 Short Bowel Syndrome
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Short bowel syndrome (SBS) occurs after congenital (before birth) or post-natal loss of at least half of the small bowel, with or without loss of a portion of the large intenstine. (See The Digestive System - An overview). The loss of bowel can be due to disease or surgical removal. SBS produces malabsorption, a condition in which the body cannot break down and/or absorb sugars, proteins or fats.
The extent of problems associated with SBS usually depends on which sections of the small bowel are affected. The normal small bowel varies in length between 10 and 28 feet and is divided into three sections.
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- The duodenum: A relatively short part of the small bowell, measuring about 10-12 inches. It immediately follows the stomach.
- The jejunum: the longest, but not largest section. The jejunum makes up about 2/5 of the rest of the small intestine, but is the largest section because its many folds give it an increased surface area for absorption.
- The ileum: the remaining 3/5 of the small bowel.
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Usually, about one half of the small bowel can be removed without causing significant problems, especially if the ileum is not involved. The entire jejunum can be usually be removed without problems resulting. The ileum can usually compensate for all the losses of the jejunum except the lactase deficiency. Removal of the ileum accounts for most of the problems seen in short bowel syndrome because it is responsible for the absorption of fats, bile salts, and B12.
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There are many causes of SBS, but the most common causes are necrotizing enterocolitis, an infectious inflammatory disease of premature newborns; intestinal atresia, a failure of development of a portion of the intestine; and an intestinal volvulus, damage of the bowel induced by a twist which impairs its blood supply. Other causes are conditions which the bowel is lost in utero. For example, intestinal malrotation and gastroschisis. SBS can also be caused by surgical removal due to disease of the ileum, such as volvulus or an infarction (blockage of the blood vessels to the bowel usually caused by a blood clot) Sometimes, a traumatic injury to the small bowel necessitates it's removal. Crohn's disease, an inflammatory disease typically of the ileum, may also be a cause.
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The signs and symptoms of short bowel syndrome are essentially all of the symptoms associated with malabsorption:
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- weight loss
- diarrhea
- abdominal bloating
- fatigue
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To determine whether your child has short-bowel syndrome, your child's doctor will take a detailed medical history and perform a physical examination. Diagnostic tests may include a combination of the following:
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- Blood tests - to the level of nutrients absorbed in the blood stream.
- Abdominal x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
- Abdominal ultrasound - a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.
- Stool sample - to assess for the presence of infection or blood or also for the presence of non-absorbed sugar and protein.
- Endoscopy - a test that uses a small, flexible tube with a light and a camera lens at the end (endoscope) to examine the inside of part of the digestive tract. Tissue samples from inside the digestive tract may also be taken for examination and testing.
- Colonoscopy - a test that uses a long, flexible tube with a light and camera lens at the end (colonoscope) to examine inside the large intestine.
- Indirect calorimetry - a test to analyze the nutritional needs of your child in the form of calories, carbohydrates, protein and fat.
- Breath hydrogen analysis - a test to quantify the degree of malabsorption of carbohydrate or sugars as well as to determine whether excess quantities of bacteria are overgrowing inside of the bowel.
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SBS compromises the (shortened) intestines' ability to absorb nutrients from foods. Parenteral nutrition (PN), where nutrients are delivered intravenously, allows the body's fuel to bypass the normal digestive entirely. Enteral nutrition (EN), often referred to as tube feeding, involves a gastrostomy tube ("G-Tube") passed through an opening into the stomach, or a jejunostomy tube ("J-Tube") passed through an opening into a portion of the small intestine. In this way, digestion is assisted, possibly preparing the intestines for oral feeding.
Click here for detailed information on the nutritional management of SBS.
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Surgery may be necessary in cases where there is an obstruction in the intestines or in cases of extreme shortening where absorption can be enhanced by operative techniques. Such techniques enhance the surface area of the intestines or prolong the transit time which enhances the exposure of the intestine to the nutrients.
Pediatric surgeons at Children's Hospital have recently developed a new bowel lengthening operation for children with short bowel syndrome, termed the serial transverse enteroplasty or STEP. To read more about this new procedure, please visit www.STEPoperation.org.
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| Drs. Christopher Duggan, Tom Jaksic and Heung Bae Kim |
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Download video segments of Dr. Christopher Duggan, Dr. Tom Jaksic and Dr. Heung Bae Kim discussing the symptoms of Short Bowel Syndrome, its nutritional management and its innovative treatment through the STEP (serial transverse enteroplasty) procedure. Requires RealPlayer. For best video playback, right click and save the files to your desktop.
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Dr. Kim describes Short Bowel Syndrome
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Dr. Duggan on the nutritional treatment of SBS
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Dr. Duggan explains the benefits and side effects of long-term PN
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Dr. Jaksic defines STEP
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Dr. Jaksic explains the benefits of STEP
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Dr. Kim describes the candidates for STEP
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Dr. Jaksic outlines the follow-up care for patients receiving the STEP procedure
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Dr. Duggan describes nutritional needs post-STEP
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Dr. Duggan outlines the transition from parenteral or enteral nutrition to oral feeding
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Dr. Kim on the STEP procedure at Children's
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