like green tea, matcha
- Take high fiber diet
- Low-fat diet
- Eat small meals in divisions of 6-8 meals per day
- Keep the body hydrated. WHO’s ORS mix is best for this.
- Drink water before eating
- Take nutritional supplements
- Certain medication used in Short bowel management is
- antibiotics to prevent bacterial overgrowth
- H2 blockers and proton pump inhibitors to regulate acid secretion
- choleretic agents to improve bile flow and prevent liver disease
- bile-salt binders to decrease diarrhea
- anti-secretin agents to reduce gastric acid in the intestine
- growth hormones to improve intestinal absorption
- drugs to improve intestinal absorption
While some food items are beneficial in SBS, some will only worsen the condition. Thus, it is advised to avoid certain food items.
Foods to avoid in SBS:
- Packed foods especially those containing sugar-alcohol sweeteners like sorbitol, mannitol. Since they are not absorbed in the gastrointestinal tract and will cause diarrhea.
- Restrict dairy intake as the lactase enzyme is required to digest it.
- Avoid sodas, packed drinks, sports drinks as they contain too many carbohydrates and not enough sodium.
- Avoid very spicy food.
The Diet plays an important role in managing Short Bowel Syndrome and going to a Dietitian can be a great investment in gaining weight and taking care of intestinal and digestive health.