Digestive Disorders > Lower Abdomen

Short bowel syndrome

Dr. med. Andre Sommer

Dr. med. Andre Sommer

Our small intestine is about five meters long, so it's not exactly short. The surface is also greatly enlarged by numerous indentations. This large area is necessary to absorb nutrients from the food porridge in our body. Carbohydrates, fats and proteins are among the macronutrients that are absorbed by the small intestine. They serve to generate energy. But even smaller vitamins and trace elements, or micronutrients, find their way into our body through the small intestine. Water, minerals and short-chain fatty acids, on the other hand, are also absorbed in the large intestine. If the small intestine function is damaged or a part of the intestine is surgically removed (small intestine resection), short bowel syndrome can occur.

What is short bowel syndrome?

In the past, short bowel syndrome was defined by the length of the bowel. If the small intestine is 100 to 150 centimeters long, a short bowel syndrome was suspected. Now the clinical picture is described by the actual loss of function of the intestine. If the shortened intestine leads to poor nutrient absorption and a disturbance in the import and export of liquids (liquid balance), short bowel syndrome is present. In addition to diarrhea, the lack of nutrients leads to rapid weight loss for those affected. If the lack of nutrients is not compensated for by other additional forms of nutrition, deficiency symptoms can occur.

The symptoms of short bowel syndrome are:

  • Diarrhea
  • Nutrient deficiency
  • Weight loss

What diseases lead to short bowel syndrome?

Short bowel syndrome often occurs after extensive removal (resection) of small intestine sections. Due to the small surface of the small intestine, nutrients are no longer adequately absorbed (intestinal failure). A surgical removal of sections of the small intestine may be necessary for various diseases. Common diseases are:

  • Abdominal artery infarction with circulatory disorder of the intestine (mesenteric infarction)
  • Crohn's disease (removal of inflammatory parts of the intestine)
  • Injuries to the abdominal organs (accidents)
  • Inflammation of the intestines after radiation (radiation enteritis)
  • Circulatory disorder due to bowel obstruction (intestinal ileus)
  • Intestinal motility disorder (intestinal pseudo-obstruction)
  • Intestinal tumor

What is the prognosis for short bowel syndrome?

The course of short bowel syndrome is individual. As a rule, however, the severity of the short bowel syndrome depends on the** residual intestinal length. In order to predict the expected nutrient restriction, the remaining length of the small intestine should be documented. The absorption of water and nutrients is the most restricted, especially in the hours after the operation. This phase is known as the hypersecretion phase. This is followed by an **adjustment phase (adaptation phase). In the adjustment phase, the remaining healthy intestine adapts to the new circumstances. The healthy intestinal cells try to increase their ability to absorb nutrients. The intestinal surface increases through growth processes. The intestine tries to compensate for the loss of length. The adjustment is very slow. The absorption capacity of the residual intestine can improve up to a year after the operation. How well this balancing works depends on several factors:

  • Extent of intestine loss
  • Section of the healthy small intestine (localization)
  • Food supply (diet advice)

Since the different sections of the small intestine have their own function, there are differences in the adjustment phase. The loss of the upper small intestine (jejunum) can be compensated for by the middle and lower sections (ileum) rather than the other way around.

Did you know?


**Vitamin B12** is absorbed exclusively in the** lower** small intestine (ileum). If this section of the intestine is removed, vitamin B12 can no longer be absorbed through food. Things are similar with **bile acids**. Bile acid loss syndrome can occur.

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What should I eat if I have short bowel syndrome?

The absorption of water and nutrients is essential for our survival. Since this ability is limited with short bowel syndrome, nutritional therapy is of great importance. A targeted diet tries to compensate for the deficiency. Immediately after the operation and in the case of severe forms of short bowel syndrome, additional nutrients and fluids must be added bypassing the intestine (parenterally). Immediately after the bowel surgery, you should eat a low-fat and low-fiber diet. Prepare the food carefully (finely chopped, steamed). If you tolerate everything well, you can slowly increase the diet. In the table you will find a list of suitable and less suitable foods for diets with short bowel syndrome.

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We recommend you keep a** food diary**. This way you can find out which foods you still tolerate well. The **Cara App** is helpful in this regard. For individual nutritional advice, contact our skilled team of nutritionists. We are glad to help you. Register here for a free consultation.
Recommended Not suitable
  • Uncarbonated water
  • Mild teas (no peppermint tea)
  • Zwieback
  • Clear broth and light soups (no tomato soup, not spicy)
  • White bread, light gray bread
  • Small amounts of butter, margarine, rapeseed oil, olive oil, linseed oil
  • Bananas, fruit compotes (without peel)
  • Plain yogurt, milk porridge
  • Mashed potatoes, rice, pasta
  • Cooked or steamed vegetables: Fennel, carrots, celery, salsify, zucchini
  • Low-fat meat
  • Fish
  • Quark, low-fat cheese
  • Raw food
  • Citrus fruits
  • Nuts, rhubarb, spinach, chard, chocolate, coffee powder, beets (contain a lot of oxalic acid: increases risk of kidney stones)
  • Fried dishes
  • Cabbage vegetables, tomatoes, legumes, cucumbers, mushrooms (flatulent!)
  • Laxative foods: Coffee, fruit juices, drinks and foods with a high sugar content
  • Sugar substitutes
  • Alcohol
  • Cigarettes

Here are a few more tips to make it easier for you to change your diet:

Nutrition tips:
Eat six to ten smaller meals during the day. This protects your intestines and facilitates the absorption of nutrients.
Drink one hour after eating at the earliest! This extends the length of time the food porridge stays in the stomach and intestines.
Do without sweet food such as jam and honey. They can make your diarrhea worse because sugar draws water out of the intestine.
Don't consume a lot of dietary fibers! They contain little energy, cause flatulence, saturate too much and promote diarrhea.
Fat intake can lead to severe diarrhea. If this is the case, you can fall back on medium chain fatty acids (MCT fats). You can find these as MCT margarine or MCT oil in stores.

How do you treat short bowel syndrome?

The described nutritional therapy is of great importance. However, if the remaining portion of the small intestine is very short (shorter than 100 centimeters), nutrient intake cannot be guaranteed via normal food intake (orally). Then additional nutrients must be supplied via enteral feeding tubes. In some cases, nutrition bypassing the intestine (parenterally) is necessary. Depending on the adaptability of the intestine, this artificial diet can also be eliminated over time. Of great importance in all forms of nutrition, is regulating hydration. This counteracts dehydration. Because of the frequent diarrhea, more water is lost than can be drunk. The diarrhea also means that important minerals (electrolytes) such as sodium, potassium and magnesium are lost. These must be replaced. The following are suitable food supplements:

  • Potassium tablets, bananas
  • Mineral-rich “sports drinks” such as Isostar® and Gatorade®
  • Medical fluid solution such as Elotrans® and Pedialyt®
  • High-dose magnesium supplements such as Magnetrans Forte
  • High-calorie supplementary food for weight loss such as Duocal®, MaltodextrinC®, Peptamen®, Elemental 028® and modules IBD®

    Did you know?

    Enteral nutrition is nutrition using the intestines. In** parenteral nutrition**, nutrients are supplied through the vein. In short bowel syndrome, these forms of nutrition are also used in combination.

How do I treat my diarrhea if I have short bowel syndrome?

In addition to the above measures to compensate for the loss of fluid and electrolytes in the case of diarrhea, there are several **medications **to treat diarrhea. These medications should only be taken in consultation with your doctor. The costs of the dietary supplements are partially covered by the health insurance companies when short bowel syndrome is noted on the prescription.

Medication Effect Application
Loperamide Inhibits diarrhea

Slower intestinal passage improved absorption of nutrients, water and minerals

A maximum of four times 1 to 2 milligrams a day
Tinctura opii

Drops

Inhibits diarrhea Three times 4 drops to three times 12 drops daily
Cholestyramine

Powder: Quantalan®

Chewable tablets: Lipocol ®

bindsBbile acids in the large intestine, which causes diarrhea there (when removing the small intestine) 2 to 4 grams one to three times a day

An hour before or after taking other medication

Sodium bicarbonate Alkaline bases against acidification
Zinc compounds Improves the adaptability of the intestine, skin symptoms and nail damage
Selenium supplements

Tablet (selenase)

With selenium deficiency, controversial positive effects Ten days to three weeks: 300 micrograms of selenium daily

Then: 100 micrograms daily

Iron supplements With iron deficiency Intravenous preparations!

(Tablets, coated tablets and drops are poorly absorbed)

Edler, J., Eisenberger, A.M., Hammer, H.F., Hütterer, E. and Pfeifer, J., 2004. Das Kurzdarmsyndrom-Teil 3: Ernährungsmedizinische und medikamentöse Therapie. Journal für Gastroenterologische und Hepatologische Erkrankungen, 2(2), pp.27-35. Downloaded on 22.08.2018 from: https://www.kup.at/journals/summary/4333.html

Vanderhoof, J.A., 1996. Short bowel syndrome. Clinics in perinatology, 23(2), pp.377-386. Downloaded on 22.08.2018 from: https://www.perinatology.theclinics.com/article/S0095-5108(18)30247-1/abstract

Dr. med. Andre Sommer

Dr. med. Andre Sommer

I’m André, a medical doctor from Berlin. Together with a team of medical doctors, nutritionists and data scientists we empower people to understand digestive issues with our app Cara.

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