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The small intestine is a part of the digestive system where most of the nutrient absorption occurs. Short bowel syndrome is a condition where there is a loss of structure or function of some part of the small intestine. This loss impairs the absorption of nutrients from the food you eat, resulting in complications like weight loss and malnutrition.
Some children are born with ashort or damaged small intestine causing short bowel syndrome. But in most cases, short bowel syndrome is the result of surgical removal of the small intestine through a procedure calledsmall bowel resection.
The treatment goal for short bowel syndrome is to restore the nutritional balance in the body. This can be done with the help of nutrition support, medicine, or surgery.
Short bowel syndrome is not a very common condition, andreports show that 3 to 4 people per million have this condition. About10,000 to 20,000 people in the United States have short bowel syndrome.
The symptoms of short bowel syndrome vary depending on which portion of the small intestine is lost or non-functional. These often include:
Short bowel syndrome is common in people who undergo small bowel resection, such as people withCrohn’s disease. These people start to experience these symptoms gradually after the surgery.
There are two main causes of short bowel syndrome. These include:
Congenital Causes:Some babies are born with a part of their small intestine missing, damaged, or not formed properly. This leads to the development of short bowel syndrome and its complications, including malnutrition and poor growth in babies. Such congenital abnormalities are rare.
Small Bowel Resection:In adults and older children, short bowel syndrome often occurs after part of the small intestine is surgically removed. This procedure is needed to treat many health conditions, such asCrohn's disease, tumors, or when the part of the small intestine is severely damaged due to accident or trauma.
A doctor can diagnose short bowel syndrome with the help of your medical history, physical examination, laboratory tests, and imaging techniques.
The first step in diagnosing short bowel syndrome is to review the patient's history of intestinal surgeries or congenital conditions related to the bowel. If the patient already had intestinal resection in the past and is complaining of symptoms like chronic diarrhea, weight loss, and fatigue, there is a high chance the patient has short bowel syndrome.
Blood tests can detect nutritional deficiencies and electrolyte imbalances in short bowel syndrome. People with short bowel syndrome tend to have undigested nutrients and excess fat in the stool. Stool tests help check for undigested nutrients orsteatorrhea — excess fat in stools — to diagnose short bowel syndrome.
Imaging tests such as CT scans and X-rays help doctors look at the size and structure of the small intestine.
Reports show that people with short bowel syndrome are at higher risk of developing gallstones. So, an ultrasound test helps detect the presence of any gallstone or biliary sludge, hinting towards the short bowel syndrome.
Additionally, endoscopy can be used to examine the insides of the bowel for any obstruction or damage.
The life expectancy of people with short bowel syndrome varies depending on multiple factors. These include the severity of the condition, complications, and how effective the treatment is.
Treatment options like total parenteral nutrition or TPN and intestinal transplantation for short bowel syndrome can significantlyimprove the survival rate in this condition and help improve quality of life. However, when short bowel syndrome results in complications, the mortality rate is comparatively high.
Studies show that the mortality rate for people with short bowel syndrome and sepsis is 6.7%, withliver dysfunction is 6.2%, and with severe malnutrition is 6.0%.
Thetreatment goal for short bowel syndrome is to maintain a good nutritional status, maximize the absorption from the remaining intestine, and prevent complications.
Here are some treatment options to achieve this goal:
Dietary changes for the treatment of short bowel syndrome is a broad term that involves eating specific diets, changes in eating habits, and taking nutritional supplements. People with short bowel syndrome are advised to eat small, more frequent, and high-calorie meals with sufficient carbohydrates, proteins, and other nutrients to meet the body's demands.
‘Nutrition support’ refers to the use of enteral and parenteral nutrition to improve nutrition outcomes and intake. So, in addition to dietary changes, some people may also needtotal prenatal nutrition. It is a technique where nutrients are given intravenously, skipping the dependency on the digestive system for their absorption.
Medications for short bowel syndrome include proton pump inhibitors, anti-diarrheal drugs, and growth hormones. Proton pump inhibitors lower stomach acid levels since higher levels of stomach acids can negatively impact intestinal absorption.
Diarrhea is one of the main concerns for people with short bowel syndrome for which antidiarrheal drugs are prescribed. These drugs slow down intestinal motility and increase the time food stays in the intestine, increasing the chances of absorption.
Growth hormone somatotropin is also approved by the FDA for the treatment of short bowel syndrome. This hormone improves intestinal absorption and lowers the need for total prenatal nutrition.
Teduglutide or Gattex is a new and amazing FDA-approved drug for short bowel syndrome treatment. It functions by promoting mucosal growth. It also helps restore gastric secretion and emptying.
Surgery in short bowel syndrome is reserved for cases when nutritional support and medications fail to improve the condition and there is a high risk of severe complications. The common surgical procedure in this case isserial transverse enteroplasty, also called STEP procedure.
STEP procedure involves changing the shape of the bowl to zig-zag which slows the flow of food in it. This longer stay of food in the small intestine allows greater absorption of nutrients, improving the symptoms of short bowels syndrome. In severe cases, asmall bowel transplant is the last option to prevent life-threatening complications.
Management of short bowel syndrome requires following a strict diet to prevent symptoms and worsening of the condition. Certain foods can benefit people with short bowel syndrome while others can trigger the symptoms and lead to complications.
This is why it's important to understand which foods to eat and which to avoid for the management of this condition.
Different parts of the small intestine absorb specific nutrients, so when a portion is lost, the body struggles to absorb those nutrients. The diet you need to follow depends on which part of the intestine is affected and what nutrients are deficient in the body.
Here are some foods that are best suited for people with short bowel syndrome:
Protein is essential for repairing tissues and healing the digestive system.Studies show that amino acids in the proteins enhance the absorption ability of the remaining part of the small intestine in short bowel syndrome. Protein foods are usually gentle on the stomach, which is helpful in short bowel syndrome.
Weight loss is another complication of short bowel syndrome, andstudies show that a protein diet with physical activity helps gain a healthy weight. Here are some protein-rich foods that can help maintain energy levels and support intestine functioning in this condition:
Lean meats
Eggs
Fish
Tofu
Protein Supplements
Protein supplements likeprotein powder are very helpful for people with short bowel syndrome because they make it easy to get enough protein. They are simple to prepare and digest, supporting a healthy weight, intestinal health, and recovery.
Refined carbohydrates areeasy to digest compared to complex carbohydrates, which is an important consideration for people with short bowel syndrome.
Foods containing refined carbohydrates provide a quick source of energy and help reduce strain on the intestines. Here are some examples of refined carbs that can help you maintain energy levels in short-bowel syndrome:
White bread
White rice
Cereals
Potatoes
White Pasta
Fats are usually slow to digest, and people with short bowel syndrome must avoid consuming high-fat foods. However, healthy fats can be consumed in moderation to meet the body's requirements.
Foods containingmedium-chain triglycerides, like coconut oil and butter are easier to process for the digestive system than long-chain fats. Medium-chain triglycerides can help provide a concentrated source of energy without worsening the symptoms of short bowel syndrome like diarrhea.
Foods with soluble fiber, such as bananas, applesauce, and oats, can also help manage short bowel syndrome by slowing digestion and improving stool consistency.
Studies show that soluble fiber absorbs water and forms a gel-like substance in the digestive system that reduces diarrhea. This improves nutrient absorption and supports intestinal health, making it beneficial for individuals with short-bowel syndrome.
Here are some of the foods that you must avoid if you’re suffering from short bowel syndrome:
Fatty foods like fried meats and french fries can worsen diarrhea. These foods can also cause oily stools in people with short bowel syndrome. This is because the compromised intestine in short bowel syndrome struggles to absorb fat properly.
Raw vegetables like broccoli and cabbage are high in complex fiber, which is hard to digest. Consuming these foods with short bowel syndrome increases the risk of bloating. If you want to enjoy any vegetable or want any specific nutritional benefits from certain vegetables, it is best to cook it properly and then eat it.
Studies show that sugary items like candy, soda, and desserts can worsen diarrhea by drawing more water into the intestine. Diarrhea worsens the already compromised nutrient absorption and leads to dehydration.
Reports show that people with short bowel syndrome are more likely to develop lactose intolerance. For such people, milk, cheese, and other dairy products may cause bloating and diarrhea. It’s best that you opt for lactose-free dairy products with this condition.
Like dietary changes, lifestyle changes can also help manage short bowel syndrome effectively. You need toeat small but frequent meals throughout the day to ensure the digestive system isn't overwhelmed, and there is enough time for nutrient absorption.
Chewing food thoroughly helps the body digest it better and reduces strain on the intestines. Avoid drinking large amounts of water during meals, as it can dilute digestive enzymes and worsen nutrient absorption. Excess of water during meals also increases the risk of diarrhea in people with short bowel syndrome.
Keeping a food diary can also help identify foods that trigger symptoms and also helps you in planning a healthy diet for your condition. These simple lifestyle changes can improve digestion, reduce symptoms like diarrhea, and support overall health in short bowel syndrome.
Short bowel syndrome is a rare digestive condition that develops when a part of the small intestine is surgically removed. Since the small intestine absorbs nutrients, the loss of a part of the small intestine leads to nutritional deficiencies.
Management of short bowel syndrome involves maintaining a healthy nutritional balance and preventing complications. This can be made possible with specific dietary and lifestyle changes such as choosing easy-to-digest but nutritious foods.
If you are suffering from this condition and not sure what to eat and what to avoid, we recommend you consult a nutritionist for ameal plan that suits your condition the best.