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Short bowel syndrome: causes, symptoms, diagnosis, treatment
Last reviewed: 05.07.2025
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Short bowel syndrome is malabsorption resulting from extensive small bowel resection. Manifestations depend on the length and function of the remaining small bowel, but diarrhea may be severe and malnutrition is common. Treatment consists of fractional feedings, antidiarrheal drugs, and sometimes total parenteral nutrition or intestinal transplantation.
Causes of Short Bowel Syndrome
The main reasons for extensive bowel resection are Crohn's disease, mesenteric thrombosis, radiation enteritis, malignancy, volvulus, and congenital anomalies.
Since the jejunum is the primary site of digestion and absorption of most nutrients, resection of the jejunum significantly impairs their absorption. As a compensatory response, the ileum changes, increasing the length and absorptive function of the villi, leading to a gradual increase in nutrient absorption.
The ileum is the portion of the small intestine where bile acids and vitamin B12 are absorbed. Severe diarrhea and malabsorption occur when more than 100 cm of the ileum is resected. In this case, there is no compensatory adaptation of the remaining jejunum. Consequently, malabsorption of fats, fat-soluble vitamins, and vitamin B12 occurs. In addition, bile salts not absorbed in the small intestine lead to secretory diarrhea. Preservation of the colon can significantly reduce electrolyte and water losses. Resection of the terminal ileum and ileocecal sphincter may predispose to bacterial overgrowth.
[ Symptoms of short bowel syndrome
Severe diarrhea with significant electrolyte losses develops in the immediate postoperative period. Patients usually require total parenteral nutrition and intensive fluid and electrolyte monitoring (including Ca and Mg). Oral isoosmotic solutions of Na and glucose (similar to the WHO-repair formulation) are gradually administered in the postoperative period after the patient's condition has stabilized and the stool volume is less than 2 L/day.
Treatment of short bowel syndrome
Patients with extensive resection (< 100 cm of remaining jejunum) and large fluid and electrolyte losses require continuous total parenteral nutrition.
Patients with more than 100 cm of jejunum remaining can achieve adequate digestion by oral intake. Fats and proteins in the diet are usually well tolerated, unlike carbohydrates, which cause a significant osmotic load. Fractional feedings reduce osmotic pressure. Ideally, 40% of calories should come from fats.
Patients who develop diarrhea after meals should take an antidiarrheal drug (eg, loperamide) 1 hour before meals. Cholestyramine, 2-4 g before meals, reduces diarrhea associated with bile salt malabsorption. Intramuscular monthly injections of vitamin B12 are indicated in patients with known vitamin deficiency. Most patients require supplemental vitamins, Ca, and Mg.
Gastric hypersecretion may develop, leading to inactivation of pancreatic enzymes; therefore, most patients are prescribed H2 blockers or proton pump inhibitors.
Small intestine transplantation is indicated for patients who cannot receive long-term total parenteral nutrition and who do not have compensation for digestive processes.