The Small Intestine
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
Intractable diarrhoea with impaired absorption of nutrients following resection or bypass of the small intestine, ultimately leading to progressive malnutrition, is referred to as ‘short bowel syndrome’. The most common causes of short bowel syndrome are resection resulting from the management of CD and its complications (which accounts for almost half of cases), mesenteric vascular thrombosis, radiation enteritis and tumours. Although features of short bowel syndrome usually appear when there is less than 200 cm of small bowel, the length and nature of the remaining intestine are also important. In general, diseases which result in short bowel syndrome tend to preferentially affect the distal small intestine, and there is some evidence that the ileum, with its tighter intercellular junctions and consequently better fluid absorptive capacity, can assume the functions of a missing jejunum, but not vice versa. While the ileocaecal valve used to be considered important with regard to preservation of absorptive function, it is more likely that this is a reflection of the associated preservation of the distal ileum and right colon than the valve itself.
Complications of Intestinal Surgery
Stephen M. Cohn, Matthew O. Dolich in Complications in Surgery and Trauma, 2014
Short bowel syndrome may be unavoidable. It is most commonly the result of emergency resection of a large length of nonviable intestine secondary to mesenteric occlusion or midgut volvulus; it is also seen in patients with Crohn’s disease who have had multiple enterectomies, and infants following extensive resections for enterocolitis or intestinal atresia. Loss of 80% of intestinal length results in short bowel syndrome that cannot be improved with intestinal adaptation. Short bowel syndrome is caused by a length of remnant viable bowel that is not compatible with adequate enteral nutrition, resulting in malabsorption of nutrients, vitamins, and water. Current therapy is directed first at managing the early fluid and electrolyte abnormalities and maintaining adequate nutritional support, and then later, attempting to optimize intestinal adaptation through the use of enteral nutrition and gut trophic agents. Surgical techniques range from intestinal lengthening techniques to small bowel transplantation.7,8
Diarrhea in Short Bowel Syndrome
John K. DiBaise, Carol Rees Parrish, Jon S. Thompson in Short Bowel Syndrome Practical Approach to Management, 2017
Diarrhea is the predominant symptom in patients with short bowel syndrome (SBS). There are multiple underlying pathophysiologic mechanisms that interact to cause diarrhea in these patients. Diarrhea is an important problem in SBS as it may result in electrolyte disturbances, volume depletion, weight loss, and numerous nutritional deficiencies and represents an important source of frustration negatively affecting these patients’ quality of life. Indeed, when severe, diarrhea may require frequent intravenous (IV) fluid supplementation or parenteral nutrition (PN). Even in the absence of long-term PN, patients with SBS have a significantly lower quality of life in terms of social functioning and mental health in comparison with matched controls [1]. This is mainly due to the diarrhea and the resulting need for hospitalization for dehydration and management of nutritional deficiencies. In addition, SBS patients with large-volume diarrhea often decrease their oral intake to prevent high stool output or ingest increased oral fluids that result in a worsening of the diarrhea, further contributing to the detriment in their quality of life [2]. Therefore, identifying and treating the underlying cause(s) of diarrhea in these patients is essential to implement a successful management strategy. Fortunately, the majority of patients with SBS are able to control the diarrhea, at least to a degree, and maintain social functioning in the form of employment and activities of daily living [3].
Advances in non-surgical treatment for pediatric patients with short bowel syndrome
Published in Expert Opinion on Orphan Drugs, 2020
Danielle Wendel, Beatrice E. Ho, Tanyaporn Kaenkumchorn, Simon P. Horslen
Intestinal failure has been defined as the inability of the gut provide the necessary digestion and absorption of nutrients and fluids for a patient to survive with the need for intravenous supplementation to maintain health and/or growth [1,2]. Short bowel syndrome (SBS) due to loss of intestinal length is the most common cause of intestinal failure and the focus of this review. SBS etiology differs depending on age (Table 1). In children, SBS results from conditions leading to extensive intestinal resection and can be divided into prenatal, or congenital, and postnatal categories. The most common condition in children leading to extensive surgical resection and SBS is necrotizing enterocolitis [3]. In adults, more common causes of extensive bowel resection include mesenteric infarction, followed by radiation enteritis and surgical complications [4].
Oral absorption of oxycodone in patients with short bowel syndrome
Published in Scandinavian Journal of Gastroenterology, 2021
Louise Ladebo, Lars Vinter-Jensen, Johanne Hestvang, Maja Schjønning Mikkelsen, Henrik Højgaard Rasmussen, Lona Louring Christrup, Asbjørn Mohr Drewes, Anne Estrup Olesen
Short bowel syndrome is a malabsorptive disorder typically resulting from extensive surgical resection as a consequence of Crohn’s disease, mesenteric vascular disease, postsurgical complications, and/or malignancies [1,2]. It may also be a result of a genetic disorder such as microvillus inclusion disease [3]. Diarrhea, fatty stools, malnutrition, dehydration and oral drug therapy failure are common among patients with short bowel syndrome. This is partly due to insufficient adaptation with abnormal motility, hormone or epithelial adaptation that can also limit the intestinal absorptive capacity under certain circumstances [4–7]. Additionally, the syndrome is associated with significant morbidity and mortality, high health care costs and reduced quality of life [8].
Nutritional interventions and outcomes of children with short bowel syndrome in a tertiary hospital setting in South Africa
Published in South African Journal of Clinical Nutrition, 2023
BD Saayman, AJW Millar, E van Niekerk
Short bowel syndrome is a complex disorder of malabsorption requiring multidisciplinary input from paediatric surgeons, nurses and dietitians to name but a few. Multidisciplinary management is associated with improved outcomes and earlier attainment of enteral autonomy as it utilises standardised coordinated care through the use of evidence-based management protocols.33 The dietitian is an essential part of this team, especially in the guidance of appropriate PN and EN interventions. The goal of nutritional management of these patients is to support optimal nutritional status, facilitate intestinal adaptation and limit morbidity and mortality (associated with long-term PN support) by promoting enteral autonomy.
Related Knowledge Centers
- Anemia
- Dehydration
- Heartburn
- Lactose Intolerance
- Malabsorption
- Malnutrition
- Weight Loss
- Small Intestine
- Diarrhea
- Kidney Stone Disease