Short Bowel Syndrome
Short bowel syndrome is the loss of intestinal absorptive surface area, which results in a
decreased ability to absorb and digest nutrients.
Causes for adults and children include Crohn’s disease, trauma, radiation, enteritis, or
ulcerative colitis. In newborns, necrotizing enterocolitis or congenital anomalies such as
omphalocele, intestinal atresia, or gastroschisis are common causes. Short bowel
syndrome also is sometimes intentional, such as following gastric bypass surgery.
The risks of short bowel syndrome
The following risks are associated with short bowel syndrome:
 Dehydration
 Electrolyte abnormalities
 Malnutrition
 Weight loss
 Excessive diarrhea and steatorrhea
 Peptic ulcer disease, gastroesophageal reflux disease, and/or proximal small bowel
inflammation often result from an inability to produce gastric inhibitory peptide;
histamine-2 receptor blockers or proton pump inhibitors often are prescribed
 Central vein catheter thrombosis or infection is reported as high as 33% in the patient
population with short bowel syndrome
 20% of patients with severe small intestine resectioning develop renal stones
 Acute and chronic complications result in morbidity in 70% of parenteral nutritiondependent patients within 5 years
 Loss of the jejunum immediately results in dramatic nutrient loss, but patients with an
intact and healthy ileum eventually will adapt to the loss within 24 months
 Loss of the ileum, particularly the distal ileum, will much more likely lead to
permanent short bowel syndrome
 Loss of the ileocecal valve leads to regurgitation of fecal matter into the small intestine,
resulting in bacterial overgrowth; D-lactic acidosis may result, with antibiotics usually
prescribed
 Ileal resection may lead to cholelithiasis and the formation of gallstones
 Liver disease occurs in many patients with short bowel syndrome, although the exact
proportion of total patients varies widely between studies (15%–65%)
 Metabolic bone disease is common
Treatment of short bowel syndrome
Treatment of short bowel syndrome includes:
 Parenteral nutrition, either as the sole or the supplemental source of nutrition (usually
necessary in the beginning, followed by enteral nutrition)
 Exogenous human growth hormone (frequently prescribed)
 Oral rehydration solutions
 Antidiarrheal drugs
 Antacids and other acid-reducing drugs during the first part of the adaptation process
 Reanastomosis (performed whenever possible)
 Intestinal transplantation for patients with no other options
Nutrition for short bowel syndrome
The following information deals with nutrition for the patient with short bowel syndrome,
and is generally divided into the acute, adaptation, and maintenance phases.
Acute phase
During the acute phase (1–3 months following resectioning), careful measurement of
intake and output is critical, and electrolyte imbalance is common. Sodium and
magnesium losses are especially significant, and normal saline with magnesium
supplementation is a valid prescription.
 Adults (normal weight) usually will require 25–35 kilocalories (kcal)/kilogram (kg)/day
 For children, intravenous (IV) lipids should make up 20%–30% of total energy needs
 Calculate protein for adults at 1–1.5 g/kg/day
 Calculate protein for children at 1.5–2.5 g/kg/day
 Calculate protein for neonates at 2.5–3.5 g/kg/day
 Measure blood glucose several times/day
Adaptation phase
The adaptation phase may last for up to 2 years following resection. The adaptive
potential depends on the area affected and the extent of damage to the bowel. Adaptation
includes changes in the functioning of the stomach, pancreas, and colon. The large
intestine is capable of overcoming the loss of the entire jejunum.
 Initiate enteral nutrition as soon as stability is reached
 Recommend elemental formulas—this is traditional, although some dietitians first
prescribe polymeric formulas and then switch to elemental, if the patient has trouble
with tolerance
 Initiate enteral nutrition and advance at a very slow rate, while still providing a
gradually reduced amount of parenteral nutrition until advanced enough to discontinue
all parenteral feedings
Maintenance phase
During the maintenance phase, total parenteral nutrition or a combination of parenteral
and enteral nutrition sometimes is necessary. Other patients will require specialized oral
supplements. If the colon is present, soluble fiber supplements often are prescribed, as are
medium-chain triglycerides.
Also consider the following:
 Thiamine deficiency is noted in patients following proximal jejunostomies and
duodenostomies—erythrocyte transketolase measurement is the recommended indicator
 Cobalamin deficiency is seen in patients with resections of their terminal ileum,
resulting in loss of 60 centimeter or more
 Fat-soluble vitamin deficiencies are common in patients suffering from steatorrhea
 Zinc supplementation often is necessary in patients with a high ostomy output
 Selenium supplementation via the parenteral solution sometimes is needed
 Magnesium supplementation sometimes is necessary, as determined by a 24-hour urine
magnesium loss test (serum concentrations may not reflect loss)
 Calcium supplementation, either in the parenteral formula or orally, is almost always
necessary
 Phosphorus supplementation generally is recommended for children
 For patients with severe diarrhea, use a diet that is low in carbohydrates and moderately
high in protein and fat
 Hyperoxaluria can result from long-term parenteral nutrition
 Some experts recommend a low-oxalate and low-citrate diet to prevent the formation of
oxalate kidney stones
 Patients with D-lactic acidosis often require a carbohydrate-restricted diet or fasting
until the condition is controlled—this population sometimes benefits from the use of
probiotics
References and recommended readings
Brizze LS. Short bowel syndrome. Available at:
http://depts.washington.edu/growing/Assess/SBS.htm. Accessed August 24, 2012.
Buchman AL. The medical and surgical management of short bowel syndrome. Available
at: http://www.medscape.com/viewarticle/474629. Accessed August 24, 2012.
Fessler TA. A dietary challenge: maximizing bowel adaptation in short bowel syndrome.
Today’s Dietitian [serial online]. 2007;1:40. Available at:
http://www.todaysdietitian.com/newarchives/jan2007pg40.shtml. Accessed August 24,
2012.
PubMed Health. Short bowel syndrome. Available at:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001284/. Accessed August 24, 2012.
Selzer CC, Kuehl SD. Short bowel syndrome. In: Pharmacotherapy Self-Assessment
Program. 5th ed. Lenexa, KS: American College of Clinical Pharmacy; 2004:95-115.
Review Date 8/12
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