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Short Bowel Syndrome


Zubair Malik

, MD, Lewis Katz School of Medicine at Temple University

Reviewed/Revised Mar 2023
Topic Resources

Short bowel syndrome is a disorder causing diarrhea and poor absorption of nutrients (malabsorption Overview of Malabsorption Malabsorption syndrome refers to a number of disorders in which nutrients from food are not absorbed properly in the small intestine. Certain disorders, infections, and surgical procedures can... read more ), which often occurs after surgical removal of a large portion of the small intestine.

  • This disorder often occurs after a large part of the small intestine (usually more than two thirds of its length) is removed.

  • Diarrhea is the main symptom.

  • After surgery to remove the bowel, people are given food and fluids by vein (intravenously).

  • Some people must continue the intravenous feedings for life.

  • Medications such as loperamide and cholestyramine can help reduce diarrhea.

The Small Intestine

Most digestion and absorption of food takes place in the small intestine. The consequences of removing a portion of the small intestine depend on how much is removed and its location. The small intestine is about 12 to 21 feet (about 4 meters) in length. If the middle part (jejunum) is removed, sometimes the last part (ileum) can adapt and absorb more nutrients. If more than about 3 feet (about 1 meter) of ileum is removed, the remaining small intestine usually cannot adapt. Before adaptation occurs, or if it does not, the intestines have difficulty absorbing many nutrients, including fats, proteins, and vitamins. If the end of the ileum has been removed, the intestines also cannot absorb bile acids secreted by the liver, which aid digestion and cannot absorb vitamin B12. The excess bile acids enter the colon and can cause diarrhea.

The diagnosis of short bowel syndrome is based on the results of a doctor's evaluation of the person’s prior surgery, symptoms, and results of an examination.

Treatment of Short Bowel Syndrome

  • Total parenteral nutrition (TPN)

  • Sometimes antidiarrheal medications, nutritional supplements, and proton pump inhibitors

Immediately after surgery, when diarrhea is typically severe, doctors give intravenous fluids to replace fluid and electrolyte losses and usually also give intravenous feedings. These feedings, called total parenteral nutrition Intravenous Feeding Intravenous feeding is used when the digestive tract cannot adequately absorb nutrients, as occurs in severe malabsorption disorders. It is also used when the digestive tract must be temporarily... read more (TPN), contain all necessary nutrients, including proteins, fats, carbohydrates, vitamins, and minerals. As people recover and their stool output lessens, they are slowly given fluids by mouth.

People who have had a large amount of small intestine removed (such as those with less than 3 feet [about 1 meter] of remaining small intestine) and those who continue to have excessive fluid and other nutrient losses require TPN for life. Other people eventually tolerate food by mouth. The recommended diet usually has more fat and protein than carbohydrate. Small, frequent meals are better than fewer, large ones.

People 1 year of age and older who need TPN may be given injections of a medication called teduglutide. This medication may help reduce the amount of TPN people need.

People who have diarrhea after meals should take antidiarrheal medications such as loperamide 1 hour before eating. Cholestyramine can be taken with meals to reduce diarrhea caused by malabsorption of bile acid.

Most people should take supplemental vitamins, calcium, and magnesium.

Because people with short bowel syndrome often have excess stomach acid, most people also take an acid-blocking medication, such as a proton pump inhibitor.

Some people require monthly injections of vitamin B12.

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