How to treat short bowel syndrome

Treatment for short bowel syndrome is based on fluid, nutrient, mineral, vitamin and calorie replacement. Depending on the phase and severity of the disease, this can be done through infusions (parenteral), nasogastric tube (enteral) or dietary supplements (oral).

Short bowel syndrome: parenteral nutrition through catheters

A central venous catheter – for example, a port or a so-called Hickman catheter – is usually required for parenteral nutrition, which usually entails a particular risk of infection. Therefore, parenteral nutrition should be carried out for as long as necessary but as short as possible, especially since enteral nutrition can promote the adaptation process of the intestine.

 

Drug therapy as an adjunct

In addition to replacing food components, various medications can help improve the symptoms of short bowel syndrome :

• Active substances such as loperamide or N-butylscopolamine inhibit intestinal movement and thus lead to a longer retention time of the food in the intestine, which can reduce diarrhoea.
• Proton pump inhibitors – such as pantoprazole or omeprazole – inhibit the increased secretion of gastric acid. Alternatively, or in addition, H2 blockers such as ranitidine can be used.
• The active ingredient, cholestyramine, binds bile acids in the intestine, which can help relieve bile acid-related diarrhoea.
• The artificial hormone teduglutide promotes the absorption of nutrients in the gut and may reduce the need for nutritional IV fluids. However, side effects such as abdominal pain, nausea and flatulence can occur during treatment. Teduglutid is unavailable as a tablet but must be injected daily into the subcutaneous fatty tissue.

life expectancy different

It is difficult to make a general prognosis for patients with short bowel syndrome because life expectancy depends on various factors. Firstly, the underlying disease that requires the bowel to be removed plays a role.

On the other hand, the prognosis depends on which parts of the small intestine were removed and how long the remaining intestine is. A residual bowel length of less than one meter is considered critical – then lifelong parenteral nutrition is usually necessary.

In addition, the patient’s age, general condition concomitant diseases, and any complications influence the prognosis. In general, however, the life expectancy of patients with short bowel syndrome has increased significantly in recent years due to the optimization of parenteral nutrition therapy.

 

Phases of short bowel syndrome

The course of a short bowel syndrome is divided into three phases, which usually flow into one another:

1. Hypersecretory phase : The first phase usually begins shortly after surgery and usually lasts up to two months. During this time there is severe fluid loss and a stool volume of over two and a half liters, which is why artificial nutrition via a catheter is usually necessary.
2. Adaptation phase : The intestine can adapt to the new requirements within one to two years. The symptoms often improve and you can begin to increase your diet – if necessary using a stomach tube.
3. Stabilization phase : After the adaptation has been completed, the switch to natural food intake can usually take place slowly.

Nutritional tips for short bowel syndrome

Depending on the course of the disease, many treatment plans include a gradual switch to natural food intake starting in the adaptation phase or in the stabilization phase. We have put together tips for you on what you should pay attention to when it comes to your diet:

• Eat six to eight small meals a day to avoid overtaxing the intestines and to achieve the best possible nutrient absorption.
• Do not drink during meals, but leave at least 30 minutes between eating and drinking liquid – because liquid accelerates the passage of food in the intestines.
• Initially avoid high-fiber foods such as fibrous vegetables, legumes and raw vegetables and slowly increase the fiber content of the food.
• Dilute fruit juices with water in a ratio of 3:1 and avoid sugary  soft drinks , as the sugar “draws” water into the intestines, which can lead to diarrhea.
• First, avoid lactose and after a few weeks test what amounts you can tolerate.

Based on your symptoms and blood values, your doctor will decide whether you need additional dietary supplements to replace vitamins, trace elements or other nutrients.

Intestinal transplantation in case of severe complications

In patients who continue to lose weight despite continued parenteral nutrition, an intestinal transplant may be the last treatment option. A transplant can also be considered if complications such as blood poisoning (sepsis), liver damage, severe metabolic disorders or frequent catheter infections occur.

Depending on the patient’s concomitant diseases, only the small intestine or other organs, such as the liver, stomach, or pancreas, can be transplanted simultaneously. However, an intestinal transplant is associated with significant risks, including the necessary suppression of the immune system (immunosuppression).