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Short bowel syndrome, also known as short gut syndrome, is a condition characterized by the body not absorbing enough fluids and nutrients due to a missing or not functioning part of the small intestine. This condition can be life-threatening if untreated.
The small intestine is a part of the digestive system that absorbs fluids, proteins, carbohydrates, fats, vitamins, and minerals from food. If the small intestine changes or is damaged, it can affect how well the body absorbs these essential nutrients. With short bowel syndrome, parts of the small intestine are surgically removed due to medical conditions, or babies are born with a short or damaged small intestine that needs surgical removal.
Short bowel syndrome can be either a lifelong or short-term condition for a child. Treatment usually includes special diets, nutritional supplements, and sometimes parenteral nutrition, where nutrients are delivered through a vein to prevent malnutrition. In some cases, surgery may also be considered.
Symptoms
In infants and children, the most common symptoms of short bowel syndrome are loose, watery stool or diarrhea. Other common symptoms include:
- Poor growth and malnutrition
- Fatigue
- Loss of weight
- Bloating
- Excessive gas
- Foul-smelling, greasy stools
- Edema, or swelling, in the feet and legs
Causes
Short bowel syndrome is caused by having a short, small intestine, which affects the body’s ability to break down and absorb food. There are two main factors that results to this:
- Small intestine growth abnormalities at birth: Some children are born with missing or damaged sections, or incomplete formation of the small intestine.
- Surgery: Short bowel syndrome can be a side effect of surgery that removed part of the small intestine to treat another condition. , such as Crohn’s disease, cancer, injuries, or blood clots.
Diagnosis
The diagnosis of short bowel syndrome involves asking one’s medical and family history, conducting an exam, and performing tests to understand their symptoms and causes.
Tests that may be required include:
- Blood tests: This can check for nutrient levels, specifically blood counts, chemistry, and vitamin levels.
- Fecal fat test.
- Imaging tests: X-rays with a contrast material, known as barium X-rays, CT scans, MRI scans, and CT or MRI enterography, can reveal blockages or changes in the intestines.
Treatment
The treatment approach for short bowel syndrome in children focuses on ensuring they get essential nutrients and easing symptoms. It commonly includes modifying their diet, using medication, and occasionally opting for surgery. Treatment decisions depend on the child’s preferences, the specific parts of the small intestine affected, and whether the colon is intact.
Treatment options include:
- Nutritional therapy: Adjusting the child’s diet and closely monitoring their nutrition is key in treating short bowel syndrome. Dietary changes may include smaller, frequent meals with a focus on high-calorie foods rich in essential nutrients while avoiding certain fats, sugars, and fibers. They must adhere to a certain diet and consume dietary supplements.
In more severe cases, enteral nutrition may be necessary, where nutrients are provided through a tube directly into the stomach or small intestine, either through surgery or inserted nasally. Another option is total parenteral nutrition (TPN), where nutrients are delivered directly into the bloodstream through a special catheter, bypassing the digestive system.
- Medicines: Antibiotics may be used in cycles to prevent excessive growth of bacteria in the small intestine, while proton pump inhibitors and H2 blockers can reduce stomach acid. Bile-salt binders are prescribed to alleviate diarrhea, and growth hormones may be given to enhance nutrient absorption. Hypomotility agents are also used to slow down the movement of food through the intestines. These medications may be prescribed in addition to dietary support.
- Surgery: Surgery can offer several benefits for your child, including increasing the length of their small intestine, decreasing the likelihood of bacterial overgrowth by narrowing the diameter of the intestine, preventing intestinal blockages, slowing down the speed of food breakdown in their intestine, and facilitating the insertion of a feeding tube. Small bowel transplantation (SBT) may also be considered as an option.
Every treatment for short bowel syndrome comes with its potential side effects. Surgery, for instance, may result in post-operative infections. While total parenteral nutrition (TPN) is generally deemed safe, it demands meticulous care and close supervision to avert complications like liver disease.
