Short bowel (short gut) syndrome is a condition caused by severe intestinal disease or the surgical removal of about one-half or more of the small intestine, according to the National Digestive Diseases Information Clearinghouse. As a result, nutrients are not properly absorbed during digestion. The main treatment for short bowel syndrome is nutritional support and an appropriate diet.
Significance
Patients diagnosed with short bowel syndrome cannot absorb adequate amounts of water, vitamins and vital nutrients necessary to sustain life. This syndrome can also cause diarrhea, leading to dehydration, malnutrition, weight loss and death without medical intervention. Short bowel syndrome can also cause food sensitivities, such as lactose intolerance.
Function
The small intestine is composed of three parts, each has an important role in digestion and nutrient absorption. Nutrient deficiencies are dependent on where the problem lies within the intestine. Iron is absorbed in the duodenum, the first section of the small intestine. The jejunum, the middle section of the small intestine, is where carbohydrates, proteins, fat and vitamins are absorbed. Finally, bile acids and vitamin B12 are absorbed in the ileum. The large intestine's role is also important as sodium, chloride and water are absorbed there.
General Features
Sugary desserts, sodas and fruit juices should be avoided to decrease risk of diarrhea, as they pull fluids into the bowel and increase the loss of nutrients. Increasing salt may be recommended depending on your bowel status. Six small meals may help nutrient absorption as well as put less strain on your shortened bowel, according to Memorial Sloan-Kettering Cancer Center. Foods should be chewed well to maximize for improved nutrient absorption.
Identification
Managing short bowel syndrome may begin with total parenteral nutrition or intravenous feeding. Once the patient can eat solid foods, the short bowel syndrome diet varies based on the patient's actual situation. Generally, patients with jejunostomies or ileostomies, with greater than 100 cm of jejunum left, should consume a higher fat diet with 50 to 60 percent of his calories, or 1000 to 1200 calories of a 2000 calorie diet, coming from fat. Carbohydrate intake should be 20 to 30 percent of total daily calories. This diet should limit fiber to less than 15 grams per day.
Patients whose colon is intact should consume a higher carbohydrate diet. The University of Virginia recommends 50 to 60 percent of calories come from carbohydrates. This patient's diet should have 20 to 30 percent of the total calories from fat. This diet should also include fiber at least 15 grams of fiber per day as part of its carbohydrate portion.
Considerations
Lactose intolerance may be precipitated by short bowel syndrome. To avoid the complications, lactose should be removed from the diet. Care should be given to prevent deficiency of calcium which could lead to osteoporosis. Fluids are often a problem for patients with small bowel syndrome. Avoid drinking fluids before and during meals. Since absorption of sodium can become a problem, the use of an oral rehydration solution may be necessary. Finally, you must limit or avoid bowel stimulants such as alcohol and caffeine. Since vitamin deficiencies may occur and vary based on the area of bowel removed, your doctor can guide you to an appropriate supplement.
References
- National Institutes of Health: Short Bowel Syndrome
- University of Virginia-Practical Gastroenterology: The Clinician's Guide to
- Canadian Medical Association Journal: Short Bowel Syndrome: A Nutritional and Medical Approach
- National Digestive Diseases Information Clearinghouse: Short Bowel Syndrome
- Cleveland Clinic: Short Bowel Syndrome Overview
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