Short bowel syndrome is a malabsorption disorder caused by either the surgical removal of the small intestine or the loss of its absorptive function due to diseases. A cardiothoracic surgeon performs a mitral valve replacement at the Fitzsimons Army Medical Center. ... In biology the small intestine is the part of the gastrointestinal tract (gut) between the stomach and the large intestine. ... It has been suggested that Refractory disease be merged into this article or section. ...

In healthy adults, the small intestine has an average length of approximately 6 meters (20 feet). Short bowel syndrome usually appears when there is less than 1.8 meters (6 feet) of the small intestine left to absorb sufficient nutrients. This article does not cite its references or sources. ...

Symptoms

The symptoms of short bowel syndrome include:

• Abdominal pain
• Diarrhea
• Steatorrhea or particularly foul-odored faeces
• Oily or sticky stool
• Fluid retention
• Weight loss and malnutrition
• Fatigue

Patients with short bowel syndrome may have complications caused by malabsorption of vitamins and minerals, such as deficiencies in vitamins A, E, D, and B12, calcium, magnesium, iron, folic acid, and zinc. These may appear as anaemia, scaling of the skin or hyperkeratosis, easy bruising, muscle spasms, and bone pain. Types 5-7 on the Bristol Stool Chart are often associated with diarrhea Diarrhea (in American English) or diarrhoea (in British English) is a generally unpleasant condition in which the sufferer has frequent watery, loose bowel movements (from the ancient Greek word διαρροή = leakage; literally meaning to run through). Acute infectious... Steatorrhea (or steatorrhoea) is the formation of bulky, grey or light colored stools. ... Weight loss, in the context of medicine or health, is a reduction of the total body weight, which can mean loss of fluid, muscle or bone mass, or fat. ... Malnutrition is a general term for the medical condition caused by an improper or insufficient diet. ... The word fatigue is used in everyday living to describe a range of afflictions, varying from a general state of lethargy to a specific work induced burning sensation within muscle. ...

Causes

Short bowel syndrome in adults is usually caused by:

• Crohn's disease, an inflammatory disorder of the digestive tract
• Volvulus, a spontaneous twisting of the small intestine that cuts off the blood supply and leads to necrosis or tissue death.
• Cancer of the small intestine
• Injury or trauma to the small intestine
• Bowel bypass surgery to treat obesity, now a rarely performed surgical procedure to remove a portion of the small intestine.
• Surgery to remove diseases or damaged portion of the small intestine.

This condition can also develop in premature infants who have necrotizing enterocolitis, a serious disease where dead tissues in the lining of the small intestine needs to be surgically removed. Crohns disease (also known as regional enteritis) is a chronic, episodic, inflammatory condition of the gastrointestinal tract characterized by transmural inflammation (affecting the entire wall of the involved bowel) and skip lesions (areas of inflammation with areas of normal lining in between). ... A volvulus is a loop of the bowel whose nose has twisted on itself. ... Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these cells to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (where cancer cells are transported through the bloodstream or lymphatic system). ... Necrotizing enterocolitis (NEC) is a medical condition primarily seen in premature infants, where portions of the bowel undergo necrosis (tissue death). ...

Treatments

Symptoms of short bowel syndrome are usually addressed by prescription medicine. These include:

• Anti-diarrheal medicine
• Vitamin and mineral supplements
• H2 blocker and proton pump inhibitors to reduce stomach acid
• Lactase supplement
• Surgery, including intestinal lengthening, tapering, and organ transplant.
• Parenteral nutrition (or nutrition administered via intravenous line).
• Nutrition administered via Gastronomy Tube

Proton pump inhibitors (or PPIs) are a group of drugs whose main action is pronounced and long-lasting reduction of gastric acid production. ... Lactase is a member of the β-galactosidase family of enzyme: enzymes that hydrolysis β 1,4 bonded attachments off of galactose. ... An organ transplant is the moving of a whole or partial organ from one body to another (or from a donor site on the patients own body), for the purpose of replacing the recipients damaged or failing organ with a working one from the donor site. ...

Intestinal adaptation

Short bowel syndrome caused by the surgical removal of a portion of the bowel may be a temporary condition, due to the adaptive property of the small intestine.

In a process called intestinal adaptation, physiological changes to the remaining portion of the small intestine occur to increase its absorptive capacity. These changes include:

• Enlargement and lengthening of the villi found in the lining
• Increase in the diameter of the small intestine
• Slow down in peristalsis or movement of food through the small intestine

Villi (singular: villus) are tiny, finger-like structures that protrude from the wall of the intestine to help absorb nutrients in the lumen. ...

Prognosis

There is no cure for short bowel syndrome. In newborn infants, the 4-year survival rate on parenteral nutrition is approximately 70%.

Although promising, small intestine transplant has a mixed success rate, with postoperative mortality rate of up to 30%. One-year and 4-year survival rate are 90% and 60%, respectively.

A new surgical procedure called serial transverse enteroplasty(STEP) shows promise in lengthening dilated short bowel. STEP is usually performed by pediatric surgeons at quaternary hospital who specialize in small bowel surgery.

External links

• eMedicine - Short Bowel Syndrome
• Better Health Channel - Short Bowel Syndrome
• Health In Plain English - Short Bowel Syndrome
• National Digestive Diseases Information Clearinghouse - Short Bowel Syndrome
• Short Gut Wiki (pediatric focus)