Treatment of Short Bowel Syndrome

How do doctors treat short bowel syndrome?

Doctors treat short bowel syndrome with nutrition support, fluids and electrolytes, medicines, and surgery. The goals of treatment are to

• make sure you get enough nutrients.
• prevent complications.
• reduce your need for parenteral nutrition, in which you receive intravenous (IV) nutrients. Long-term parenteral nutrition increases the risk for complications.

Nutrition support

The main treatment for short bowel syndrome is nutrition support. The type and amount of nutrition support you need may depend on what stage your short bowel syndrome is in and how severe the syndrome is.

Your doctor may refer you to a registered dietitian to help make sure you get enough nutrients. Ask your doctor about the cost of a registered dietitian’s services. If you have health insurance, check your insurance company’s website or call customer service to find out if they will pay for some or all of these services.

Acute stage

The first stage of short bowel syndrome is the acute stage. This stage often lasts about 3 to 4 weeks.² However, the length of this stage varies from person to person.

In the acute stage, most people have intestinal failure, meaning the small intestine cannot absorb enough nutrients to maintain health or to support growth in children. During this stage, your doctor may recommend

• parenteral nutrition, in which you receive nutrients through an IV inserted into a vein.
• enteral nutrition, in which you receive liquid food through a tube inserted into the stomach or small intestine. The tube may be inserted through your nose or through the wall of your abdomen.
• eating and drinking small amounts. For infants and young children, eating and drinking as soon as they are able to may prevent problems with eating and drinking later in life.

Receiving enteral nutrition or eating and drinking can help your intestines heal.

The main treatment for short bowel syndrome is nutrition support, including parenteral nutrition.

Adaptation stage

The second stage of short bowel syndrome is the adaptation stage. During this stage, your remaining intestines adapt, or change to work better. In adults with short bowel syndrome, the adaptation stage lasts about 2 years.³ In children, the adaptation stage may last longer.³

How well your remaining intestines adapt may depend on

• how much of the small intestine you have and how healthy it is
• which parts of the small intestine were removed or are diseased or damaged
• whether part or all of the large intestine was removed

As your intestines adapt and absorb more nutrients, your doctor or dietitian may recommend

• more enteral nutrition
• more foods and drinks
• less parenteral nutrition, or, if your intestines adapt enough, stopping parenteral nutrition

As you reduce or stop parenteral nutrition, you may also need vitamin or mineral supplements. For safety reasons, talk with your doctor before using dietary supplements or any other complementary or alternative medicines or practices.

Maintenance stage

The last stage of short bowel syndrome is the maintenance stage. When your intestines have stopped adapting, you are in the maintenance stage. If your intestines still cannot absorb enough nutrients to keep you healthy, this condition is called chronic intestinal failure. Your doctor may recommend long-term parenteral nutrition or surgery to treat chronic intestinal failure.

Fluids and electrolytes

Short bowel syndrome can lead to dehydration, which means your body doesn’t have enough fluids and electrolytes to work properly. To prevent dehydration, doctors may recommend

• IV fluids and electrolytes. As your intestines adapt and absorb more fluids and electrolytes, you may need to get less of these nutrients through an IV.
• oral rehydration solutions—special drinks that contain glucose and electrolytes.

Talk with your doctor about what you should drink and what drinks you should limit or avoid. Doctors may recommend

• avoiding sugary drinks, such as sodas and fruit juices. These drinks can make dehydration worse.
• in some cases, limiting drinks that have low amounts of glucose and electrolytes, such as water, tea, or coffee. Drinking too much of these liquids may make dehydration worse, especially if your colon has been removed.

Medicines

Doctors may recommend or prescribe medicines to help treat short bowel syndrome, including

• proton pump inhibitors or H2 blockers, which lower the amount of acid the stomach makes
• medicines that help relieve symptoms, such as diarrhea
• medicines, such as glucagon-like peptide-2 (GLP-2) analogs, which help increase the amount of nutrients your intestines can absorb

Surgery

In some cases, doctors recommend surgery to help treat short bowel syndrome. Doctors may recommend surgery to

• place a tube, called a catheter, in a vein to provide parenteral nutrition and IV fluids
• place a feeding tube through the abdominal wall and into the stomach or small intestine to provide enteral nutrition
• repair or remove damaged areas or other problems in the intestines
• lengthen or change the structure of the intestines to help them absorb more nutrients, if other treatments don’t work

Some people with short bowel syndrome may need an intestinal transplant. Doctors may recommend an intestinal transplant for people who have chronic intestinal failure, need long-term parenteral nutrition, and develop life-threatening complications.

How do doctors prevent or treat complications of short bowel syndrome?

Treatments for short bowel syndrome also help prevent or treat many complications.

If you develop or are at risk for specific complications, your doctor may recommend other treatments. Depending on the complication, treatments may include changes to what you eat and drink, dietary supplements, medicines, or surgery.

Some people with short bowel syndrome develop intestinal failure-associated liver disease, which is liver damage due to intestinal failure and parenteral nutrition. If the liver damage is severe, doctors may recommend a liver transplant. If needed, people with short bowel syndrome may have liver and intestinal transplants at the same time.

Can doctors prevent short bowel syndrome?

In some cases, doctors can lower the risk that patients will get short bowel syndrome. For example, during a small bowel resection, surgeons can try to save as much of the intestine as possible. Surgeons may also take steps to help the remaining small intestine work better.

However, in many cases, short bowel syndrome cannot be prevented.

References