The term short bowel syndrome refers to the effects of losing larger sections of the small intestine. Particularly distressing for affected individuals are usually symptoms such as severe diarrhea and weight loss. Usually, treatment of short bowel syndrome requires artificial feeding, at least temporarily – but after a few months, a gradual switch to a natural diet can be made in many cases.
Causes: surgery and radiation
Short bowel syndrome usually occurs when large parts of the small bowel have to be removed during one or more operations (structural short bowel syndrome). For example, this may be necessary for the following conditions:
- Crohn’s disease
- Necrotizing enterocolitis
- Tumors of the intestine or adjacent organs.
- Deficiency of blood supply to the intestine – for example, due to thrombosis or narrowing of a vessel.
A so-called functional short bowel syndrome, on the other hand, occurs when sections of the small intestine are damaged to such an extent that they lose their function – for example, due to radiation therapy.
Decreased nutrient absorption as a result
The loss of sections of the small intestine has several consequences: First, depending on the affected section, there is decreased absorption of nutrients and minerals such as calcium, magnesium, iron, folic acid, and vitamin B12 and fat-soluble vitamins.
For another, increased bile acids are secreted, which can lead to gallstones and impairs fat digestion.
Loss of water and salts
In addition, the residence time of the food pulp in the intestine is shorter – as a result, not enough water is absorbed and frequent and liquid bowel movements occur. Especially if parts of the colon also had to be removed, the increased excretion of water and salts can lead to severe diarrhea.
In most cases, fluids and minerals (such as potassium and sodium) must then be supplied in the form of infusions to prevent dehydration and disturbances in mineral balance.
Versatile symptoms of short bowel syndrome
Small bowel losses of up to 50 percent of length are usually well compensated. In most cases, symptoms do not appear until more than half of the small intestine has been removed. Then, short bowel syndrome may manifest itself with the following symptoms:
- Diarrhea
- Greasy stools (steatorrhea)
- Weight loss
- Anemia or increased bleeding tendency (hemorrhagic diathesis).
- Gallstones or kidney stones
- Bone diseases such as osteoporosis
- Muscle cramps
- Listlessness and fatigue
In addition, there may be a deficiency of the lactose-splitting enzyme lactase and, as a result, lactose intolerance, which can lead to cramping pain and diarrhea after consuming dairy products.
Short bowel syndrome in children
In newborns, congenital malformations (atresias) of the intestine are often the cause of short bowel syndrome. In addition, intestinal torsion (volvolus) or so-called necrotizing enterocolitis – an inflammatory bowel disease – may require removal of large bowel segments in infants or young children.
The prognosis of children with short bowel syndrome is often good because the child’s intestine has considerable adaptive capacity. However, individually adapted nutritional therapy is particularly important, because malnutrition can lead to failure to thrive: Affected children are then clearly too light and too small for their age.
