Question 1

Describe the basics of GI tract anatomy and how it affects a short bowel syndrome (SBS) patient.

Accepted Answer

Patients with SBS will have varying degrees of bowel remaining. Depending upon the bowel's location and length, that remains physically or functionally will determine the ability to wean from parenteral nutrition. 
 
Digestion breaks down food into small bits that can be absorbed through the intestinal lining to reach the rest of the body. It begins in the mouth with the chewing and grinding of the teeth and continues into the stomach. The stomach secretes acid to breakdown food further. In some patients with SBS, there is gastric hypersecretion of acid because the small intestine portion that usually signals to stop acid production is resected or removed. 
 
Food then moves into the small intestine, which consists of three sections:
 
1. Duodenum: Short (about 10 inches), but an important section of the small bowel. The section in which bile and pancreatic enzymes empty to aid in digestion. Bile is made by the liver and stored in the gallbladder. Bile is needed for the digestion of fats and the absorption of fat-soluble vitamins A, D, E, and K. The pancreas also produces bicarbonate, which is vital in neutralizing the acid produced by your stomach. This is important for patients with high output who may require bicarbonate supplements due to large bicarbonate losses. The duodenum is also the primary location for the absorption of iron, calcium, and folate. 
 
2. Jejunum: The second portion of the small bowel, about 6-10 feet in an adult. Many nutrients and minerals, such as magnesium and sodium, as well as many medications, are absorbed in the jejunum. 
 
3. Ileum: Third and final portion of the small intestine, about 10-12 feet in length. This is where the last portion of nutrients and minerals will be absorbed. Important to note for SBS patients is that vitamin B12 is exclusively absorbed in the terminal ileum. If this portion of the ileum is not intact, then supplementation with B12 will be required. 
 
Ileocecal valve: This is the valve at the end of the ileum that separates the last portion of the ileum from the first portion of the colon known as the cecum. The valve helps to keep nutrients in the ileum longer for absorption, and then once the contents have moved past the valve, it keeps contents from spilling back into the small intestine. 
 
The Colon: The colon (about 5 ft. in length) serves to absorb the excess fluid and electrolytes left from the small intestine, particularly sodium and potassium. The colonic bacteria also breakdown leftover starch and fiber in the diet into short-chain fatty acids (SCFAs), which can be used as fuel for the intestinal cells. If a SBS patient has a colon, then the dietary recommendations will differ compared to a SBS patient without a colon.
 
To see an easy step-by-step process, see our digestion handout download. (javascript:void(0))

Question 2

What is short bowel syndrome (SBS)?

Accepted Answer

Short bowel syndrome (SBS) is when the body can't absorb enough fluids and nutrients because part of the small intestine is missing or isn't working correctly.

Question 3

What causes short bowel syndrome in adults?

Accepted Answer

In general, short bowel syndrome in adults is a result of surgical resection of the small intestine due to:
 • Complications from Crohn's disease
 • Volvulus
 • Mesenteric Ischemia or other vascular injury or disease
 • Thrombosis (blood clots)
 • Post-operative complications, particularly weight loss surgeries
 • Certain cancers, such as neuroendocrine tumors
 • Trauma
 • Radiation damage (radiaton enteritis) 
 • Intussusception: One section of either the large or small intestine folds into itself, much like a collapsible telescope. 
Functional causes: Motility disorders, such as chronic intestinal pseudo-obstruction (CIPO)

Question 4

What are signs and symptoms of short bowel syndrome?

Accepted Answer

• Diarrhea or high ostomy output
 • Dehydration
 • Gas and stomach pain
 • Bloating
 • Poor weight gain
 • Vomiting
 • Fatigue
 • Food sensitivities
 • Kidney stones (due to high oxalate levels)
 • Ulcers (due to gastric hypersecretion of acid, see SBS complications section)
 • Heartburn
 • Malnutrition: Results when the body does not get the right amount of vitamins, minerals, and nutrients it needs to maintain healthy tissues and organ function.
Symptoms will vary based on the underlying diagnosis. The above symptoms are in relation to malnutrition and malabsorption.

Question 5

How is short bowel syndrome diagnosed?

Accepted Answer

Multiple tests may be used to help diagnose short bowel and rule out other gastrointestinal disorders. Tests also serve to determine your nutritional status. 
 
1. Medical History
 
2. Physical Exam: During the physical exam, clinicians look for signs of malnutrition such as decreased muscle mass and other signs of vitamin and mineral deficiencies.
 
3. Bloodwork: Checks levels of vitamins, minerals, and electrolytes. Will also check certain levels to assess liver function and blood counts. 
 
4. Fecal Fat Test: This tests for fat in the stool, a sign of malabsorption and common in short bowel patients.
 
5. AbdominalX-Ray: This may be used to view dilated bowel and assess possible bowel obstruction.
 
6. Upper GI Series: This is also known as a barium swallow. It uses x rays and fluoroscopy to help diagnose problems of the upper GI tract. Fluoroscopy is a form of x-ray that makes it possible to see your internal organs' motion on a monitor. This test can help show strictures (narrowing) or dilation (widening) of areas of your intestine.
 
7. AbdominalCT Scan: This may be used to assess bowel obstruction and other intestine changes.
 
8. Endoscopy or Colonoscopy: These may be used to assess for inflammation inside your intestine as well as the length of your bowel.

Question 6

What are the goals in managing short bowel syndrome (SBS)? What are ways these goals are reached?

Accepted Answer

• Providing adequate nutrition and hydration.
 • Preventing any complications as they arise.
 • Decreasing or eliminating the need for total parenteral nutrition (TPN) and intravenous (IV) hydration.
 • Maximizing the use of the existing bowel and stimulating intestinal adaptation.
 
Intestinal rehabilitation (javascript:void(0))helps to accomplish these goals. In general, the attempt is to:
 • Increase the amount of time nutrients and fluids spend in the intestine by slowing intestinal transit.
 • Controlling the increased secretion of stomach acid, also known as gastric hypersecretion.
 • Avoiding things that can increase stool output, such as drinks or foods high in simple sugars or considered 'osmotic agents.' Even low-calorie sweeteners such as “sugar alcohols (sorbitol)” are osmotic agents.
 • Treating small intestinal bacterial overgrowth as it arises to decrease bloating and diarrhea.
 • Limit the amount of food and fluid intake if there is exceptionally high ostomy or stool output.

Question 7

What are 3 common ostomies you may have after a bowel resection?

Accepted Answer

1. Jejunostomy: This is when the second portion of the small intestine, the jejunum, is brought to the abdominal wall and empties outside of the body into a bag. 
 
2. Ileostomy: This is when the third portion of the small intestine, the ileum, is brought to the abdominal wall and empties outside of the body into a bag. 
 
3. Colostomy: This is when the colon is brought through the abdominal wall and empties outside of the body into a bag. 
 
To read more about ostomies, please visit our page here o(javascript:void(0))r go to the United Ostomy Associations of America (https://www.ostomy.org/)website.

Short Bowel Syndrome (SBS)

Short Bowel Syndrome
(SBS)