Treatments of Short Bowel Syndrome
How is Short Bowel Syndrome Treated
The aims of treatment for short bowel syndrome (SBS) are to promote adaptation and get the best use out of the existing bowel, maintain adequate nutritional status, and manage symptoms and complications. Complications can arise not only as a result of the underlying condition, but also in connection with treatments.
The ultimate goal is for the patient to resume daily life as well as possible. Treatment involves some combination of:
- Nutrition and dietary strategies
- Managing gastric acid secretions, bacterial overgrowth, bile salt malabsorption, and diarrhea
Treatment of short bowel syndrome begins immediately after bowel loss. It starts with restoring fluid and electrolyte balance and quickly progresses to nutritional support. Nutritional support includes individualized meal plans and may involve the use of supplements, oral rehydration solutions, enteral nutrition, or parenteral nutrition. Treatment will often include medications, and in some instances surgery. In situations where all other treatment approaches have failed, intestinal transplant is considered. The course of treatment will depend on how well the bowel is able to support individual fluid and nutrient needs.
Deciding on the Treatment
Deciding on the treatment requires knowledge about the remaining length of small bowel. This may require diagnostic testing, which usually begins with x-rays and/or an enteroscopy (using an endoscope, a thin, flexible tube with a light and a lens on the end) to examine the esophagus, stomach, and small bowel.
In the average adult, the minimal length of small bowel required so that some nutrient absorption can be anticipated is 4 feet. Usually this is counted as 4 feet of jejunum beyond the point where the duodenum ends (ligament of treitz). Parenteral nutrition is always required for remaining small bowel of less than 4 feet.
The length required for adequate fluid absorption and avoidance of dehydration will be influenced by whether or not the colon is intact. Parenteral nutrition is still required on many days for remaining bowel length of less than 10 feet.