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Short bowel syndrome (SBS, also short gut syndrome or simply short gut) is a malabsorption
Malabsorption

Malabsorption is a state arising from abnormality in digestion or absorption of Nutrient across the gastrointestinal tract.Impairment can be of single or multiple nutrients depending on the abnormality....
 disorder caused by the surgical
Surgery

Surgery is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, to help improve bodily function or appearance, or sometimes for some other reason....
 removal of the small intestine
Small intestine

In vertebrates, including mammals, reptiles, birds, and bony fish, the small intestine is the part of the gastrointestinal tract following the stomach, and is where the vast majority of digestion takes place....
, 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 usually does not develop unless a person has lost more than two thirds of their small intestine.

symptoms of short bowel syndrome can include:

Patients with short bowel syndrome may have complications caused by malabsorption of vitamins and minerals, such as deficiencies in vitamin
Vitamin

A vitamin is an organic compound required as a nutrient in tiny amounts by an organism. A compound is called a vitamin when it cannot be biosynthesis in sufficient quantities by an organism, and must be obtained from the diet....
s A
Vitamin A

Vitamin A, a bi-polar molecule formed with bi-polar covalent bonds between carbon and hydrogen, is linked to a family of similarly shaped molecules, the retinoids, which complete the remainder of the vitamin sequence....
, D
Vitamin D

Vitamin D is a group of fat-soluble prohormones, the two major forms of which are vitamin D2 and vitamin D3 . The term vitamin D also refers to metabolites and other analogues of these substances....
, E
Vitamin E

Vitamin E is the collective name for a set of 8 related a-, ?-, ?-, and d-tocopherols and the corresponding four tocotrienols, which are fat-soluble vitamins with antioxidant properties....
, K
Vitamin K

Vitamin K denotes a group of lipophilic, hydrophobic vitamins that are needed for the posttranslational modification of certain proteins, mostly required for blood coagulation....
, and B12
Vitamin B12

Vitamin B12 is a water soluble vitamin with a key role in the normal functioning of the brain and nervous system, and for the formation of blood....
, calcium
Calcium in biology

Calcium plays a pivotal role in the physiology and biochemistry of organisms and the cell . It plays an important role in signal transduction pathways, where it acts as a second messenger, in neurotransmitter release from neurons, contraction of all muscle cell types, and fertilization....
, magnesium
Magnesium

Magnesium is a chemical element with the symbol Mg, atomic number 12, atomic weight 24.3050 and common oxidation number +2.Magnesium, an alkaline earth metal, is the ninth most abundance of the chemical elements in the universe by mass....
, iron
Iron

Iron is a chemical element with the symbol Fe and atomic number 26. Iron is a Group 8 element and period 4 element. Iron is lustrous and silvery in color....
, folic acid
Folic acid

Folic acid and Folate are forms of the water-soluble B vitamins. Vitamin B9 is essential to numerous bodily functions ranging from nucleotide synthesis to the remethylation of homocysteine....
, and zinc
Zinc

Zinc is a metallic chemical element with the symbol Zn and atomic number 30. It is a first-row transition metal of the group 12 element of the periodic table....
.






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Encyclopedia


Short bowel syndrome (SBS, also short gut syndrome or simply short gut) is a malabsorption
Malabsorption

Malabsorption is a state arising from abnormality in digestion or absorption of Nutrient across the gastrointestinal tract.Impairment can be of single or multiple nutrients depending on the abnormality....
 disorder caused by the surgical
Surgery

Surgery is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, to help improve bodily function or appearance, or sometimes for some other reason....
 removal of the small intestine
Small intestine

In vertebrates, including mammals, reptiles, birds, and bony fish, the small intestine is the part of the gastrointestinal tract following the stomach, and is where the vast majority of digestion takes place....
, 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 usually does not develop unless a person has lost more than two thirds of their small intestine.

Signs and symptoms

The symptoms of short bowel syndrome can include:
  • Abdominal pain
    Abdominal pain

    Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom....
  • Diarrhea
    Diarrhea

    In medicine, diarrhea, also spelled diarrhoea , is characterized by frequent loose or liquid bowel movements. The spelling of "diarrhea" is an appropriation of the Greek "diarrhoia" meaning "a flowing through." ....
     and steatorrhea
    Steatorrhea

    Steatorrhea is the presence of excess fat in faeces. Stools may also float due to excess lipid, a.k.a. "floater", have an oily appearance and be especially foul smelling....
     (oily or sticky stool, which can be particularly foul-odored)
  • Fluid retention
  • Weight loss
    Weight loss

    Weight loss, in the context of medicine or health or physical fitness, is a reduction of the total body weight, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue....
     and malnutrition
    Malnutrition

    Malnutrition is a general term for a medical condition caused by an improper or inadequate diet and nutrition.According to the World Health Organization, hunger and malnutrition are the single gravest threats to the world's public health and malnutrition is by far the biggest contributor to child mortality, present in half of all cases....
  • Fatigue
    Fatigue (physical)

    Fatigue is a weariness caused by exertion. It can describe a range of afflictions, varying from a general state of wikt:lethargy to a specific work-induced burning sensation within one's muscles....


Patients with short bowel syndrome may have complications caused by malabsorption of vitamins and minerals, such as deficiencies in vitamin
Vitamin

A vitamin is an organic compound required as a nutrient in tiny amounts by an organism. A compound is called a vitamin when it cannot be biosynthesis in sufficient quantities by an organism, and must be obtained from the diet....
s A
Vitamin A

Vitamin A, a bi-polar molecule formed with bi-polar covalent bonds between carbon and hydrogen, is linked to a family of similarly shaped molecules, the retinoids, which complete the remainder of the vitamin sequence....
, D
Vitamin D

Vitamin D is a group of fat-soluble prohormones, the two major forms of which are vitamin D2 and vitamin D3 . The term vitamin D also refers to metabolites and other analogues of these substances....
, E
Vitamin E

Vitamin E is the collective name for a set of 8 related a-, ?-, ?-, and d-tocopherols and the corresponding four tocotrienols, which are fat-soluble vitamins with antioxidant properties....
, K
Vitamin K

Vitamin K denotes a group of lipophilic, hydrophobic vitamins that are needed for the posttranslational modification of certain proteins, mostly required for blood coagulation....
, and B12
Vitamin B12

Vitamin B12 is a water soluble vitamin with a key role in the normal functioning of the brain and nervous system, and for the formation of blood....
, calcium
Calcium in biology

Calcium plays a pivotal role in the physiology and biochemistry of organisms and the cell . It plays an important role in signal transduction pathways, where it acts as a second messenger, in neurotransmitter release from neurons, contraction of all muscle cell types, and fertilization....
, magnesium
Magnesium

Magnesium is a chemical element with the symbol Mg, atomic number 12, atomic weight 24.3050 and common oxidation number +2.Magnesium, an alkaline earth metal, is the ninth most abundance of the chemical elements in the universe by mass....
, iron
Iron

Iron is a chemical element with the symbol Fe and atomic number 26. Iron is a Group 8 element and period 4 element. Iron is lustrous and silvery in color....
, folic acid
Folic acid

Folic acid and Folate are forms of the water-soluble B vitamins. Vitamin B9 is essential to numerous bodily functions ranging from nucleotide synthesis to the remethylation of homocysteine....
, and zinc
Zinc

Zinc is a metallic chemical element with the symbol Zn and atomic number 30. It is a first-row transition metal of the group 12 element of the periodic table....
. These may appear as anemia
Anemia

Anemia or an?mia/anaemia is defined as a qualitative or quantitative deficiency of hemoglobin, a protein found inside red blood cells ....
, hyperkeratosis
Hyperkeratosis

Hyperkeratosis is thickening of the stratum corneum, often associated with a qualitative abnormality of the keratin....
 (scaling of the skin), easy bruising, muscle spasms, poor blood clotting, and bone pain.

Causes

Short bowel syndrome in adults is usually caused by surgery for:
  • Crohn's disease
    Crohn's disease

    Crohn's disease is an inflammatory disease which may affect any part of the gastrointestinal tract from mouth to anus, causing a wide variety of symptoms....
    , an inflammatory disorder of the digestive tract
  • Volvulus
    Volvulus

    A volvulus is a life-threatening bowel obstruction in which a loop of bowel has abnormally twisted on itself....
    , a spontaneous twisting of the small intestine that cuts off the blood supply and leads to tissue death
  • Tumor
    Tumor

    A tumor or tumour is the name for a swelling or lesion formed by an abnormal growth of cells . Tumor is not synonymous with cancer. A tumor can be Benign neoplasm, Carcinoma in situ or malignant, whereas cancer is by definition malignant....
    s of the small intestine
  • Injury
    Injury

    Injury or bodily injury is damage or harm caused to the structure or Purpose of the body caused by an outside wiktionary:agent or force, which may be physical or chemical....
     or trauma to the small intestine
  • Necrotizing enterocolitis
    Necrotizing enterocolitis

    Necrotizing enterocolitis is a medical condition primarily seen in premature birth infants, where portions of the bowel undergo necrosis ....
     (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

In healthy adults, the small intestine has an average length of approximately 6 meters (19.7 feet). Short bowel syndrome usually develops when there is less than 2 meters (6.6 feet) of the small intestine left to absorb sufficient nutrient
Nutrient

A nutrient is a chemical that an organism needs to live and grow or a substance used in an organism's metabolism which must be taken in from its environment....
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.

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:
  • 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

Symptoms of short bowel syndrome are usually addressed by prescription medicine. These include:
  • Anti-diarrheal medicine (e.g. loperamide
    Loperamide

    Loperamide, a synthetic piperidine derivative, is a medication effective against diarrhea resulting from gastroenteritis or inflammatory bowel disease....
    , codeine
    Codeine

    Codeine or methylmorphine is an opiate used for its analgesic, Cough medicine and Antidiarrhoeal properties. It is by far the most widely used opiate in the world and probably the most commonly used drug overall according to numerous reports over the years by organizations such as the World Health Organization and its League of Nations...
    )
  • Vitamin and mineral supplements
  • H2 blocker and proton pump inhibitor
    Proton pump inhibitor

    Proton pump inhibitors are a group of Medications whose main action is a pronounced and long-lasting reduction of gastric acid production. They are the most potent inhibitors of acid secretion available today....
    s to reduce stomach acid
  • Lactase
    Lactase

    Lactase , a part of the ?-galactosidase family of enzymes, is a glycoside hydrolase involved in the hydrolysis of the disaccharide lactose into constituent galactose and glucose monomers....
     supplement (to improve the bloating and diarrhoea associated with lactose intolerance
    Lactose intolerance

    Lactose intolerance is the inability to Metabolism lactose, a sugar found in milk and other dairy products, because the required enzyme lactase is absent in the intestinal system or its availability is lowered....
    )
  • Surgery, including intestinal lengthening, tapering, and small bowel transplant.
  • Parenteral nutrition (PN or TPN for total parenteral nutrition
    Total parenteral nutrition

    Total parenteral nutrition , is the practice of feeding a person intravenously, bypassing the usual process of eating and digestion. The person receives nutritional formulas containing salts, glucose, amino acids, lipids and added vitamins....
     - nutrition administered via intravenous line).
  • Nutrition administered via gastrostomy tube


In 2004, the FDA approved a therapy that reduces the frequency and volume of TPN, comprising:

NutreStoreTM [L-glutamine for oral solution] and Zorbtive [somatropin (rDNA origin) for injection] together with a specialized oral diet. Byrne, TA, Wilmore DW, Iyer K, et al. Growth hormone, glutamine, and an optimal diet reduces parenteral nutrition in patients with short bowel syndrome. Ann Surg. 2005;242;655-661

Prognosis

There is no cure for short bowel syndrome. In newborn infants, the 4-year survival rate on parenteral nutrition
Total parenteral nutrition

Total parenteral nutrition , is the practice of feeding a person intravenously, bypassing the usual process of eating and digestion. The person receives nutritional formulas containing salts, glucose, amino acids, lipids and added vitamins....
 is approximately 70%. Some studies suggest that much of the mortality is due to a complication of the TPN, especially chronic liver disease
Chronic liver disease

Chronic liver disease is a liver disease of slow process and persisting over a long period of time, resulting in a progressive destruction of the liver....
. Much hope is vested in Omegaven
Omegaven

Omegaven is a fatty acid emulsion produced by Fresenius Kabi. It is used for total parenteral nutrition , e.g. in short bowel syndrome. It is rich in omega-3 fatty acids....
, a type of lipid TPN feed, in which recent case reports suggest the risk of liver disease is much lower.

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.

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.

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