Treatment of short bowel syndrome is based on replacement of fluids, nutrients, minerals, vitamins, and calories. Depending on the phase and severity of the disease, this may be done by infusion (parenteral), gavage (enteral), or nutritional supplements (oral).
Short bowel syndrome: parenteral nutrition through catheters.
Parenteral nutrition usually requires a central venous catheter – for example, a port or a so-called Hickman catheter – which usually carries some risk of infection. Therefore, parenteral nutrition should be given for as long as necessary but as short a time as possible, especially since enteral nutrition can promote the intestinal adaptation process.
Drug therapy as an adjunct
In addition to replacing dietary components, various medications can help improve symptoms in short bowel syndrome:
- Agents such as loperamide or N-butylscopolamine inhibit intestinal motility, leading to a prolonged retention of food in the intestine, which can reduce diarrhea.
- Proton pump inhibitors – for example, pantoprazole or omeprazole – inhibit increased secretion of gastric acid. Alternatively or complementary H2-blockers such as ranitidine can be used.
- The active ingredient colestyramine binds bile acids in the intestine, which can help relieve bile acid-induced diarrhea.
- The artificial hormone teduglutide promotes absorption of nutrients in the intestine, which may reduce the need for nutritional infusions. However, side effects such as abdominal pain, nausea and bloating may occur during treatment. Teduglutide is not available as a tablet, but must be injected daily into the subcutaneous fat.
Life expectancy varies
It is difficult to give a universal prognosis for patients with short bowel syndrome, because life expectancy depends on several factors: First, the underlying disease for which the bowel had to be removed plays a role. On the other hand, the prognosis depends on which parts of the small intestine were removed and how long the remaining intestine is. A residual intestine length of less than one meter is considered critical – in this case, lifelong parenteral nutrition is usually necessary. In addition, the patient’s age, general condition and concomitant diseases as well as any complications that may occur influence the prognosis. In general, however, it can be said that the optimization of parenteral nutrition therapy has significantly increased the life expectancy of patients with short bowel syndrome in recent years.
Phases of short bowel syndrome
The course of short bowel syndrome is divided into three phases, which usually merge smoothly:
- Hypersecretion phase: the first phase usually begins shortly after surgery and usually lasts up to two months. During this time, there is severe fluid loss and a stool volume of more than two and a half liters, which is why artificial feeding through a catheter is usually necessary.
- Adaptation phase: within one to two years, the intestine can adapt to the new requirements. Often, the complaints then improve and it can be started with a food build-up – if necessary by means of a stomach tube.
- Stabilization phase: after completion of the adaptation can usually slowly switch to a natural food intake.
Diet tips for short bowel syndrome
Depending on the course of the disease, many treatment plans include a gradual switch to a natural food intake from the adaptation phase or in the stabilization phase. We have compiled tips for you on what to look for in your diet then:
- Take six to eight small meals a day to not overload the intestine and to achieve the best possible nutrient absorption.
- Do not drink during meals, but keep at least 30 minutes between eating and liquid intake – because liquid accelerates the passage of food mash in the intestine.
- Initially, avoid high-fiber foods such as fibrous vegetables, legumes and raw vegetables and slowly increase the fiber content of the food.
- Dilute fruit juices with water in a ratio of 3:1 and avoid sugary soft drinks, because the sugar “pulls” water inside the intestine, which can lead to diarrhea.
- Initially, do without lactose and test after a few weeks, what quantities you can tolerate.
Based on your symptoms and blood values, your doctor will decide whether you need additional supplements to replace vitamins, trace elements or other nutrients.
Intestinal transplantation for severe complications
For patients who are steadily losing weight despite continuous parenteral nutrition, intestinal transplantation may be considered as a last treatment option. Transplantation may also be considered if complications such as sepsis, liver damage, severe metabolic abnormalities, or frequent catheter infections occur. Depending on the patient’s concomitant diseases, only the small intestine or other organs such as the liver, stomach or pancreas can be transplanted at the same time. However, intestinal transplantation is associated with major risks, including the need for suppression of the immune system (immunosuppression).
