In order to explain the science behind short gut syndrome, we first need a quick anatomy refresher. 

Digestion is the process of breaking down food into substances that can be used by the body such as vitamins, minerals, protein and carbohydrates. Digestion begins in the mouth by chewing (mechanical means) and excretion of saliva (enzymatic means). Food is swallowed and travels down the esophagus to the stomach. A strong, muscular organ, the stomach mashes and moves food around further breaking it down with the help of stomach acid. The food then enters the duodenum which is the upper-most part of the small intestine. At an average of 22 feet long, the small intestine is not really small at all and where most food digestion and nutrient absorption take place. The duodenum, supplied by the liver, pancreas and gallbladder uses bile and enzymes to breakdown nutrients, proteins, carbohydrates, and fats. The duodenum is where most of the enzymatic activity takes place. The food then enters the jejunum, the middle portion of the small intestine where the primary function is to absorb water, sugars, amino acids, and fatty acids into your bloodstream to either be used or stored. The last stretch of the small intestine is called the ileum. The function of the ileum is mainly to absorb vitamin B12, bile salts, and any products of digestion that were not absorbed by the jejunum. Lastly, your food enters the large intestine which is actually much shorter in length than the small intestine. At an average of 5 feet long, the large intestine includes the cecum and ascending colon, transverse colon, descending colon, and sigmoid colon. By the time food reaches the large intestine, most nutrients and 90% of water has been absorbed by the blood stream. The large intestine is responsible for breaking down indigestible food material and producing the final waste product. The ascending colon absorbs the remaining water and other key nutrients from the indigestible material then the descending colon stores the final waste product. The sigmoid colon contracts to increase the pressure inside the colon, causing the waste to move into the rectum until excretion. Your body relies on all of the products extracted from food in order to function. So damage, malfunction or disruption to the small intestine can significantly interfere with overall health.

So what is short bowel syndrome also known as short gut? 

According to the NIH, short bowel syndrome is a group of problems related to poor absorption of nutrients that occur in our intestines. People with short bowel syndrome cannot absorb enough water, vitamins, minerals, protein, fat, calories, and other nutrients from food. 

Causes of SBS

• Portions of the small intestine have been surgically removed. Conditions that may require surgical removal of large portions of the small intestine include Crohn’s disease, cancer, traumatic injuries and blood clots in the arteries that provide blood to the intestines.
• Portions of the small intestine are missing or damaged at birth. Babies may be born with a short small intestine or with a damaged small intestine that must be surgically removed.

Symptoms of SBS

Symptoms and intensity depend on the severity and location of damage or absence of portions of the small intestine but according to the NIH, the main symptom is diarrhea and nutritional deficiencies are common. Diarrhea can lead to dehydration, malnutrition, and weight loss. Dehydration means the body lacks enough fluid and electrolytes. Malnutrition is a condition that develops when the body does not get the right amount of vitamins, minerals, and nutrients. Both nutrition and hydration are necessary to  maintain healthy tissues and organ function. 

Other signs and symptoms include

• bloating
• cramping
• fatigue, or feeling tired
• foul-smelling stool
• heartburn
• too much gas
• vomiting
• weakness

People with short bowel syndrome are also more likely to develop food allergies and sensitivities, such as lactose intolerance. Lactose intolerance is a condition in which people have digestive symptoms such as bloating, diarrhea, and gas after eating or drinking milk or milk products.

Other complications of Short Bowel Syndrome

In addition to malnutrition, an individual with short bowel syndrome may suffer from additional complications including

• peptic ulcers
• kidney stones
• small intestinal bacterial overgrowth 

How is Short Bowel Syndrome diagnosed?

A health care provider diagnoses short bowel syndrome based on

• a physical exam that can show signs of dehydration and malnutrition 
• blood tests which can confirm electrolyte and nutrient abnormalities
• fecal fat tests can show how efficiently the bowel is processing fat
• X-ray and CT scan of the small and large intestine can show abnormalities in the intestines
• upper GI series, also called a barium swallow, uses x rays and fluoroscopy to help diagnose problems of the upper GI tract.  An upper GI series can show narrowing and widening of the small and large intestines, evidence of obstruction and changes structure in the intestines.

How is Short Bowel Syndrome treated?

A health care provider will recommend treatment for short bowel syndrome based on a patient’s nutritional needs which will vary from patient to patient. Treatment may include

• Dietary changes and nutritional support
• eating small, frequent meals
• adequate fluid intake
• nutritional supplements
• using medications to treat diarrhea
• avoiding foods that can trigger diarrhea
• avoiding high-fat foods
• avoiding caffeine
• adults should drink water, sports drinks, and salty broths as prescribed. Children are generally recommended to drink oral rehydration solutions that contain salts and minerals such as Pedialyte, Naturalyte, Infalyte, and CeraLyte
• Various oral medications such as
• medications to prevent bacterial overgrowth
• H2 blockers to treat too much gastric acid secretion
• proton pump inhibitors to treat too much gastric acid secretion
• choleretic agents to improve bile flow and prevent liver disease
• bile-salt binders to decrease diarrhea
• anti-secretin agents to reduce gastric acid in the intestine
• hypomotility agents to increase the time it takes food to travel through the intestines, leading to increased nutrient absorption
• growth hormones to improve intestinal absorption
• teduglutide to improve intestinal absorption
• Enteral nutrition- a way of delivering nutrition directly to your stomach or small intestine through a small tube called a catheter. The tube can be inserted through your nose (nasogastric tube) or passed through a small incision in the skin on your abdomen into your stomach (gastrostomy) or into your jejunum (jejunostomy).
• Parenteral nutrition. This treatment delivers fluids, electrolytes, vitamins and minerals into the bloodstream through an intravenous tube or catheter which is a tube placed into a vein usually through the chest or upper arm. .
• Surgery to alter the intestine whether that be dilation or removing diseased portions
• Intestinal transplant

People who have any signs or symptoms of severe dehydration should call or see a health care provider right away:

• excessive thirst
• dark-colored urine
• infrequent urination
• lethargy, dizziness, or faintness
• dry skin

Infants and children are most likely to become dehydrated. Parents or caretakers should watch for the following signs and symptoms of dehydration:

• dry mouth and tongue
• lack of tears when crying
• infants with no wet diapers for 3 hours or more
• infants with a sunken soft spot
• unusually cranky or drowsy behavior
• sunken eyes or cheeks
• fever

How can CareAline help people with short gut?

Short gut patients often require enteral and parenteral feedings. CareAline provides a safe way to secure tubing whether that be a sleeve for a picc line, or a wrap for central line tubing or gastric tubing. Enteral and parenteral feedings provide life sustaining nutritional and hydration support. The interruption in that  treatment can pose a serious risk to health and well-being. CareAline wraps and sleeves offer protection for you and your treatment. Access points for these lines are limited and if infection occurs, the site may not be reused at all or for a period of time. So, maintaining a line for as long as possible can increase the lifespan of a short gut sufferer relying on supplemental feedings. CareAline is proven to reduce complications like line dislodgement and infections that can lead to losing that access point sooner. For more information on CareAline line securement devices visit our store https://carealine.com/shop/

This blog is dedicated to Michael Seres –  a prominent patient advocate and patient innovator who reminded the medical community that patients need to be included in the conversation. Michael and Kezia spoke together on a panel at the Cleveland Clinic Patient Engagement Conference in 2019. His tireless advocacy and impactful innovation will continue to make the world a better place for patients all over the world. 

Resources

https://www.mayoclinic.org/diseases-conditions/short-bowel-syndrome/symptoms-causes/syc-20355091

https://www.niddk.nih.gov/health-information/digestive-diseases/short-bowel-syndrome#symptoms

https://www.niddk.nih.gov/health-information/digestive-diseases/short-bowel-syndrome#treat

Disclaimer

The information here has been obtained by the reputable sources listed above and written by a licensed nurse but are meant as talking points alone and is no substitute for treatment and advice from a licensed physician. This blog provides general information and discussions about health and related subjects. The information and other content provided in this blog, or in any linked materials, are not intended and should not be construed as medical advice, nor is the information a substitute for professional medical expertise or treatment.

If you or any other person has a medical concern, you should consult with your health care provider or seek other professional medical treatment. Never disregard professional medical advice or delay in seeking care because of research here. . If you think you may have a medical emergency, call your doctor or emergency services immediately.