SHORT

APPLIED
CLINICAL
BOWEL
NUTRITION SYNDRO
ME

SUBMITTED BY – DILSHAD TASNIM & KEERTHANA.A

REG NO – RA2322032010006 & RA2322032010012
M.Sc. CND (1st Year)
 OUTLINE
1. INTRODUCTION
2. CAUSES & symptoms
3. DIAGNOSIS
4. complications
5. TREATMENT
6. DIETARY MANAGEMENT
 RDA ( RECOMMENDED DIETARY ALLOWANCES)
 Food sources
7. Conclusion
8. References

Introduction
Short bowel syndrome is a condition that develops when the small intestine, also called the
small bowel, is shortened or damaged and cannot absorb enough nutrients from the foods
you eat to maintain health. The small intestine is where most of the nutrients you get from
foods are absorbed by your body during digestion. Short bowel syndrome may be mild,
moderate, or severe, depending on how well the small intestine is working. The amount of
remaining GI tract required to maintain acceptable digestive and absorptive capacity
depends on a number of factors, including the age of individual, the original reason for the
resection, which portions of the GI tract remain, and the health of the remaining GI tract.

CAUSES & SYMPTOMS

Common signs and symptoms of short bowel syndrome may include:

 Diarrhoea
 Greasy, foul-smelling stools
 Fatigue
 Weight loss
 Malnutrition
 Swelling (oedema) in the lower extremities

DIAGNOSIS
A diagnosis of short bowel syndrome is made based upon a detailed patient
history, a thorough clinical evaluation and a variety of specialized tests
including laboratory tests and X-ray studies.

 Clinical Testing and Work-Up

An important laboratory test is a complete blood count (CBC), which is used
to check for anaemia. Additional laboratory tests may be performed to assess
the levels of albumin, which may indicate poor nutritional status when low and
dehydration when high; liver enzymes, which may indicate liver cell damage
when persistently elevated; electrolyte abnormalities, which may indicate
deficiencies or dehydration; and creatinine, which indicates function of the
 kidneys. Laboratory tests may also be used to detect deficiencies of vitamins
or minerals, which can occur with short bowel syndrome.

 Imaging techniques may be used to assess individuals with short bowel

syndrome. Such tests include plain abdominal X-rays to detect signs of
obstruction or ileus (paralysis of intestinal muscles), computerized
tomography (CT) scanning of the abdomen (abdominal CAT scan), magnetic
resonance imaging (MRI) of the abdomen or an abdominal ultrasound. During
CT scanning, a computer and X-rays are used to create a film showing cross-
sectional images of certain tissue structures. An abdominal CAT scan enables
physicians to identify problems such as bowel obstruction and assess the
health of the liver. An abdominal ultrasound may be used to detect biliary
sludge or gallstones, which are often associated with short bowel syndrome.
An upper gastrointestinal series (an x-ray that examines the upper and middle
portion of the gastrointestinal system) with a small bowel follow through and
abdominal MRI (imaging which does not involve radiation exposure), allows
physicians to detect areas of stricture (narrowing) or abnormal connections
(fistulas) within the small bowels and assess the health of the lining of the
small bowel.

 Additional tests may be performed to detect or assess potential complications

of short bowel syndrome. For example, a liver biopsy may be performed to
assess the health and function of the liver. Upper and lower endoscopic
studies may also help in the evaluation of the function of the remaining
intestine.
COMPLICATION

Nutrition complications
In people with short bowel syndrome, the small intestine can’t absorb enough water, vitamins,
minerals, protein, fat, calories, and other nutrients from foods and drinks, a condition
called malabsorption. Malabsorption can lead to

 dehydration
 low levels of certain vitamins and minerals
 malnutrition
 problems with growth and development in infants and children

Digestive tract complications

Short bowel syndrome and its treatment can affect how the digestive tract works, leading to
complications such as
  lactose intolerance, a condition in which you have bloating, diarrhea, and gas after
you consume foods or drinks that contain lactose
 small intestinal bacterial overgrowth, an increase in the number of bacteria or a
change in the type of bacteria in the small intestine
 problems with the movement of food through the digestive tract, which can lead to
small intestinal bacterial overgrowth and chronic inflammation in the small intestine
 too much stomach acid, which may occur for 6 to 12 months after a small bowel
resection and can lead to peptic ulcers1

Other complications
Short bowel syndrome and treatment with parenteral nutrition may lead to complications in other
parts of the body, including

 bone problems, such as osteoporosis NIH external link or low bone mass , also called osteopenia
NIH external link

 gallstones—hard, pebblelike pieces of material that form in your gallbladder

 intestinal failure-associated liver disease—liver damage related to intestinal failure
and long-term parenteral nutrition
 kidney stones—hard, pebblelike pieces of material that form in one or both of
your kidneys
 problems related to the tube, called a catheter, that is inserted into a vein to provide
parenteral nutrition
TREATMENT
Doctors treat short bowel syndrome with nutrition support , fluids and electrolytes, medicines,
NIH external link

and surgery. The goals of treatment are

 make sure you get enough nutrients.

 prevent complications.
 reduce need for parenteral nutrition, in which they 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 need may depend on what stage short bowel syndrome is in and how severe
the syndrome is.

Doctor may refer to a registered dietitian to help make sure they get enough nutrients.

Acute stage

The first stage of short bowel syndrome is the acute stage. This stage often lasts about 3 to 4
weeks. 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,
remaining intestines adapt, or change to work better. In adults with short bowel syndrome, the
adaptation stage lasts about 2 years. In children, the adaptation stage may last longer.

Remaining intestines adapt may depend on

 how much of the small intestine they 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 the intestines adapt and absorb more nutrients, doctor or dietitian may recommend

 more enteral nutrition

 more foods and drinks
 less parenteral nutrition, or, if the intestines adapt enough, stopping parenteral
nutrition
As we reduce or stop parenteral nutrition, they also need vitamin or mineral supplements. For
safety reasons, talk with doctor before using dietary supplements or any other complementary
NIH external link

or alternative medicines or practices.

NIH external link

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 body doesn’t have enough fluids
and electrolytes to work properly. To prevent dehydration, doctors may recommend

 IV fluids and electrolytes. As the intestines adapt and absorb more fluids and
electrolytes, they may need to get less of these nutrients through an IV.
 Oral rehydration solutions—special drinks that contain glucose and electrolytes.

Talk with doctor about what they should drink and what drinks 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 the 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.

DIETARY MANAGEMENT

Short Bowel Syndrome (SBS) is a condition that occurs when a significant portion of
the small intestine is surgically removed or is missing congenitally, leading to
malabsorption of nutrients. Dietary management plays a crucial role in supporting
individuals with Short Bowel Syndrome. The primary goals are to optimize nutrient
absorption, prevent malnutrition, and maintain overall health. Here are some general
dietary guidelines and recommended dietary allowances (RDA) for key nutrients for
individuals with Short Bowel Syndrome:

1. Small, Frequent Meals:

 Instead of three large meals, encourage multiple smaller meals throughout the
day. This helps in better absorption of nutrients.
2. Nutrient-Dense Foods:
 Focus on nutrient-dense foods to ensure that the body gets the necessary
vitamins and minerals. Include lean proteins, whole grains, fruits, and vegetables.
3. Protein Intake:
 Adequate protein is essential for tissue repair and overall health. Include protein-
rich foods such as lean meats, poultry, fish, eggs, dairy products, and plant-
based protein sources.
4. Fluids and Electrolytes:
 Due to the shortened intestine, individuals with SBS may have difficulty absorbing
fluids and electrolytes. Stay hydrated and consider electrolyte-rich beverages or
oral rehydration solutions.
5. Supplements:
 Depending on individual needs, supplements may be necessary. This can include
vitamins (especially fat-soluble vitamins A, D, E, and K), minerals, and other
nutrients. Consult with a healthcare professional to determine specific
supplement requirements.
6. Fat Intake:
 Monitor fat intake, as some individuals may have difficulty digesting and
absorbing fats. Medium-chain triglycerides (MCTs) are sometimes better
tolerated than long-chain fats.
7. Avoid Certain Foods:
 Limit or avoid high-fiber foods, as they can exacerbate diarrhea. Also, limit the
intake of foods that may be difficult to digest, such as certain raw vegetables and
tough meats.
8. Lactose Intolerance:
 Some individuals with SBS may develop lactose intolerance. Monitor dairy intake
and consider lactose-free alternatives.
9. Monitoring and Adjusting:
 Regular monitoring of nutritional status is crucial. Adjust the diet as needed
based on the individual's response, nutrient levels, and overall health.
10. Collaboration with Healthcare Professionals:
 Work closely with a healthcare team, including a registered dietitian, to create a
personalized dietary plan. Regular follow-ups with healthcare professionals are
essential for ongoing monitoring and adjustments.
11. Parenteral Nutrition:
 In severe cases, individuals with SBS may require parenteral nutrition, where
nutrients are delivered directly into the bloodstream. This is typically done under
the supervision of healthcare professionals.
FOOD SOURCES

1. Protein:

 Sources: Lean meats, poultry, fish, eggs, dairy products, tofu, legumes,
and protein supplements.

2. Fat:

 Sources: Healthy fats from olive oil, avocados, nuts, seeds, and fatty
fish like salmon. Medium-chain triglycerides (MCT) oil may be
beneficial as it is absorbed more easily.

3. Carbohydrates:

 Sources: Whole grains, fruits, vegetables, and legumes. Choose easily

digestible carbohydrates, and consider avoiding large amounts of high-
fiber foods if they cause discomfort.

4. Vitamins and Minerals:

 Include a variety of fruits and vegetables to ensure a broad spectrum of

vitamins and minerals.

 Consider supplementation if there are deficiencies, but consult with a

healthcare professional for personalized advice.

5. Electrolytes:

 Consume foods rich in potassium, sodium, and magnesium. Bananas,

potatoes, tomatoes, and oranges are good sources.

6. Calcium:

 Sources: Dairy products, fortified plant-based milk, tofu, and green

leafy vegetables.

7. Vitamin D:

 Sources: Fatty fish, egg yolks, and fortified foods. Sun exposure is also
a natural source of vitamin D.
8. B12:

 Since B12 absorption may be compromised, consider B12

supplementation or B12-fortified foods like fortified cereals, nutritional
yeast, or B12 supplements.

9. Fluids:

 Stay well-hydrated. Sip on water throughout the day and consider oral
rehydration solutions if needed.

10. Small, Frequent Meals:

 Due to potential malabsorption, it may be beneficial to eat smaller,

more frequent meals throughout the day.
 RDA (2012)

CONCLUSION
Short bowel syndrome is a complex disease that occurs due to the physical loss or
the loss of function of a portion of the small and/or large intestine. Consequently,
individuals with short bowel syndrome often have a reduced ability to absorb
nutrients such as fats, carbohydrates (sugars) vitamins, minerals, trace elements
and fluids (malabsorption). The specific symptoms and severity of short bowel
syndrome vary from one person to another. Diarrhoea is common, often severe and
can cause dehydration, which can even be life threatening. Short bowel syndrome
can lead to malnutrition, unintended weight loss and additional symptoms may be
due to the loss of essential vitamins and minerals. There is no cure, but the disorder
usually can be treated effectively. However, in some cases, short bowel syndrome
can lead to severe, disabling and life-threatening complications. Short bowel
syndrome is most commonly associated with the surgical removal (resection) of half
or more of the small intestine. Such surgery is performed to treat intestinal diseases
such as Crohn’s disease, injury or trauma to the small bowel, or congenital birth
defects. The presence or absence of the large intestine (colon) also plays an
important role in the genesis and/or treatment of the short bowel syndrome.

REFERENCES
1. https://rarediseases.org/rare-diseases/short-bowel-syndrome/
2. [1] DiBaise JK, Sudan D. Chapter 67: Short bowel syndrome and small bowel transplantation. In:
Podolsky DK, Camilleri M, Fitz JG, Kalloo AN, Shanahan F, Wang TC, eds. Yamada’s Textbook of

Gastroenterology. 6th ed. John Wiley & Sons, Ltd; 2016:1305–1323.

3. https://www.mskcc.org/cancer-care/patient-education/nutrition-guidelines-patients-short-
bowel-syndrome
4. https://www.researchgate.net/figure/Causes-of-short-bowel-syndrome_tbl1_308522704
5. https://pubmed.ncbi.nlm.nih.gov/11873098/
6.