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22 November, 2009

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Short Bowel syndrome

Absorption of food nutrients happens in the small intestine. Food is squeezed from the stomach, through a sphincter (valve) and into the first part of the small intestine (duodenum), where it is mixed with digestive enzymes. Next, muscular contractions (peristalsis) massage the food into the lower parts of the small intestine (jejunum and ileum). Nutrients are absorbed from the ileum, which is lined with millions of microscopic finger-like projections called villi. Each villus is connected to a mesh of capillaries so that nutrients can pass into the bloodstream. Short bowel syndrome refers to the malabsorption of food nutrients due to disease or surgical removal of parts of the small intestine. Around half of the small intestine can be out of action before malabsorption occurs. Common causes of short bowel syndrome include Crohn's disease and necrotising enterocolitis.

Symptoms
The symptoms of short bowel syndrome can include:

Abdominal pain
Diarrhoea
Stools that float or smell particularly bad
Fluid retention
Unintended weight loss
Extreme fatigue.

Complications of malnutrition
A person with short bowel syndrome is likely to be deficient in a range of important nutrients such as calcium, folate, iron, magnesium, vitamin B12 and zinc. Some of the disorders caused by malnutrition include:

Anaemia
Skin rashes
Unusual skin sensations
Fatigue
Dehydration
Increased susceptibility to infections
Osteoporosis
Impaired growth and development in children.

A range of causes
Some of the causes of short bowel syndrome include:

Crohn's disease - a condition that causes inflammation of the full thickness of the bowel wall and can target any part of the digestive tract, from mouth to anus, for reasons unknown. If the small intestine is affected, absorption of food nutrients will be impaired.
Necrotising enterocolitis - a condition that tends to target newborns, particularly premature babies, for reasons unknown. Reduced blood supply to the intestinal walls results in the death of the intestinal lining. The dead tissue must be surgically removed. Around one third of babies with necrotising enterocolitis will die, despite medical treatment.
Bowel surgery - disease (such as complications of Crohn's disease or necrotising enterocolitis) or injury may require the surgical removal of part of the small intestine.
Bowel bypass surgery - an operation to help treat morbid obesity by reducing the small intestine's ability to absorb food and the associated kilojoules. This extreme surgical procedure is rarely performed these days because of the risk of serious complications, including malnutrition, chronic diarrhoea, liver disease and kidney stones.

Intestinal adaptation
A person can lose more than 50 per cent of their small intestine before they experience problems such as malnutrition. This shows the remarkable ability of the small intestine to recover and function after disease or extensive surgery, particularly in children. This ability is called 'intestinal adaptation'. After a section of the small intestine is surgically removed and the healthy portions are sewn together, the organ dilates and grows bigger. The villi become larger, so that more food nutrients can be absorbed, and the movement of food along the small intestine (peristalsis) slows to allow more time for absorption of nutrients. The mechanisms behind this adaptation are not known, but genes are thought to play an important role. Researchers have discovered the amino acid glutamine to be important in cell regeneration after bowel resection.

Diagnostic methods
If a person has had bowel surgery, or is known to have a bowel disorder that affects absorption, the appearance of symptoms such as diarrhoea and abdominal pain suggests short bowel syndrome. This condition is common after bowel resection and can improve in time, once intestinal adaptation takes place. Some of the tests to confirm the diagnosis of short bowel syndrome may include:

Blood tests
Stool examinations.

Treatment options
Cases of short bowel syndrome that don't resolve in time need lifelong treatment. The aim of treatment is to provide symptom relief. Strategies may include:

Special diet - including high kilojoule, high nutrition, low fat and low residue foods.
Vitamin and mineral supplements.
Medications to slow peristalsis.
Bile salt-binding medications.
Medications to reduce stomach acid, if too much acid is a contributing factor.
In severe cases, a liquid diet given intravenously.
In severe cases, a small intestine transplant operation may be considered.

Small intestine transplant
Small intestine transplant operations are becoming a clinical reality, rather than experimental procedures. Since the small intestine contains lymphoid tissue, problems of rejection need to be overcome with powerful immunosuppressive drugs.

Where to get help

Your doctor
Gastroenterologist
Australian Crohn's and Colitis Association (ACCA) Tel. (03) 9726 9008

Things to remember

Short bowel syndrome refers to the malabsorption of food nutrients due to disease or surgical removal of parts of the small intestine.
Common causes of short bowel syndrome include Crohn's disease and necrotising enterocolitis.
Treatment aims to ease the symptoms and includes special diets and medications.

You might also be interested in:
Coeliac disease.
Crohn's and colitis.
Digestive system.
Gastroenteritis - giardiasis.
Irritable bowel syndrome.

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