The treatment of the short bowel syndrome is based on the replacement of fluids, nutrients, minerals, vitamins and calories. Depending on the stage and severity of the disease, this can be done by infusions (parenteral), gastric tube (enteral) or supplements (oral).
Parenteral nutrition through catheters
For parenteral nutrition is usually a central venous catheter - for example, a port or a so-called Hickman catheter - required, which usually carries a certain risk of infection. Therefore, the parenteral nutrition should be carried out as long as necessary, but as short as possible, especially as enteral nutrition can promote the adaptation process of the intestine.
Drug therapy as a supplement
In addition to the replacement of dietary constituents in the case of the short bowel syndrome various medications can contribute to an improvement of the symptoms:
- Agents such as loperamide or N-butylscopolamine inhibit bowel movement, resulting in prolonged retention of food in the gut, which can reduce diarrhea.
- Proton pump inhibitors - for example, pantoprazole or omeprazole - inhibit the increased secretion of gastric acid. Alternatively or additionally, H2 blockers such as ranitidine can be used.
- The active substance colestyramine binds bile acids in the intestine, which can contribute to the relief of bile acid-related diarrhea.
- The artificial hormone teduglutide promotes the absorption of nutrients in the intestine and can thus reduce the need for nutritional infusions. However, side effects such as abdominal pain, nausea and flatulence may occur during treatment. Teduglutide is not available as a tablet but must be injected daily into the subcutaneous fat tissue.
Life expectancy different
It is difficult to provide a generalized prognosis for patients with short bowel syndrome, as life expectancy depends on several factors: First, the underlying disease that caused the bowel to be removed plays a role.
Second, the prognosis depends on which parts of the small intestine have been removed and how long the remaining intestine is. A residual intestine length of less than one meter is considered critical - then usually a lifelong parenteral nutrition is necessary.
In addition, the age, general condition and concomitant diseases of the patient as well as complications affect the prognosis. In general, however, it can be said that the optimization of parenteral nutrition therapy has significantly increased the life expectancy of patients with short bowel syndrome in recent years.
Phases of the short bowel syndrome
The course of a short bowel syndrome is divided into three phases, which usually merge into each other:
- Hypersecretion Phase: The first phase usually begins shortly after the operation and usually lasts up to two months. During this time, it comes to heavy fluid loss and a stool volume of over two and a half liters, which is why an artificial diet via a catheter is usually necessary.
- Adaptation phase: Within one to two years, the intestine can adapt to the new requirements. Often, the symptoms then improve and it can be started with a diet - if necessary by means of a nasogastric tube.
- Stabilization phase: After completion of the adaptation, it is usually possible to slowly switch to natural food intake.
Nutrition tips for short bowel syndrome
Depending on the course of the disease, many treatment plans, starting with the adaptation phase or during the stabilization phase, will see a gradual switch to natural food intake. We have put together tips for you, what to look out for when you eat:
- Take six to eight small meals a day, so as not to overstrain the intestine and to achieve the best possible nutrient uptake.
- Do not drink during meals, but keep at least 30 minutes between food and fluid intake - because fluid speeds up the passage of food in the intestine.
- Avoid fiber-rich foods such as fibrous vegetables, legumes, and raw foods at the beginning, and slowly increase the dietary fiber content.
- Dilute fruit juices with water in the ratio 3: 1 and avoid sugary soft drinks, because the sugar "pulls" water into the intestine inside, which can lead to diarrhea.
- First refrain from lactose and test after a few weeks, which quantities you can tolerate.
Based on your symptoms and blood levels, your doctor will decide if you also need supplemental supplements to replace vitamins, trace elements or other nutrients.
Intestinal transplantation in severe complications
In patients who steadily lose weight despite a sustained parenteral diet, colon transplantation may be the last treatment option. Although complications such as sepsis, liver damage, severe metabolic disorders or frequent catheter infections should occur, transplantation may be considered.
Depending on the comorbidities of the patient, only the small intestine or other organs such as the liver, stomach or pancreas can be transplanted. However, gut transplantation is associated with great risks, including the need to suppress the immune system (immunosuppression).