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A condition called short bowel syndrome is rare. Medical statistics show that in Poland 6 people suffer from it for every million inhabitants. In the world, and especially in highly developed countries, the incidence of the disease is higher – e.g. in the USA, 40 people per million suffer from short bowel syndrome.
The essence of the short bowel syndrome is that a smaller or larger fragment of the small intestine ceases to function. This condition may occur as a result of another bowel disease or after surgical removal of a portion of the small intestine. The consequence of this is extremely dangerous for our body, significantly limited absorption of nutrients from food. Impaired absorption of water and nutrients leads to water and electrolyte deficiencies, i.e. not only malnutrition, but also disorders in the proper functioning of individual organs. This is because, for example, the heart cannot function properly without regular supplies of magnesium or potassium. Without calcium supplies, bones weaken, leading first to osteopenia and later to osteoporosis.
Great bowel work
Why is the efficiency of the small intestine so important for our body? Simply put – they absorb the nutrients needed by every cell in our body. How does it happend?
Food crushed and softened by saliva goes to the stomach. The pancreas and stomach produce digestive enzymes – including pepsin, which is responsible for digesting proteins, and lipase, which starts the digestion of fats. Once the enzymes have fulfilled their role, the food content is moved to the duodenum – the first segment of the small intestine. The small intestine is the main site where digestion and absorption take place. In adults, the small intestine is approximately 7 meters long. It stretches from the stomach to the junction with the large intestine. It is divided into three sections – duodenum, jejunum and ileum.
The final digestion and absorption of proteins, carbohydrates, fats and other components takes place in the duodenum and the first 120-150 cm of the jejunum. About 7 liters of digestive juices get into the small intestine, apart from the fluids drunk, but only 80 percent. the fluid is absorbed. Water-soluble vitamins are absorbed in the duodenum, calcium, iron, magnesium, zinc, phosphorus, amino acids and peptides, fatty acids, fat-soluble vitamins, simple sugars, water and electrolytes are absorbed in the jejunum. In the ileum, bile salts, vitamin B12 and a group of fat-soluble vitamins are absorbed, e.g. A, D, E, K.
This short description shows the great and important role of the small intestine in the entire functioning of our body. If the nutrients cannot be absorbed by the intestine, the patient becomes emaciated and, consequently, dies.
The culprit list
The most common causes of the short bowel syndrome are necrosis of the small intestine, caused by vascular disorders such as embolism or arterial or venous thrombosis. Surgery to remove a part of the small intestine that had to be performed due to Crohn’s disease or an injury, e.g. as a result of a road accident, is in second place. Another cause is severe malabsorption due to refractory celiac disease or inflammation of the intestine following irradiation.
Specialists emphasize that it is quite difficult to determine how long a properly functioning section of the small intestine should be so that all important nutrients are absorbed in the right proportions. Much depends on the general condition of the patient, the type of underlying medical condition and the efficiency of the rest of the intestine.
What are the symptoms of the disease
Doctors divide them into two basic groups – early and late.
The early symptoms include long-term diarrhea, which causes fluid and electrolyte disturbances, dehydration, acidosis, malnutrition and nutritional deficiencies, and cachexia. Late complications include gastric and duodenal ulcer disease, lactic acidosis, nephrolithiasis and gallstones, liver failure, cardiac arrhythmias, iron deficiency anemia, coagulation disorders, tetany, osteopenia and osteoporosis, as well as mental disorders.
Simple diagnosis, difficult treatment
It is not difficult for a doctor to diagnose short bowel syndrome. Usually, they are made with knowledge of the patient’s underlying disease or a description of an operation in the course of which a specific section of the small intestine was removed. The symptoms accompanying the disease are also always taken into account – in this case long-term diarrhea.
To be sure, blood counts, blood chemistry (determination of the concentration of important micronutrients – magnesium, zinc, selenium), a general urine test, and a daily urine collection are also ordered.
Treatment of short bowel syndrome is long and not always fully successful. They are divided into 3 important periods.
1. Postoperative period. The main task of doctors then is to compensate for fluid and electrolyte deficiencies as quickly as possible. This is not an easy task because the patient loses fluid from the body not only when sweating or urinating, but also due to frequent diarrhea. An important element of the therapy is the prevention of peptic ulcer disease, which is promoted by the excessive secretion of hydrochloric acid in the stomach, which is characteristic of the short bowel syndrome. Patients usually take proton pump inhibitors to protect the gastric mucosa and drugs that inhibit peristalsis, i.e. stop diarrhea. In order to protect the patient from malnutrition, parenteral nutrition, i.e. intravenous administration of nutrients, is used.
To improve the functioning of the intestine, enteral nutrition is required, which is administered through a gavage or gastrostomy. If the patient is able to eat even a small amount of food normally, this is used to avoid enteral nutrition, which can cause diarrhea.
2. The adaptation period. During this period of treatment, the patient consumes more and more food orally, but the portion size depends on the disease that caused the short bowel syndrome, the patient’s age and, above all, the condition (condition and efficiency) of the mucosa in the rest of the intestine.
3. The period of long-term treatment. If the short bowel syndrome has been severe, it may turn out that the only form of treatment is parenteral administration of the main nutrients.
The current state of medical knowledge does not allow for a complete cure of the short bowel syndrome. But with proper medical care, it is possible to adapt the left section of the intestine to new tasks. Even when a significant fragment of the diseased intestine has been removed during the operation, favorable for the patient changes already two days after the surgery. First of all, intestinal villi grow and the intestinal crypts deepen, which facilitates the absorption of nutrients and water by the intestine. In other words, the intestinal absorption area is increased. In addition, it is possible to secrete intestinal hormones, which improves the peristalsis of the gastrointestinal tract and protects against the multiplication of bacteria and fungi. The bowel adaptation to new tasks is most effective in young children, and slowest in the elderly.
What future?
After leaving the hospital and establishing the appropriate nutritional treatment, each patient must remain under the care of a specialized parenteral and enteral nutrition clinic, which employs surgeons, gastroenterologists, nutritionists, internists, nurses and properly trained social workers. Care for the sick person must be comprehensive in order to prevent malnutrition. The patient himself has to come for regular checkups and pay attention to fluctuations in body weight. Any loss of weight can be a signal of deteriorating health. Regular blood tests are also important to prevent micronutrient and macronutrient deficiencies that can cause serious ailments, for example, of the heart. It is necessary to control the level of glycaemia and, in the case of insulin deficiency, to supplement it.
Careful supervision over the health of people with short bowel syndrome is extremely important for the further fate of the patient.