Short bowel syndrome: causes and consequences

The term "short bowel syndrome" is understood to mean the effects of the loss of larger sections of the small intestine. Symptoms such as severe diarrhea and weight loss are usually particularly distressing for affected persons. As a rule, at least temporarily, an artificial diet is necessary in the treatment of the short bowel syndrome - but after a few months, a gradual switch to a natural diet can be made.

Causes: surgery and radiation

A short bowel syndrome usually arises when in one or more operations, large parts of the small intestine must be removed (structural short bowel syndrome). This may be necessary, for example, in the following diseases:

  • Crohn's disease
  • Necrotizing enterocolitis
  • Tumors of the intestine or adjacent organs
  • Lack of blood flow of the intestine - such as thrombosis or narrowing of a vessel

A so-called functional short bowel syndrome, on the other hand, occurs when portions of the small intestine are damaged to such an extent that they lose their function - for example due to radiation therapy.

Decreased nutrient uptake as a result

The loss of small bowel sections has several consequences: Firstly, depending on the affected section, there is a reduced intake of nutrients and minerals such as calcium, magnesium, iron, folic acid as well as vitamin B12 and fat-soluble vitamins.

On the other hand, more bile acids are secreted, which can cause gallstones and fat digestion is impaired.

Loss of water and salts

In addition, the residence time of the food in the intestine is shorter - as a result, not enough water is absorbed and there are frequent and fluid bowel movements. In particular, if parts of the large intestine had to be removed, the increased excretion of water and salts can lead to severe diarrhea.

Mostly then liquid and minerals (such as potassium and sodium) must be supplied in the form of infusions to avoid dehydration and disturbances in the mineral balance.

Versatile symptoms of short bowel syndrome

Small bowel losses of up to 50 percent of the length are usually well compensated. Most complaints only occur when more than half of the small intestine has been removed. Then a short bowel syndrome can express itself by the following symptoms:

  • diarrhea
  • greasy bowel movements (steatorrhea)
  • weight loss
  • Anemia or increased bleeding tendency (haemorrhagic diathesis)
  • Gallstones or kidney stones
  • Bone diseases such as osteoporosis
  • muscle cramps
  • Listlessness and exhaustion

In addition, there may be a deficiency of the lactose-splitting enzyme lactase and, as a result, lactose intolerance, which can lead to spasmodic pain and diarrhea after consuming dairy products.

Short bowel syndrome in children

In newborns congenital malformations (atresia) of the intestine are often the cause of a short bowel syndrome. In addition, a bowel twist (Volvolus) or a so-called necrotizing enterocolitis - an inflammatory bowel disease - may require the removal of large bowel incisions in infants or toddlers.

The prognosis of children with short bowel syndrome is often good, because the infant intestine has a considerable adaptability. However, an individually adapted nutritional therapy is particularly important, because malnutrition can lead to a failure to thrive: Affected children are then clearly too easy and too small for their age.

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