Short Bowel Syndrome (SBS) | Diagnosis & Treatment

How is short bowel syndrome diagnosed?

To evaluate short bowel syndrome, your child's clinician will take a detailed medical history, perform a physical examination, order various specialized laboratory tests and may also order tests to show any structural problems with the intestine. These can include:

  • abdominal x-ray, often with contrast material to better define the gastrointestinal anatomy and function
  • abdominal ultrasound, to evaluate blood vessel structures as well as various organs
  • modified barium swallow, to analyze upper gastrointestinal anatomy and function
  • 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. In some cases, fluid is collected during an endoscopy to help aid with diagnosis and treatment of small bowel bacterial overgrowth.
  • 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. As with the endoscopy, tissue samples from inside the digestive tract may also be taken for examination and testing.

Your child's clinician may also offer the following specialized tests of nutritional status:

  • breath hydrogen analysis, to quantify the degree of malabsorption of carbohydrate or sugars as well as to determine whether excess quantities of bacteria are growing inside the bowel
  • indirect calorimetry, a test to analyze the nutritional needs of your child in the form of calories, carbohydrates, protein and fat
  • body composition tests, to evaluate fat and lean muscle
  • DEXA scans, to evaluate bone density
  • motility testing, to evaluate gastrointestinal function
  • FibroScan, to assess the liver

What are the treatment options for SBS?

Nutritional management

Since your child's intestines aren't able to absorb enough nutrients, they may need to get some nutrients through either parenteral nutrition (PN) or enteral nutrition (EN).

With PN, a special nutritional formula is delivered directly into your child's bloodstream through intravenous feeding (IV). This formula is carefully developed by your child's nutrition team and calibrated to their body's precise needs. Delivering nutrients straight to your child's bloodstream means that it can bypass the digestive system altogether. PN is typically given on a daily basis. If your child requires PN for longer-term support, we will generally gradually decrease the length of each infusion.

If your child is receiving EN, a feeding tube is often used to deliver necessary nutrients. Many children also receive specialized nutritional supplements by mouth.

There are two general ways we feed children through EN:

  • gastrostomy tube (G-tube), which is passed through an opening into your child's stomach
  • jejunostomy tube (J-tube), which is passed through an opening into a portion of the small intestine

The enteral formula is also carefully developed by your child's nutrition team and calibrated to their body's precise needs. Specific lipid management approaches include:

  • Omegaven, a unique fish oil-based emulsion developed by Mark Puder, MD, that appears to help treat cholestasis, a form of liver disease resulting from total PN
  • Smoflipid, an IV fat emulsion made from soy, olive, fish and medium-chain oils
  • Clinolipid, an IV fat emulsion made from olive and soy oils

Medicine

Your child's clinician will often prescribe medications to help manage your child's short bowel syndrome (SBS) and supplement nutritional intake. Some of these might include:

  • loperamide: used to control diarrhea by giving the intestines more time to absorb water and nutrients
  • ursodeoxycholic acid: a naturally occurring bile acid that is used to help prevent gallstones
  • acid-blocking agents: including H2 blocker and proton-pump inhibitors to reduce excess stomach acid
  • vitamin and mineral supplements: either multivitamins or single nutrient supplements to prevent or treat deficiencies
  • antibiotics: to treat infections, including small bowel bacterial overgrowth

Surgery

The first goal is to preserve as much of your child's intestines as possible. Such intestinal sparing is accomplished by salvaging all viable intestine during the initial surgical procedure and, when necessary, performing a "second look" operation later to determine whether the viable portions are recovering.

Sometimes it's possible to surgically reshape the small intestine to increase the surface area of the intestines and prolong the amount of time it takes for food to move through, giving the intestines more time to extract nutrients, an approach called the serial transverse enteroplasty procedure (STEP).

Transplant

Many children do quite well with IV feedings, but sometimes complications arise that make it no longer an option. In this case, your child might be a candidate for an intestinal transplant. There are a few different types of intestinal transplants, including:

  • intestinal transplant
  • intestinal/liver transplant
  • multivisceral transplant (the intestines are replaced, along with the liver and/or spleen, and sometimes the stomach)

Boston Children's Hospital is the only center to New England to offer intestinal transplants.