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{{Infobox_Disease |
{{Infobox_Disease |
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   Name          = {{PAGENAME}} |
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   MedlinePlus    = 000237|
  eMedicineSubj  = med |
  eMedicineTopic = 2746 |
  eMedicine_mult = {{eMedicine2|ped|2088}} |  
   MeshID        = D012778 |
   MeshID        = D012778 |
}}
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{{SI}}
{{Short bowel syndrome}}
{{CMG}}


{{EH}}
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''


==Overview==
{{CMG}}; {{AE}} {{SSH}}


'''Short bowel syndrome''' (SBS, also '''short gut syndrome''' or simply '''short gut''') is a [[malabsorption]] disorder caused by the [[surgery|surgical]] removal of the [[small intestine]], or rarely due to the complete dysfunction of a large segment of bowel. Most cases are acquired, although some children are born with a congenital short bowel. It does usually not develop unless a person has lost more than two thirds of their small intestine.
{{SK}} SBS; short gut syndrome; short gut; small intestine insufficiency; chronic idiopathic intestinal pseudoobstruction; hypomotility disorder; congenital short bowel syndrome; short bowel; pseudoobstructive syndrome; pseudointestinal obstructive syndrome; massive bowel resection syndrome; idiopathic intestinal pseudo-obstruction
==[[Short bowel syndrome overview|Overview]]==


==Signs and symptoms==
==[[Short bowel syndrome historical perspective|Historical Perspective]]==
The symptoms of short bowel syndrome can include:
* [[Abdominal pain]]
* [[Diarrhea]] and [[steatorrhea]] (oily or sticky stool, which can be particularly foul-odored)
* Fluid retention
* [[Weight loss]] and [[malnutrition]]
* [[Fatigue (physical)|Fatigue]]


Patients with short bowel syndrome may have complications caused by malabsorption of vitamins and minerals, such as deficiencies in [[vitamin]]s [[vitamin A|A]], [[vitamin D|D]], [[vitamin E|E]], [[vitamin K|K]], and [[vitamin B12|B12]], [[calcium in biology|calcium]], [[magnesium]], [[iron]], [[folic acid]], and [[zinc]].  These may appear as [[anemia]], [[hyperkeratosis]] (scaling of the skin), easy bruising, muscle spasms, poor blood clotting, and bone pain.
==[[Short bowel syndrome classification|Classification]]==


==Causes==
==[[Short bowel syndrome pathophysiology|Pathophysiology]]==
Short bowel syndrome in adults is usually caused by surgery for:
* [[Crohn's disease]], an inflammatory disorder of the digestive tract
* [[Volvulus]], a spontaneous twisting of the small intestine that cuts off the blood supply and leads to tissue death
* [[Tumor]]s of the small intestine
* [[Injury]] or trauma to the small intestine
* [[Necrotizing enterocolitis]] (premature newborn)
* Bypass surgery to treat obesity, a now uncommonly performed surgical procedure
* Surgery to remove diseases or damaged portion of the small intestine


==Pathophysiology==
==[[Short bowel syndrome causes|Causes]]==
In healthy adults, the small intestine has an average length of approximately 6 meters (20 feet).  Short bowel syndrome usually develops when there is less than 1.8 meters (6 feet) of the small intestine left to absorb sufficient [[nutrient]]s.


Short bowel syndrome caused by the surgical removal of a portion of the bowel may be a temporary condition, due to the adaptive property of the small intestine.
==[[Short bowel syndrome differential diagnosis|Differentiating Short bowel syndrome from other Diseases]]==


In a process called intestinal adaptation, physiological changes to the remaining portion of the small intestine occur to increase its absorptive capacity.  These changes include:
==[[Short bowel syndrome epidemiology and demographics|Epidemiology and Demographics]]==
* Enlargement and lengthening of the [[villi]] found in the lining
* Increase in the diameter of the small intestine
* Slow down in peristalsis or movement of food through the small intestine


==Treatments==
==[[Short bowel syndrome risk factors|Risk Factors]]==
Symptoms of short bowel syndrome are usually addressed by prescription medicine.  These include:
* Anti-diarrheal medicine (e.g. [[loperamide]], [[codeine]])
* Vitamin and mineral supplements
* [[H2 blocker]] and [[proton pump inhibitor]]s to reduce stomach acid
* [[Lactase]] supplement (to improve the bloating and diarrhoea associated with [[lactose intolerance]])
* Surgery, including intestinal lengthening, tapering, and [[organ transplant]].
* Parenteral nutrition (PN or [[Total parenteral nutrition|TPN]] - nutrition administered via intravenous line).
* Nutrition administered via gastronomy tube


==Prognosis==
==[[Short bowel syndrome screening|Screening]]==
There is no cure for short bowel syndrome.  In newborn infants, the 4-year survival rate on [[Total parenteral nutrition|parenteral nutrition]] is approximately 70%. Some studies suggest that much of the mortality is due to a complication of the TPN, especially [[chronic liver disease]].<ref>{{cite journal |author=Vanderhoof JA, Langnas AN |title=Short-bowel syndrome in children and adults |journal=Gastroenterology |volume=113 |issue=5 |pages=1767-78 |year=1997 |pmid=9352883 |doi=}}</ref> Much hope is vested in [[Omegaven]], a type of lipid TPN feed, in which recent case reports suggest the risk of liver disease is much lower.<ref>{{cite journal |author=Gura KM, Duggan CP, Collier SB, ''et al'' |title=Reversal of parenteral nutrition-associated liver disease in two infants with short bowel syndrome using parenteral fish oil: implications for future management |journal=Pediatrics |volume=118 |issue=1 |pages=e197-201 |year=2006 |pmid=16818533 |doi=10.1542/peds.2005-2662}}</ref>


Although promising, small intestine transplant has a mixed success rate, with postoperative mortality rate of up to 30%.  One-year and 4-year survival rate are 90% and 60%, respectively.
==[[Short bowel syndrome natural history, complications and prognosis|Natural History, Complications and Prognosis]]==


Surgical procedures to lengthen dilated bowel include the Bianchi Procedure (where the bowel is cut in half and one end is sewn to the other) and a newer procedure called serial transverse enteroplasty (STEP -- where the bowel is cut and stapled in a zigzag pattern).  There is controversy over the efficacy of these procedures. They are usually performed by pediatric surgeons at quaternary hospital who specialize in small bowel surgery.
==Diagnosis==
[[Short bowel syndrome history and symptoms|History and Symptoms]] | [[Short bowel syndrome physical examination|Physical Examination]] | [[Short bowel syndrome laboratory findings|Laboratory Findings]] | [[Short bowel syndrome electrocardiogram|Electrocardiogram]] | [[Short bowel syndrome x ray|X-ray]] | [[Short bowel syndrome echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Short bowel syndrome CT|CT Scan]] | [[Short bowel syndrome MRI|MRI]] | [[Short bowel syndrome other imaging findings|Other Imaging Findings]] | [[Short bowel syndrome other diagnostic studies|Other Diagnostic Studies]]


==References==
==Treatment==
<references/>
[[Short bowel syndrome medical therapy|Medical Therapy]] | [[Short bowel syndrome surgery|Surgery]] | [[Short bowel syndrome primary prevention|Primary Prevention]] | [[Short bowel syndrome secondary prevention|Secondary Prevention]] | [[Short bowel syndrome cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Short bowel syndrome future or investigational therapies|Future or Investigational Therapies]] | [[Short bowel syndrome guidelines for management|Guidelines for Management]]
 
==Case Studies==
[[Short bowel syndrome case study one|Case #1]]


==External links==
==External links==
* [http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Short_bowel_syndrome?OpenDocument Better Health Channel - Short Bowel Syndrome]
* [http://www.healthinplainenglish.com/health/digestive/short_bowel_syndrome/index.htm Health In Plain English - Short Bowel Syndrome]
* [http://digestive.niddk.nih.gov/ddiseases/pubs/shortbowel/ National Digestive Diseases Information Clearinghouse - Short Bowel Syndrome]
* [http://digestive.niddk.nih.gov/ddiseases/pubs/shortbowel/ National Digestive Diseases Information Clearinghouse - Short Bowel Syndrome]


{{SIB}}
 
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Latest revision as of 00:09, 30 July 2020

Short bowel syndrome
ICD-9 579.3
DiseasesDB 12026
MedlinePlus 000237
MeSH D012778

Short bowel syndrome Microchapters

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

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Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

Synonyms and keywords: SBS; short gut syndrome; short gut; small intestine insufficiency; chronic idiopathic intestinal pseudoobstruction; hypomotility disorder; congenital short bowel syndrome; short bowel; pseudoobstructive syndrome; pseudointestinal obstructive syndrome; massive bowel resection syndrome; idiopathic intestinal pseudo-obstruction

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Short bowel syndrome from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | X-ray | Echocardiography and Ultrasound | CT Scan | MRI | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies | Guidelines for Management

Case Studies

Case #1

External links


​

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