Short Bowel Syndrome | NIDDK (2022)

What is Short Bowel Syndrome

Short bowel syndrome is a group of problems related to poor absorption of nutrients. Short bowel syndrome typically occurs in people who have

  • had at least half of their small intestine removed and sometimes all or part of their large intestine removed
  • significant damage of the small intestine
  • poor motility, or movement, inside the intestines

Short bowel syndrome may be mild, moderate, or severe, depending on how well the small intestine is working.

People with short bowel syndrome cannot absorb enough water, vitamins, minerals, protein, fat, calories, and other nutrients from food. What nutrients the small intestine has trouble absorbing depends on which section of the small intestine has been damaged or removed.

What is the small intestine?

The small intestine is the tube-shaped organ between the stomach and large intestine. Most food digestion and nutrient absorption take place in the small intestine. The small intestine is about 20 feet long and includes the duodenum, jejunum, and ileum:

duodenum—the first part of the small intestine, where iron and other minerals are absorbed

jejunum—the middle section of the small intestine, where carbohydrates, proteins, fat, and most vitamins are absorbed

ileum—the lower end of the small intestine, where bile acids and vitamin B12 are absorbed

What is the large intestine?

The large intestine is about 5 feet long in adults and absorbs water and any remaining nutrients from partially digested food passed from the small intestine. The large intestine then changes waste from liquid to a solid matter called stool.

(Video) Short bowel syndrome - causes, symptoms, diagnosis, treatment, pathology

Short Bowel Syndrome | NIDDK (1)

What causes Short Bowel Syndrome?

The main cause of short bowel syndrome is surgery to remove a portion of the small intestine. This surgery can treat intestinal diseases, injuries, or birth defects.

Some children are born with an abnormally short small intestine or with part of their bowel missing, which can cause short bowel syndrome. In infants, short bowel syndrome most commonly occurs following surgery to treat necrotizing enterocolitis, a condition in which part of the tissue in the intestines is destroyed.1

Short bowel syndrome may also occur following surgery to treat conditions such as

  • cancer and damage to the intestines caused by cancer treatment
  • Crohn's disease, a disorder that causes inflammation, or swelling, and irritation of any part of the digestive tract
  • gastroschisis, which occurs when the intestines stick out of the body through one side of the umbilical cord
  • internal hernia, which occurs when the small intestine is displaced into pockets in the abdominal lining
  • intestinal atresia, which occurs 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, in which one section of either the large or small intestine folds into itself, much like a collapsible telescope
  • meconium ileus, which occurs when the meconium, a newborn's first stool, is thicker and stickier than normal and blocks the ileum
  • midgut volvulus, which occurs when blood supply to the middle of the small intestine is completely cut off
  • omphalocele, which occurs when the intestines, liver, or other organs stick out through the navel, or belly button

Even if a person does not have surgery, disease or injury can damage the small intestine.

How common is Short Bowel Syndrome?

Short bowel syndrome is a rare condition. Each year, short bowel syndrome affects about three out of every million people.1

What are the signs and symptoms of Short Bowel Syndrome?

The main symptom of short bowel syndrome is diarrhea—loose, watery stools. Diarrhea can lead to dehydration, malnutrition, and weight loss. Dehydration means the body lacks enough fluid and electrolytes—chemicals in salts, including sodium, potassium, and chloride—to work properly. Malnutrition is a condition that develops when the body does not get the right amount of vitamins, minerals, and nutrients it needs to maintain healthy tissues and organ function. Loose stools contain more fluid and electrolytes than solid stools. These problems can be severe and can be life threatening without proper treatment.

Other signs and symptoms may include

  • bloating
  • cramping
  • fatigue, or feeling tired
  • foul-smelling stool
  • heartburn
  • too much gas
  • vomiting
  • weakness

People with short bowel syndrome are also more likely to develop food allergies and sensitivities, such as lactose intolerance. Lactose intolerance is a condition in which people have digestive symptoms—such as bloating, diarrhea, and gas—after eating or drinking milk or milk products.

(Video) Short Bowel Syndrome | GI Society

What are the complications of Short Bowel Syndrome?

The complications of short bowel syndrome may include

  • malnutrition
  • peptic ulcers—sores on the lining of the stomach or duodenum caused by too much gastric acid
  • kidney stones—solid pieces of material that form in the kidneys
  • small intestinal bacterial overgrowth—a condition in which abnormally large numbers of bacteria grow in the small intestine

How is Short Bowel Syndrome diagnosed?

A health care provider diagnoses short bowel syndrome based on

  • a medical and family history
  • a physical exam
  • blood tests
  • fecal fat tests
  • an x-ray of the small and large intestines
  • upper gastrointestinal (GI) series
  • computerized tomography (CT) scan

Medical and Family History

Taking a medical and family history may help a health care provider diagnose short bowel syndrome. He or she will ask the patient about symptoms and may request a history of past operations.

Physical Exam

A physical exam may help diagnose short bowel syndrome. During a physical exam, a health care provider usually

  • examines a patient's body, looking for muscle wasting or weight loss and signs of vitamin and mineral deficiencies
  • uses a stethoscope to listen to sounds in the abdomen
  • taps on specific areas of the patient's body

Blood Tests

A blood test involves drawing a patient's blood at a health care provider's office or a commercial facility and sending the sample to a lab for analysis. Blood tests can show mineral and vitamin levels and measure complete blood count.

Fecal Fat Tests

A fecal fat test measures the body's ability to break down and absorb fat. For this test, a patient provides a stool sample at a health care provider's office. The patient may also use a take-home test kit. The patient collects stool in plastic wrap that he or she lays over the toilet seat and places a sample into a container. A patient can also use a special tissue provided by the health care provider's office to collect the sample and place the tissue into the container. For children wearing diapers, the parent or caretaker can line the diaper with plastic to collect the stool. The health care provider will send the sample to a lab for analysis. A fecal fat test can show how well the small intestine is working.

X-ray

An x-ray is a picture created by using radiation and recorded on film or on a computer. The amount of radiation used is small. An x-ray technician performs the x-ray at a hospital or an outpatient center, and a radiologist—a doctor who specializes in medical imaging—interprets the images. An x-ray of the small intestine can show that the last segment of the large intestine is narrower than normal. Blocked stool causes the part of the intestine just before this narrow segment to stretch and bulge.

Upper Gastrointestinal Series

Upper GI series, also called a barium swallow, uses x rays and fluoroscopy to help diagnose problems of the upper GI tract. Fluoroscopy is a form of x ray that makes it possible to see the internal organs and their motion on a video monitor. An x-ray technician performs this test at a hospital or an outpatient center, and a radiologist interprets the images.

(Video) Short Bowel Syndrome | Q&A with Samuel Alaish, M.D.

During the procedure, the patient will stand or sit in front of an x-ray machine and drink barium, a chalky liquid. Barium coats the esophagus, stomach, and small intestine so the radiologist and a health care provider can see the shape of these organs more clearly on x-rays.

A patient may experience bloating and nausea for a short time after the test. For several days afterward, barium liquid in the GI tract causes white or light-colored stools. A health care provider will give the patient specific instructions about eating and drinking after the test. Upper GI series can show narrowing and widening of the small and large intestines.

Computerized Tomography Scan

Computerized tomography scans use a combination of x-rays and computer technology to create images. For a CT scan, a health care provider may give the patient a solution to drink and an injection of a special dye, called a contrast medium. CT scans require the patient to lie on a table that slides into a tunnel-shaped device that takes x-rays.

An x-ray technician performs the procedure in an outpatient center or a hospital, and a radiologist interprets the images. The patient does not need anesthesia. CT scans can show bowel obstruction and changes in the intestines.

How is Short Bowel Syndrome treated?

A health care provider will recommend treatment for short bowel syndrome based on a patient's nutritional needs. Treatment may include

  • nutritional support
  • medications
  • surgery
  • intestinal transplant

Nutritional Support

The main treatment for short bowel syndrome is nutritional support, which may include the following:

  • Oral rehydration. Adults should drink water, sports drinks, sodas without caffeine, and salty broths. Children should drink oral rehydration solutions—special drinks that contain salts and minerals to prevent dehydration—such as Pedialyte, Naturalyte, Infalyte, and CeraLyte, which are sold in most grocery stores and drugstores.
  • Parenteral nutrition. This treatment delivers fluids, electrolytes, and liquid vitamins and minerals into the bloodstream through an intravenous (IV) tube—a tube placed into a vein. Health care providers give parenteral nutrition to people who cannot or should not get their nutrition or enough fluids through eating.
  • Enteral nutrition. This treatment delivers liquid food to the stomach or small intestine through a feeding tube—a small, soft, plastic tube placed through the nose or mouth into the stomach. Gallstones—small, pebblelike substances that develop in the gallbladder—are a complication of enteral nutrition.
  • Vitamin and mineral supplements. A person may need to take vitamin and mineral supplements during or after parenteral or enteral nutrition.
  • Special diet. A health care provider can recommend a specific diet plan for the patient that may include
    • small, frequent feedings
    • avoiding foods that can cause diarrhea, such as foods high in sugar, protein, and fiber
    • avoiding high-fat foods

Medications

A health care provider may prescribe medications to treat short bowel syndrome, including

  • antibiotics to prevent bacterial overgrowth
  • H2 blockers to treat too much gastric acid secretion
  • proton pump inhibitors to treat too much gastric acid secretion
  • choleretic agents to improve bile flow and prevent liver disease
  • bile-salt binders to decrease diarrhea
  • anti-secretin agents to reduce gastric acid in the intestine
  • hypomotility agents to increase the time it takes food to travel through the intestines, leading to increased nutrient absorption
  • growth hormones to improve intestinal absorption
  • teduglutide to improve intestinal absorption

Surgery

The goal of surgery is to increase the small intestine's ability to absorb nutrients. Approximately half of the patients with short bowel syndrome need surgery.2 Surgery used to treat short bowel syndrome includes procedures that

(Video) Short Bowel Syndrome - Brylie's Story - Nebraska Medicine

  • prevent blockage and preserve the length of the small intestine
  • narrow any dilated segment of the small intestine
  • slow the time it takes for food to travel through the small intestine
  • lengthen the small intestine

Long-term treatment and recovery, which for some may take years, depend in part on

  • what sections of the small intestine were removed
  • how much of the intestine is damaged
  • how well the muscles of the intestine work
  • how well the remaining small intestine adapts over time

Intestinal Transplant

An intestinal transplant is surgery to remove a diseased or an injured small intestine and replace it with a healthy small intestine from a person who has just died, called a donor. Sometimes a living donor can provide a segment of his or her small intestine.

Transplant surgeons—doctors who specialize in performing transplant surgery—perform the surgery on patients for whom other treatments have failed and who have life threatening complications from long-term parenteral nutrition. An intestinal-transplant team performs the surgery in a hospital. The patient will need anesthesia. Complications of intestinal transplantation include infections and rejection of the transplanted organ.

A successful intestinal transplant can be a life-saving treatment for people with intestinal failure caused by short bowel syndrome. By 2008, transplant surgeons had performed almost 2,000 intestinal transplantations in the United States—approximately 75 percent of which were in patients younger than 18 years of age.3

A health care provider will tailor treatment to the severity of the patient's disease:

  • Treatment for mild short bowel syndrome involves eating small, frequent meals; drinking fluid; taking nutritional supplements; and using medications to treat diarrhea.
  • Treatment for moderate short bowel syndrome is similar to that for mild short bowel syndrome, with the addition of parenteral nutrition as needed.
  • Treatment for severe short bowel syndrome involves use of parenteral nutrition and oral rehydration solutions. Patients may receive enteral nutrition or continue normal eating, even though most of the nutrients are not absorbed. Both enteral nutrition and normal eating stimulate the remaining intestine to work better and may allow patients to discontinue parenteral nutrition. Some patients with severe short bowel syndrome require parenteral nutrition indefinitely or surgery.

Can Short Bowel Syndrome be prevented?

People can ask their health care providers about surgical techniques that minimize scar tissue. Scientists have not yet found a way to prevent short bowel syndrome that is present at birth, as its cause is unknown.

What is Intestinal Adaptation?

Intestinal adaptation is a process that usually occurs in children after removal of a large portion of their small intestine. The remaining small intestine goes through a period of adaptation and grows to increase its ability to absorb nutrients. Intestinal adaptation can take up to 2 years to occur, and during this time a person may be heavily dependent on parenteral or enteral nutrition.1

Eating, Diet, and Nutrition

Researchers have not found that eating, diet, and nutrition play a role in causing or preventing short bowel syndrome.

(Video) Short Bowel Syndrome: What You Need to Know

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

References

FAQs

What is the survival rate of short bowel syndrome? ›

Early postoperative mortality can be as high as 30%. Data from leading transplant centers have shown that the 1-year survival rates can be as high as 80-90%, and approximately 60% of patients are alive at 4 years.

How do you know if your child has short bowel syndrome? ›

Watery diarrhea is the most common symptom of short bowel syndrome in infants and children. Bloating. Excessive gas and/or foul-smelling stool. Poor appetite.

Can you live a long life with short bowel syndrome? ›

Long-term survival is possible and does not depend primarily on the length of the remaining bowel but on complications such as parenteral nutrition-associated cholestasis, recurrent septicaemia, central venous catheter infections, and the motility of the remaining intestine.

Can you live a normal life with short bowel syndrome? ›

There is no cure, but the disorder usually can be treated effectively. However, in some cases, short bowel syndrome can lead to severe, disabling and life-threatening complications. Short bowel syndrome is most commonly associated with the surgical removal (resection) of half or more of the small intestine.

How do you fix short bowel syndrome? ›

Treatment for mild short bowel syndrome involves eating small, frequent meals; drinking fluid; taking nutritional supplements; and using medications to treat diarrhea. Treatment for moderate short bowel syndrome is similar to that for mild short bowel syndrome, with the addition of parenteral nutrition as needed.

What foods are good for short bowel syndrome? ›

Patients who have had a large part of their intestines removed will usually have special dietary needs. They may no longer be able to absorb enough nutrients and fluids from the food they eat.
...
Good Choices for Fruits
  • Applesauce.
  • Pears.
  • Peaches.
  • Mandarin oranges.
  • Apricots.
  • Cherries.
  • Plums.

Is short bowel syndrome genetic? ›

CSBS was first described by Hamilton et al. and it has always been considered to have a genetic cause.

How long do kids with short gut live? ›

The four-year survival rate for newborn infants on TPN was 70 percent; in newborns with less than 10 percent of expected intestinal length, the five-year survival was 20 percent (Ann.

What organs are affected by short bowel syndrome? ›

Short bowel syndrome is a group of problems. They happen to people who have had a large part of their small intestine surgically removed. The small intestine is a long, curving organ. It connects your stomach to your large intestine (colon).

What is a major complication for children with short bowel syndrome? ›

Children with short bowel syndrome usually have severe malabsorptive diarrhea. This can lead to complications including: Dehydration. Growth impairment and failure to thrive.

Can you recover from short bowel syndrome? ›

Some people may need treatment for only a short time. They get what doctors call intestinal adaptation, when the small intestine is able to adjust to its shorter length and work as it should. It can take up to 2 years for that to happen, and most people still need treatment before their organ gets used to things.

Does the bowel grow back? ›

The intestine is the most highly regenerative organ in the human body, regenerating its lining, called the epithelium, every five to seven days. Continual cell renewal allows the epithelium to withstand the constant wear and tear it suffers while breaking down food, absorbing nutrients, and eliminating waste.

Can people with short bowel syndrome drink alcohol? ›

Short bowel syndrome patients, especially those with no colon and very high ostomy outputs, need to stay hydrated. Water isn't the best way to stay hydrated. In patients with high output ostomies, water and other hypotonic fluids like tea, coffee, fruit juices and alcohol can actually make the output worse.

Which vitamin is deficiency in short bowel syndrome? ›

Abstract. Introduction Vitamin D (vit D) deficiency is a common consequence of short bowel syndrome and can detrimentally affect bone and muscle health. Oral vit D supplements can be absorbed variably and parenteral supplementation does not always result in improved serum levels.

Can small intestine grow back? ›

Abstract. The small intestine (SI) is difficult to regenerate or reconstruct due to its complex structure and functions. Recent developments in stem cell research, advanced engineering technologies, and regenerative medicine strategies bring new hope of solving clinical problems of the SI.

How do you stay hydrated with short bowel syndrome? ›

Only drink ½ cup (4 ounces) of liquids during each meal

Drinking large amounts of liquids with meals pushes your food through your bowel more quickly. This means that you may not digest or absorb enough nutrients. Drink most of your liquids between meals, at least 1 hour before or after a meal.

What kind of doctor treats short bowel syndrome? ›

At Mayo Clinic, digestive specialists (gastroenterologists) and nutrition specialists work as a multidisciplinary team to care for people with short bowel syndrome. Your team may include other professionals as needed.

How much small bowel can you live with? ›

In individuals with healthy remnant bowel who receive the “standard” supportive care and treatment as described above, a minimum of 110–150 cm of small bowel is required to achieve nutritional autonomy if there is no colon in continuity, and 50–70 cm of small bowel if a portion of colon remains in continuity with the ...

Can you live with half a bowel? ›

The answer to the first question, believe it or not is - YES! You can live without a large intestine - something that comes as a shock to many people. The large intestine or colon has one primary role, water and electrolyte absorption to concentrate the stool.

How long is recovery from small intestine surgery? ›

You should feel better after 1 to 2 weeks and will probably be back to normal in 2 to 4 weeks. Your bowel movements may not be regular for several weeks. Also, you may have some blood in your stool. This care sheet gives you a general idea about how long it will take for you to recover.

What happens when small intestine stops working? ›

If blood flow to your intestine is completely and suddenly blocked, intestinal tissue can die (gangrene). A hole through the wall of the intestines (perforation). A perforation can develop, which can cause the contents of the intestine to leak into the abdominal cavity. This may cause a serious infection (peritonitis).

What foods should you not eat after having a small bowel resection? ›

Avoid gummy foods such as bread and tough meats, as well as spicy, fried, or gas-producing foods. To prevent swallowing air, which produces excess gas, avoid drinking through a straw and don't chew gum or tobacco. Take small bites, chew your food well, and avoid gulping.

Can you live without a small intestine? ›

Most people can live without a stomach or large intestine, but it is harder to live without a small intestine. When all or most of the small intestine has to be removed or stops working, nutrients must be put directly into the blood stream (intravenous or IV) in liquid form.

Can you live without a colon? ›

People can live without a colon, but may need to wear a bag outside their body to collect stool. However, a surgical procedure can be performed to create a pouch in the small intestine that takes the place of the colon, and in this case, wearing a bag is not necessary, according to the Mayo Clinic.

What happens if you don't have a duodenum? ›

If the pyloric valve located between the stomach and first part of the small intestine (duodenum) is removed, the stomach is unable to retain food long enough for partial digestion to occur. Food then travels too rapidly into the small intestine producing a condition known as the post-gastrectomy syndrome.

What foods are good for short bowel syndrome? ›

Patients who have had a large part of their intestines removed will usually have special dietary needs. They may no longer be able to absorb enough nutrients and fluids from the food they eat.
...
Good Choices for Fruits
  • Applesauce.
  • Pears.
  • Peaches.
  • Mandarin oranges.
  • Apricots.
  • Cherries.
  • Plums.

How much small bowel can you live with? ›

In individuals with healthy remnant bowel who receive the “standard” supportive care and treatment as described above, a minimum of 110–150 cm of small bowel is required to achieve nutritional autonomy if there is no colon in continuity, and 50–70 cm of small bowel if a portion of colon remains in continuity with the ...

What kind of doctor treats short bowel syndrome? ›

At Mayo Clinic, digestive specialists (gastroenterologists) and nutrition specialists work as a multidisciplinary team to care for people with short bowel syndrome. Your team may include other professionals as needed.

What happens if the small intestine is not working well? ›

Short bowel syndrome usually affects people who've had a lot of their small intestine removed. Without this part, your body can't get enough nutrients and water from the food you eat. This causes bowel troubles, like diarrhea, which can be dangerous if you go without treatment.

Can you drink water with short bowel syndrome? ›

The main treatment for short bowel syndrome is nutritional support, which may include the following: Oral rehydration. Adults should drink water, sports drinks, sodas without caffeine, and salty broths.

How is short bowel treated? ›

Doctors may recommend surgery for children and adults with short bowel syndrome. Types of surgery include procedures to slow the passage of nutrients through the intestine or a procedure to lengthen the intestine (autologous gastrointestinal reconstruction), as well as small bowel transplantation (SBT).

Which vitamin is deficiency in short bowel syndrome? ›

Abstract. Introduction Vitamin D (vit D) deficiency is a common consequence of short bowel syndrome and can detrimentally affect bone and muscle health. Oral vit D supplements can be absorbed variably and parenteral supplementation does not always result in improved serum levels.

What are the chronic complications of short bowel syndrome in adults? ›

This can cause dehydration, weight loss, vitamin deficiency, malnutrition, and a decrease in your overall quality of life. It may even lead to death. Other complications can include: Liver disease.

Can small intestine grow back? ›

Abstract. The small intestine (SI) is difficult to regenerate or reconstruct due to its complex structure and functions. Recent developments in stem cell research, advanced engineering technologies, and regenerative medicine strategies bring new hope of solving clinical problems of the SI.

Can you survive without small bowel? ›

You Cannot, Live Without Your Small Intestine.

Some patients may undergo surgery to remove some of their small bowel. These can be done for several reasons: A malabsorptive bariatric surgery such as gastric bypass to address morbid obesity, by limiting the calories absorbed by the small intestine.

Is short bowel syndrome genetic? ›

CSBS was first described by Hamilton et al. and it has always been considered to have a genetic cause.

How can I gain weight with short bowel syndrome? ›

Eat small, frequent meals, around 5-6 or more per day. Patients with short bowel syndrome usually need to increase their dietary energy intake by approximately half to compensate for malabsorption and maintain weight4. Chew your food well. Separate food and drinks by sipping beverages between meals.

What happens if part of your intestine dies? ›

If blood flow to your intestine is completely and suddenly blocked, intestinal tissue can die (gangrene). A hole through the wall of the intestines (perforation). A perforation can develop, which can cause the contents of the intestine to leak into the abdominal cavity. This may cause a serious infection (peritonitis).

What are 3 common disorders of the small intestine? ›

Diseases and disorders of the small intestine are common. They include Crohn's disease, celiac disease, small intestinal bacterial overgrowth, and irritable bowel syndrome. These may cause digestive symptoms such as abdominal pain, bloating, diarrhea, constipation, nausea, or vomiting.

Does colonoscopy check small intestine? ›

A colonoscopy examines your entire colon, sometimes including the very end of the small intestine.

Where is small intestine pain felt? ›

Signs and symptoms of small bowel disorders

You likely feel discomfort around the abdomen, rectum and lower belly. Symptoms may include: Diarrhea. Constipation.

Videos

1. Short Bowel Syndrome
(NASPGHAN)
2. Short Bowel Syndrome: Diet, Hydration, and Treatment
(The Oley Foundation)
3. Managing Short Bowel Syndrome With Associated Intestinal Failure
(PeerView CME)
4. Short Bowel Syndrome with Intestinal Failure – Patient Stories: Joel
(Takeda)
5. Understanding Short Bowel Syndrome in Kids | Boston Children's Hospital
(Boston Children's Hospital)
6. Pamela's Story: Short Bowel Syndrome (SBS) Patient l Nutrition Support Dietitian
(Cleveland Clinic Abu Dhabi)

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