Short Bowel Syndrome

Short Bowel Syndrome – General Information

Short Bowel Syndrome is a disease characterized by malabsorption, diarrhea, steatorrhea, fluid and electrolyte imbalances, and a severe stage of malnutrition. In most cases, the main cause of this syndrome is the functional or anatomic loss of extensive segments of the small intestine affecting its capacity to absorb nutrients. This resection does not necessary trigger the syndrome, but its presence makes the patient more susceptible to developing it. Due to the patient’s intestinal resection, both digestive and absorptive processes are severely affected. There are also other more severe medical conditions that can cause Short Bowel Syndrome as a complication or it may appear as a side effect of certain medication. Medical disorders that may trigger this syndrome can include Crohn’s disease, radiation enteritis, trauma or obstruction to the patient’s small intestine, and mesenteric vascular accident.

There are many other conditions that can trigger the syndrome, but in pediatric population there are strict factors that can cause it which include necrotizing enterocolitis, intestinal atresias, and intestinal volvulus. Other diseases that can cause Short Bowel Syndrome include the following: meconium peritonitis, gastroschisis and congenital short small bowel. This medical condition usually develops in three stages: the acute phase, in which the patient can develop life threatening dehydration and electrolyte disturbances, the adaptation phase, characterized by the presence of enterocyte hyperplasia, and the maintenance phase, in which the metabolic and nutritional homeostasis can be achieved by oral feeding. If the disease is not treated properly the patient can develop life threatening complications.

Short Bowel Syndrome – Symptoms

In most cases, when a patient suffers from Short Bowel Syndrome, he/she is also likely to present a history of intestinal reaction such as Crohn’s disease, or even a history of severe abdominal or vascular accidents such as midgut volvulus or embolus in the superior part of the mesenteric arteries. Due the fact that the mechanism of Short Bowel Syndrome is affecting intestinal malabsorption, the main sign and symptom of it is diarrhea. In addition to diarrhea, patients can also experience one or more of the following signs and symptoms: weight loss, fatigue, malaise and lethargy. These manifestations can appear due to intestinal recession but there are cases in which they can be triggered by diarrheic diathesis, resultant dehydration, electrolyte imbalance, protein malnutrition and loss of important minerals and vitamins.

Vitamin and mineral deficiencies can lead to several specific signs and symptoms such as blindness and xerophthalmia, due to vitamin A imbalance, paresthesias and tetany, due to vitamin D imbalance, paresthesias, ataxic gait, and visual deficiencies due to vitamin E depletion and bruisability or prolonged bleeding due to vitamin K deficiency. The manifestations of Short Bowel Syndrome play an important role in diagnosing the condition. In some cases, these symptoms may reveal the presence of other more severe diseases. There are cases in which the patient can suffer from severe protein depletion and he/she is likely to experience symptoms such as loss of digital muscle mass and peripheral edema. Some patients can present essential fatty acid deficiency and can experience symptoms such as growth retardation, dermatitis and alopecia.

Short Bowel Syndrome – Treatment

It is very important to diagnose the Short Bowel Syndrome in the first stages of development to increase the patient’s rate of healing and to prevent the disease from causing life threatening complications. In most cases, patients who suffer from this kind of medical condition frequently experience large fluid shifts and difficulty in the electrolyte and volume homeostasis, especially in the first postoperative period. The main goal of the treatment is to ensure that the patient is gemodynamically stable and to administrate medication that can help the doctor to control the disease.

In treating Short Bowel Syndrome, the first treatment option is parenteral nutrition, because it provides adequate protein, calories, and other macronutrients and micronutrients until the patient’s bowel has time to adapt. This kind of procedure is administrated once a day and can be started with standard formulations on an inpatient basis. It is very important for the patient to make efforts to infuse daily prescription in shorter time periods, applying a procedure called cycling; this allows liberation from the solution pump for a period of time every day. There are patients who suffer from an advanced stage of Short Bowel Syndrome and despite the bowel’s adaptation and nutritional treatment they are not yet able to be liberated from the parenteral nutrition. In these cases, the next treatment option is based on the administration of a growth hormone, in doses of 0.3 mg/kg intravenously (IV). The most common prescription growth hormone is Zorbtive, which is actually a recombinant human growth hormone that acts by eliciting an anabolic and anticatabolic influence on the patient’s various cells, such as myocytes, hepatocytes, adipocytes, lymphocytes, and hematopoietic cells.

There are also other specific drug treatments that can be successfully applied to treat Short Bowel Syndrome, which have the goal of decreasing the gastric hypersecretion or decreasing the severity of certain signs and symptoms such as diarrhea. Usually, the gastric hypersecretion can be treated with the use of proton pump inhibitors or histamine blockers, especially in the first stages of the postoperative period. Some doctors focus on treating the main manifestation of the Short Bowel Syndrome, such as diarrhea. In most cases, the treatment also includes the use of medication. The most common medicines that can be successfully applied include Imodium, applied in doses of 4 mg/kg and Lomotil, administered in doses of 2 to 5 mg/kg depending on the symptom severity. Usually, patients who have lost all of their colon and ileum are very difficult to treat, and the first measure that can be applied consists in doses of 100 mg/kg of somatostatin analogue, Octreotide for at least three times a day. This therapy can help reducing the stool quantities. There are some cases in which the patient’s organism does not respond well to the medication treatment, and doctors have to intervene surgically. The surgical therapy may consist of two types of operations: intestinal transplantation and nontransplant operation. The second type of operation uses certain procedures such as intestinal lengthening or tapering.