Short bowel syndrome: causes, treatment and diet

Short bowel syndrome: causes, treatment and diet

The disease spreads from 1-9/100,000 and results in the small intestine working less than 200 cm in length.

Congenital short bowel syndrome affects the age group of children while other types of short bowel mainly affect adults.

Since the jejunum is the main site for digestion and absorption of most nutrients, excision of the jejunum leads to loss of the absorption zone, which significantly reduces its function: malabsorption of fats, fat-soluble vitamins and vitamin B12, resulting in malnutrition, and bile acids that are not Absorbed into the colon causes secretory diarrhoea.

Short bowel syndrome, depending on the cause, can be distinguished into two main types

  • Congenital short bowel syndrome: the defect is already present at birth;
  • Secondary short bowel syndrome: The defect is not present at birth and appears later.

Secondary short bowel syndrome is generally caused or facilitated by:

  • Extensive surgical resection, usually when more than two-thirds of the length of the small intestine (postoperative short bowel) is removed;
  • Crohn’s disease;
  • Mesenteric infarction.
  • actinic enteritis
  • Intestinal neoplasms.
  • Recurrent intestinal trauma.
  • Intestinal torsion.

symptoms

Symptoms depend on the length and remaining function of the remaining small intestine.

Symptoms and signs in general

  • Even severe diarrhea
  • Malabsorption of vitamin B12 and fats.
  • malnutrition
  • Stomach ache;
  • Malnutrition by default;
  • loss of appetite (weight loss);
  • Intestinal dilatation.
  • variable motion
  • Floating, greasy, foul-smelling stools.

Note: Severe diarrhea and malabsorption of bile acids occur when the ileum is cut to a length of 100 cm (1 m) or more.

Possible complications of short bowel syndrome are presumptive acute malnutrition and anorexia (weight loss)

Excision of the terminal ileum and ileocecal valve may increase bacterial growth with an increased risk of infection.

In some cases, intestinal obstruction, intestinal ischemia, intestinal infarction, and patient death may result if normal vascularization is not rapidly restored.

diagnose

Diagnosis is suspected on the basis of history and objective examination and is mainly confirmed by radiological examinations such as abdominal X-rays and CT scans.

Psychiatric treatment

Treatment consists in combating the manifestations of diarrhea (by giving loperamide or the like, or cholestyramine 2-4 g instead of taking it only after meals).

Excessive secretion of gastric acid may develop, which inhibits the activity of pancreatic enzymes; For this reason, most patients take H2 antagonists or proton pump inhibitors.

Intestinal transplantation is recommended for patients who are not candidates for long-term total parenteral nutrition and for whom adaptation has not been achieved.

Short bowel treatment after surgery

In the immediate postoperative period, diarrhea is usually severe with significant electrolyte loss.

Patients usually require complete parenteral nutrition and intensive monitoring of fluids and electrolytes (including calcium and magnesium).

An isotonic PO solution of Na and glucose is slowly introduced in the postoperative phase when the patient is stable and stool output is <2 L/day.

In patients with extensive resection (< 100 cm of jejunum remaining) and those with excessive fluid and electrolyte loss, lifelong total parenteral nutrition is required. Patients with > 100 cm of the remaining jejunum may contain adequate nutrition through oral feeding.

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source:

medicina online


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