Short Bowel Syndrome
Short bowel syndrome treatment is aimed to correct nutritional deficiencies, the symptoms and complications after surgery and is modulated mainly by the size of resection:
If the patient remains with the duodenum and jejunum untouched and in place (below 100 cm is resected form the jejunum), then nutrition can be achieved normally through the oral cavity. These patients suffering from short bowel syndrome develop watery diarrhea without steatorrhea which responds well to Imodium (loperamide), Cholestyramine or Sandostatin. The diet will be high in carbohydrates, low in fats. If you B12 deficiency is present, B12 will be administered by muscular injection, once a month or at three months interval. Other deficiencies of vitamins and minerals will be corrected also.
If the resection is extensive, and even includes a part of the colon, as it occurs during surgery for Crohn’s disease, postoperative treatment will be more difficult. Basically, the diet rich in carbohydrates and low in fat is also recommended for this group of patients, fat is more affected regarding the absorption process than carbohydrates and protein. For greater nutritional deficiencies, food consumption will be increased (more meals / day), many patients requiring parenteral nutrition (intravenously) with special solutions containing mixtures of lipids, proteins, carbohydrates and minerals.
A problem that may occur and contributes to increased nutrient malabsorption is bacterial pollution (see colonic diverticulosis) evidenced by a similar breath test as for Helicobacter pylori. Antibiotic treatment will often be required (with metronidazole in most cases). Intestinal transplantation is currently the practice in many medical centers, the main indication being the need of total parenteral nutrition (feeding the patient exclusively using infusion solutions due to loss of intestinal absorption) complicated by progressive liver disease (due to this type of diet fatty liver may occur). If the liver damage is advanced, intestinal transplantation can be combined with liver transplantation. Of course, post-transplant complications are multiple, so it is not yet routine practice in most university hospitals.
Latest news: Researchers from Paris recently published follow-up results of 31 children with small bowel transplant, which were followed for an average of 7 years, 27 of them led a normal life post-transplant, with no need for parenteral nutrition and also presenting normal growth and development.