Alternative Names short bowel malabsorption syndrome
Definition Short bowel syndrome is a condition caused by surgery that removes part of the small intestine, such as an ileostomy.
What is going on in the body? The small bowel carries food from the stomach to the large bowel, which attaches to the rectum and anus. It plays an important role in digestion. Vitamins, minerals, salts, and important fats are absorbed through the small bowel.
Removal of part of the small bowel decreases the area to absorb these nutrients. Many people can tolerate removal of up to 50% to 60% of the small bowel without having problems. However, when more than this amount or a key part of small bowel is removed, symptoms often occur. These symptoms make up what is called the short bowel syndrome.
What are the signs and symptoms of the condition? The main symptoms of this condition are abdominal pain, or distress, and diarrhoea. Malabsorption, or poor absoption, of important nutrients may lead to weight loss, low blood counts including anaemia, and vitamin deficiencies.
What are the causes and risks of the condition? The cause of this condition is removal of too much of the small bowel. Common reasons for surgery to remove part of the small bowel include:
treatment for a condition called Crohn's disease, which causes severe bowel inflammation for unknown reasons
bowel bypass surgery, usually done to help people with severe obesity lose weight
removal of dead bowel, which usually occurs due to poor blood supply
removal of areas of small bowel damaged by radiation therapy, which is commonly used to treat cancer. The damage to the bowel is known as radiation enteritis.
What can be done to prevent the condition? People who have not had small bowel surgery are not at risk for this condition. Surgeons try to remove as little bowel as possible when doing surgery to prevent this condition.
How is the condition diagnosed? Short bowel syndrome is suspected if the characteristic symptoms occur in a person who has had small bowel surgery. If diarrhoea, Malabsorption, or weight loss occur for long periods of time, the diagnosis can usually be made. There is no single test that confirms the diagnosis.
What are the long-term effects of the condition? Short bowel syndrome can lead to weight loss, chronic diarrhoea, and vitamin and mineral deficiencies due to malabsorption. Such deficiencies may include vitamin B12, folate, iron, Calcium, zinc, and magnesium. This can cause problems throughout the body, such as anaemia, skin rashes, and abnormal sensations in the legs.
An individual with short bowel syndrome is also more likely to develop kidney stones and gallstones.
What are the risks to others? Short bowel syndrome is not contagious and poses no risks to others.
What are the treatments for the condition? Diet is the primary treatment for short bowel syndrome. A person must take in at least 10,000 kilojoules per day through a diet containing mostly complex carbohydrates and protein. A low-fat diet helps reduce diarrhoea. Some medications, such as loperamide, also help control the diarrhoea.
Vitamin and mineral supplements are often needed, especially vitamin B12 and folate. calcium and iron supplements may be needed. A bile salt-binding medication, such as cholestyramine, is often given to help control symptoms.
Some people with this condition produce too much stomach acid. This can further decrease digestion. Medications such as omeprazole or ranitidine can be used to help reduce the amount of stomach acid.
Other medications and supplements may also be needed in some cases. Some people need what is called total parenteral nutrition, or hyperalimentation. This is a procedure in which kilojoules and needed nutrients, including protein and fat, are given through an intravenous line, or IV. A small bowel transplant is now used in some severe cases.
What are the side effects of the treatments? Most of the dietary changes used to treat this condition have no specific side effects.
The most common side effects of the medications used to reduce stomach acid include:
Other medications also have possible side effects, which depend on the specific medication used.
The use of an intravenous line to deliver nutrition may cause infection and bleeding. Giving nutritional support through an intravenous line over a long period time increases the risk of death due to liver disease. Severe infection of the blood from an intravenous line contaminated by bacteria may also occur.
What happens after treatment for the condition? Most individuals with short bowel syndrome need lifelong treatment.
How is the condition monitored? There is no specific laboratory test to monitor short bowel syndrome. Any new or worsening symptoms should be reported to the doctor.
Author: Minot Cleveland, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
