Short Bowel Syndrome (SBS)

Short bowel syndrome (SBS), or simply "short gut," is a condition caused by the loss of a functioning small intestine. The small intestine is an important part of the digestive tract — it's where we absorb most of the sugars, proteins, fats, vitamins, and minerals from the food we eat. When a child doesn't have enough small intestine, the body can't absorb the nutrients it needs to grow and thrive.

SBS is a serious condition because if left untreated, it can lead to dehydration and malnutrition and can be life threatening. The extent of your child's problems with SBS usually depends on which sections and how much of the small intestine are affected.

Short bowel syndrome is a rare condition — but you don’t have to go it alone. This animated video can help both kids and adults understand how short bowel syndrome occurs and how we treat it at Boston Children’s Hospital.

The symptoms of short bowel syndrome (SBS) are essentially all those associated with the inability to absorb nutrients from food (malabsorption), including:

• Weight loss/failure to gain weight
• Dehydration
• Diarrhea
• Abdominal bloating
• Vomiting
• Abdominal pain
• Vitamin and mineral deficiencies

In addition to preventing the intestine from absorbing nutrients, SBS poses other problems. For instance, if your child doesn't have enough small intestine, the remaining part tries to fix the problem on its own. It expands, creating more surface area to draw in nutrients. The wider the intestine, the longer it takes for the body to move nutrients through it. More time in the intestines means more time for the bacteria that would normally be swept promptly along to multiply, increasing your child's chance of infection, known as small bowel bacterial overgrowth.

SBS is caused by an insufficient length of small intestine. There are several reasons why SBS may occur:

• Intestinal problems that your baby was born with. These can include intestinal atresia or stenosis, gastroschisis, volvulus, and severe Hirschsprung's disease.
• Necrotizing enterocolitis (NEC). NEC is an illness that damages the intestinal tissues in babies and can lead to holes or areas of narrowing (strictures) in the intestines.
• Other causes. These may include a traumatic injury to the small bowel that requires that it be removed, Crohn's disease, radiation enteritis, vasculitis, and others.

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

The Center for Advanced Intestinal Rehabilitation (CAIR) at Boston Children's Hospital is one of the world's premier programs for the treatment of SBS. Each year, our program cares for more than 200 children from all regions of the country and abroad. In 2002, our doctors performed the world's first serial transverse enteroplasty procedure (STEP), a surgical technique that lengthens and tapers the intestines of children with SBS. Since then, we have performed dozens of these procedures with success. Our interdisciplinary center is also renowned for innovations in the nutritional and medical management of children with SBS. CAIR was the first center to use a novel intravenous preparation (Omegaven) for the treatment of liver disease associated with intestinal failure.