Short bowel syndrome: Prevalence, causes, symptoms, treatment and life expectancy

Human bowels are made up of the large intestine (colon) and the small intestine. Short bowel syndrome or short gut syndrome is a condition that affects people who have had a lot of their small intestine removed, significant damage to the small intestine, or poor mobility inside the intestines. Without this part of the body, your digestive system isn’t able to get enough nutrients and water from the food you eat, causing bowel troubles.

If this condition is not properly treated, it can be dangerous. There are many things doctors can do to ease the symptoms of short bowel syndrome and make sure patients are getting the right amount of nutrition. The body may take time to adjust to having a smaller intestine, but sticking to a treatment plan and getting necessary support is key to living a healthy, active life.

What are the causes and symptoms of short bowel syndrome?

The average adult has about 20 feet of small intestine. People with short bowel syndrome have at least half of their small intestine missing or removed. There are many reasons why this occurs: Some people are born with bowel problems that damage parts of the intestine, while others are simply born with shorter bowels. More often, this condition happens after surgery to remove a large part of the small intestine. Reasons why doctors may remove parts of the small intestine include Crohn’s disease, cancer, damage from radiation therapy, or bowel injury. The condition may also occur after surgery to treat any of the following conditions:

Gastroschisis: When the intestines stick out of the body through one side of the umbilical cord
Internal hernia: When the small intestine is displaced into pockets in the abdominal lining
Intestinal atresia: When a part of the intestines doesn’t form completely
Intestinal injury from loss of blood flow due to a blocked blood vessel
Intestinal injury from trauma
Intussusception: One section of either the large or small intestine folds into itself
Meconium ileus: When the meconium, a newborn’s first stool, is thicker and stickier than normal and blocks the ileum
Midgut volvulus: When blood supply to the middle of the small intestine is completely cut off
Omphalocele: When the intestines, liver, or other organs stick out through the navel or belly button

The most common symptom of short bowel syndrome is persistent diarrhea. Other symptoms include cramping, bloating, gas, heartburn, fatigue, weakness, and weight loss. Since a person with short bowel syndrome has trouble getting nutrients and vitamins from food, additional symptoms may include anemia, fatty liver, easy bruising, gallstones, kidney stones, trouble eating certain foods, as well as bone pain and osteoporosis.

Complications of short bowel syndrome

Some complications that occur from short bowel syndrome include gallstones and kidney stones, intestinal bacterial overgrowth, peptic ulcers, malnutrition, and any of the conditions described in the symptoms section. Treatments for short bowel syndrome may also cause some complications, including:

Catheter-related infections
Blood clots
Kidney or liver problems developing from TPN
Organ rejection and infections developing after an organ transplant

How to diagnose short bowel syndrome

Short bowel syndrome is diagnosed by a health care provider based on their medical and family history, a physical exam, blood tests, an x-ray of the small and large intestines, fecal fat tests, upper gastrointestinal (GI) series, and computerized tomography (CT) scan.

Medical and family history

Understanding medical and family history can give doctors a better understanding of the patient’s symptoms and past operations. This information can help determine whether their symptoms are the result of short bowel syndrome.

Physical exam

A physical exam is also helpful to diagnose the condition. During this exam, a healthcare provider will examine the patient’s body, looking for muscle wasting or weight loss as well as signs of mineral and vitamin deficiencies. They may also use a stethoscope to listen to abdominal sounds and tap on specific areas of the patient’s body.

Blood tests

Blood tests are another way to diagnose short bowel syndrome. This involves drawing a patient’s blood at the doctor’s office or commercial facility and analyzing the sample in a lab.

Fecal fat tests

A fecal fat test analyzes the body’s ability to break down and absorb fat. The patient will provide a stool sample, which may be done at the health care provider’s office or with a take-home test kit. The sample will be sent to a lab for analysis and can determine how well the small intestine is working.

X-ray

An x-ray is created by using a small amount of radiation and is recorded on film or on a computer. The image created is interpreted by a radiologist—they will be able to see the size of the small intestine.

Upper GI series

Also known as a barium swallow, an upper GI series test uses x-rays and a fluoroscopy to help diagnose problems with the upper GI tract. A fluoroscopy is a type of x-ray that allows the internal organs and their motion to be seen on a video monitor. The technician will perform this test at the hospital and a radiologist will interpret the images. During the test, the patient will sit or stand in front an x-ray machine and drink barium. This drink coats the esophagus, stomach, and small intestine, so the specialist can see the shape of the organs clearer. After the test, the patient may experience nausea and bloating, and the solution will cause white or light-colored stools for a few days.

CT scan

A CT scan uses a combination of x-rays and computer technology to create images. A healthcare provider may give the patient a solution to drink and then injection of a special dye, called a contrast medium, before the scan. The patient must lie on a table that slides into a tunnel-shaped device, which takes x-rays. The technician will perform the procedure, and a radiologist will interpret the images. This procedure does not require anesthesia, and CT scans can bowel obstruction or any changes in the intestines.

How to treat short bowel syndrome

To treat short bowel syndrome, doctors may prescribe several medications including drugs that prevent diarrhea, regulate stomach acids and their release, increase the small intestine’s ability to absorb nutrients, inhibit intestinal bacteria growth, stimulate bile flow, and protect the liver. About 50 percent of people living with this condition will need surgery at some point. The surgery is intended to improve the small intestine’s absorption of nutrients. Treatment for short bowel syndrome in the form of surgery may include the following:

Bianchi procedure: Where the bowel is lengthened by cutting the bowel in half and sewing one end to the other
Stricturoplasty: Opens up a narrowed part of the intestine while preserving the length of the intestine
Serial transverse enteroplasty: Creates a zigzag pattern of the intestines to increase its length
An intestinal transplant, in very severe cases

Home remedies for short bowel syndrome

Home remedies for short bowel syndrome include eating frequently to stimulate the absorption of nutrients, drinking liquids between meals to reduce diarrhea, staying hydrated throughout the day, and eating bland foods that can help control diarrhea. A diet for short bowel syndrome should include bananas, rice, oatmeal, toast, and applesauce. Patients can also take vitamin and mineral supplements according to the guidance of a doctor.

Prevention, prognosis, and life expectancy of short bowel syndrome

To prevent short bowel syndrome, patients can ask their doctor about surgical techniques that minimize scar tissue. Scientists have not yet discovered a solution to prevent short bowel syndrome that is present at birth, as the condition’s cause in this form remains unknown. The life expectancy of most infants with this syndrome is between four to five years, but the life expectancy of adults is much better. Although there is no known cure for short bowel syndrome, there is a possibility that the condition can be improved with a surgical procedure. The main goal is to increase the ability of the small intestine time to absorb nutrients.