Nutrition Strategies for Managing Short Bowel Syndrome
Nutrition strategies aim to prevent malnutrition and dehydration, and maintain the best possible nutrition status. This may include oral eating, enteral nutrition, and parenteral nutrition. All methods may be used by patients in their homes. Nutrition support specialists (registered dietitians, nurses, doctors) play a key role in helping manage short bowel syndrome (SBS). Nutrition specialists will tailor the approach used to each person according to their individualized needs and provide detailed dietary guidelines. Nutritional needs may change over time.
Oral eating is preferred whenever possible. Recommended diet components and balance of nutrients will vary in each person with SBS. A number of factors influence this including the resection site(s) and remaining bowel.
In the majority of people with short bowel syndrome the colon is intact. The general dietary guidelines for those with a colon involve a low fat, high carbohydrate diet. A diet that includes chopped, ground, or well chewed nutrient rich foods, with small frequent meals (up to 6-8 per day) is recommended. Fluids should be taken in between meals rather than with meals.
Concentrated sweet foods and liquids should be avoided; and foods high in oxalate limited to avoid kidney stones. Lactose restriction may help some individuals, as well as limiting alcohol, and caffeine.
With greater stool losses recommendations are for beverages formulated to replace fluid and electrolytes (isotonic). Oral rehydration solutions contain specific amounts of sodium, carbohydrate, and water, which increase fluid absorption in the small bowel.
Salty meals and/or snacks, plus a soluble fiber supplement can be helpful when the absorptive colon segment is present. In addition, a probiotic supplement and multivitamin and mineral supplements may also be advised. A supplement of pancreatic enzymes is often used to aid in digestion and help prevent gas and passing fat in stools (steatorrhea) when other measures are not effective. The type and dose of supplement advised will depend on the site and extent of surgical resection.
Enteral nutrition is used when oral eating does not supply adequate nutrition. Enteral nutrition involves the delivery of liquid food to the stomach or small intestine through a feeding tube. While not without risks, it is associated with fewer complications than parenteral nutrition.
Both enteral nutrition and oral eating stimulate the remaining intestine to function better (adaptation). This may allow patients to avoid or discontinue parenteral nutrition.
The length of remaining and functioning small intestine is a key factor. The length needed for adequate absorption will be influenced by whether or not the colon is intact. When nutritional goals cannot be met by other means, the medical management will likely rely on long-term use of parenteral nutrition.
Removal of up to 50% of total small bowel is generally well tolerated from the standpoint of maintaining nutritional requirements. If greater than 50% of small bowel is removed the amount of functional small bowel remaining and whether the colon is still present are the determining factors if parenteral nutrition can be avoided.
Parenteral nutrition bypasses the digestive system. It involves the delivery of fluids, electrolytes, and liquid nutrients into the bloodstream through a tube placed in a vein (intravenous or IV). It is often needed short-term after resection while the remaining bowel adapts. It may be needed long-term depending on the bowel’s ability to absorb nutrients. If there is greater than 4 feet of small bowel remaining, then attempts to go from daily parenteral nutrition to a less frequent use can be tried.
Parenteral nutrition is a complex therapy. The long-term use of parenteral nutrition significantly impacts quality of life issues such as loss of sleep, mobility, and social interactions. It also increases the risk for infections and other complications. Some complications can be life-threatening, including liver failure, vein thrombosis (blood clot), and sepsis (bloodstream infection). A specialist in nutrition support will provide detailed instructions on how to use and maintain parenteral, or enteral, nutrition.