Short Bowel Syndrome
`and Crohn’s Disease
`
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`Short Bowel Syndrome and Crohn’s Disease
`Short Bowel Syndrome (sometimes referred to as SBS) is a disorder that affects people who
`have had large portions of their small intestine surgically removed as a result of a digestive
`illness, such as Crohn’s disease. Approximately 10,000–20,000 people in the United States
`have short bowel syndrome.
`
`The bowel consists of two parts, the small and large intestines. The large intestine, also known
`as the colon, is about five feet long. It is the thicker, lower end of the digestive tract. Its main pur-
`pose is to absorb water and electrolytes from solid waste before the waste is eliminated from the
`body. The body can safely live without some (or all) of the colon. The small intestine makes up the
`narrower portion of the bowel and is approximately 23 feet in length for a full-grown adult. Nearly
`all digestion of food and absorption of nutrients takes place in the small intestine. Because of its
`essential function in nutrition, losing portions of the small bowel to surgery can have significant
`negative effects.
`
`The small intestine has three sections—the duodenum, the jejunum, and the ileum. Each seg-
`ment performs a specific role in the digestion and absorption of nutrients. When large amounts
`of the small intestine are removed the body is unable to absorb adequate amounts of water,
`vitamins, and other nutrients from food in order to stay healthy and survive. The effects of short
`bowel syndrome can range in seriousness from mild to life-threatening.
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`Crohn’s disease is one of the two major inflammatory conditions
`that affect the gastrointestinal (GI) tract.
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`Causes of Short Bowel Syndrome (SBS)
`Crohn’s disease is one of two major inflammatory condi-
`tions that affect the gastrointestinal (GI) tract. Together
`with ulcerative colitis, they are commonly known as
`inflammatory bowel diseases, or IBD. The major cause of
`short bowel syndrome for Crohn’s disease patients is the
`surgical removal of large amounts of the small intestine.
`In others, short bowel is present at birth.  It is also pos-
`sible for a person with a small intestine of normal length
`to develop SBS if injury, disease, or other conditions
`prevent it from working as it should.
`
`Surgery for Crohn’s Disease
`Crohn’s disease can affect any part of the gastrointestinal
`tract, from the mouth to the anus. When medications are
`no longer effective at controlling the inflammation and
`managing the symptoms of Crohn’s disease, or when
`complications develop, treatment sometimes includes
`the removal of affected sections of the small intestine.
`This type of operation is known as a resection. This surgi-
`cal resection can result in a diminished surface area,
`thereby reducing the body’s ability to effectively absorb
`fluid and nutrients. Most people can adapt to losing short
`segments of their small bowel.
`
`Surgery is also sometimes necessary to treat complications
`that arise from chronic inflammation and scarring. Exam-
`ples include stricture (a narrowing of the intestinal wall),
`perforation (when the intestinal wall is punctured or torn),
`or hemorrhage (excessive bleeding). Other complications
`can include the development of an abscess (a localized
`collection of pus and/or infection) or a fistula (an abnor-
`mal pathway leading from one part of the intestine to
`another part, to another organ in the body, or sometimes
`outside the body through the skin).
`
`After a diseased part of the intestine is removed, the two
`remaining ends are sewn together. This is called an anas-
`tomosis. Although resection may provide symptom relief
`
`for many years, the disease can recur at or near the site
`of the anastomosis, generally concentrating around areas
`of scar tissue.
`
`Another type of surgery for Crohn’s disease is called a
`stricturoplasty. This is an operation performed to open up
`a blockage, or stricture. The goal of this procedure is to
`widen the narrowed section of intestine without removing
`
`
`Brochures are available on a variety of topics at www.ccfa.org
`
`it. Surgeons make an incision along the length of the af-
`fected portion of intestine, then pinch it closed in the op-
`posite direction (perpendicular to the original incision),
`and seal it shut. The result is a widened, but slightly
`shortened area with no loss of intestinal length. There
`are some situations in which stricturoplasty cannot be
`performed. In these cases, the doctor and patient must
`discuss other options.
`
`The Crohn’s & Colitis Foundation of America provides information for educational purposes only. We encourage you to review this educational material
`with your health care professional. The Foundation does not provide medical or other health care opinions or services. The inclusion of another organi-
`zation’s resource or referral to another organization does not represent an endorsement of a particular individual, group, company, or product.
`
`Crohn’s & Colitis Foundation of America
`
`Short Bowel Syndrome and Crohn’s Disease
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`Particular nutritional deficiencies can be linked to the specific
`section of the small intestine that is damaged, surgically removed,
`or working inadequately.
`
`About two-thirds to three-quarters of people with Crohn’s
`disease will eventually undergo surgery at some point in
`their lifetime. Of those, about half will require multiple
`surgeries to remove additional sections of the small in-
`testine as a result of the disease and other complications
`from previous surgeries.
`
`In addition to Crohn’s disease, there are other causes of
`short bowel syndrome. These include:
`• Radiation damage. Radiation therapy may damage the
`small intestine (radiation enteritis).
`• Volvulus. This is a twisting or tangling of the small
`intestine that restricts blood flow, thereby damaging
`intestinal tissue. Surgery is required to remove perma-
`nently damaged tissue.
`• Vascular injury or disease. If the blood vessels of the
`small intestine are injured or diseased, blood flow may
`be impaired.
`• Adhesions. Scar tissue can form outside the bowel,
`causing periodic blockages that require surgical man-
`agement.
`• Chronic pseudo-obstruction. This is a nerve and muscle
`disorder that impairs intestinal contractions, resulting
`in malabsorption of nutrients and other complications.
`• Bypass surgery to treat obesity.
`• Intestinal cancer. Surgical resections may be necessary
`to remove tumors.
`• Trauma.
`• Congenital defects.
`
`Signs and Symptoms
`Patients with short bowel syndrome can experience a va-
`riety of symptoms. All of these are related to their body’s
`inability to absorb enough nutrients, fluids, electrolytes,
`vitamins, and minerals from the food they eat. Particu-
`lar nutritional deficiencies can be linked to the specific
`section of the small intestine that is damaged, surgically
`removed, or working inadequately:
`
`• Duodenum: The upper section of the small intestine,
`where iron, calcium, and magnesium are absorbed.
`• Jejunum: The middle section of the small intestine,
`where the absorption of proteins, fat, carbohydrates,
`vitamins, and minerals occurs.
`• Ileum: The lower section of the small intestine, where
`vitamin B12 and bile acids are absorbed. Bile acids help
`the body absorb fat-soluble vitamins (A, D, E, and K).
`• Colon: The presence or absence of the colon will have
`an impact on SBS. Although the colon is not generally
`thought of as part of the GI tract where nutrients are
`absorbed, in SBS, it may be able to recover 10%–20%
`of malabsorbed carbohydrates. This may provide a
`critical caloric buffer for some patients. Additionally,
`the colon may be able to absorb significant amounts of
`water and electrolytes.
`
`The most common symptom of short bowel syndrome is
`chronic (long-term) diarrhea. This, in turn, can cause mal-
`nutrition, dehydration, and weight loss. These problems
`can become life-threatening if not treated properly.
`
`Other symptoms of short bowel syndrome may include:
`• Abdominal pain and cramping
`• Bloating
`• Heartburn
`• Flatulence (intestinal gas)
`• Steatorrhea (oily and/or foul-smelling stool)
`• Fatigue
`• Weakness
`• Bacterial infections
`• Food sensitivities
`
`Additional signs of nutrient and vitamin deficiencies
`caused by SBS include:
`• Anemia (low blood counts)
`• Easy bruising
`• Osteoporosis (thinned/fragile bones) and bone pain
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`Short Bowel Syndrome and Crohn’s Disease
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`The most significant indicator that points toward short bowel syndrome
`is a history of surgical resection of the small intestine.
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`Making the Diagnosis
`The most significant indicator that points toward short
`bowel syndrome is a history of surgical resection of the
`small intestine. A medical history of digestive ailments
`also may indicate that the small intestine is not work-
`ing properly. The following tests are commonly used to
`confirm a diagnosis:
`• Blood tests. These can reveal anemia and assess the
`levels of vitamins, minerals, electrolytes, and other
`chemicals linked to metabolism and digestion. Elevated
`liver enzymes and low potassium levels may also point
`to SBS.
`• Physical examination. Jaundice (yellowing of the skin),
`loss of muscle mass, skin rashes, and scaly skin (due to
`vitamin A deficiency) can be indicators of SBS. Also, vi-
`tamin deficiencies may cause reduced feeling in hands
`and feet.
`• Stool examination. Testing solid waste can determine
`whether a person is absorbing the amount of dietary fat
`and carbohydrates necessary for proper nutrition.
`
`Complications
`Short bowel syndrome can be accompanied by a number
`of complications. These include:
`• Kidney stones. Decreased absorption of fats, calcium,
`and bile salts in the bowel can cause kidney stones,
`which are known to decrease urine flow from the kidneys
`to the bladder, impair kidney function, and cause pain.
`• Electrolyte abnormalities. Electrolytes —such as po-
`tassium, sodium, and magnesium—are minerals that
`control important functions in the body. Unbalanced
`electrolytes can result in irregular heartbeat, muscle
`weakness, headache, and nausea.
`• Vitamin and mineral deficiencies. Short bowel syn-
`drome can affect the amount of vitamins that the body
`absorbs, sometimes with serious consequences. For
`instance, a lack of vitamin B12 can result in damage to
`the brain and nerves in the spinal cord, while a defi-
`ciency in vitamin E can cause swelling and poor muscle
`coordination. Too little vitamin C can lead to problems
`with the gums and skin. Reduced absorption of vitamin
`D and calcium can cause osteoporosis and lead to
`
`fractures. In addition, the diarrhea commonly associat-
`ed with short bowel syndrome can result in low mineral
`levels such as zinc and magnesium, sometimes leading
`to skin rashes, muscle cramping, and irregular heart
`rhythms.
`• Acidosis. Acidosis is an unusually high level of lactic
`acid in the bloodstream. People with short bowel
`syndrome may be unable to digest carbohydrates well.
`Undigested carbohydrates create lactic acid. When
`the body absorbs more lactic acid than it can use and
`dispose of, acidosis may result. Symptoms include
`confusion, blurred vision, and slurred speech.
`• Bacterial overgrowth. In contrast to the large intestine,
`which is rich in bacteria, the small intestine normally
`hosts a minimal amount of bacteria. In people with
`short bowel syndrome, those bacteria may multiply by
`feeding on unabsorbed nutrients. Patients who have
`had their ileocecal valve surgically removed (typically
`during a resection procedure) may be at heightened
`risk for developing small bowel bacterial overgrowth.
`This valve, which connects the small and large intes-
`tines, normally prevents the flow of bacteria from the
`large intestine to the small intestine, and without it,
`the movement of bacteria goes unchecked. Symptoms
`of small bowel bacteria overgrowth include diarrhea,
`bloating, nausea, and vomiting.
`• Gastric hypersecretion. Acid production is increased
`in patients with short bowel syndrome. High levels of
`stomach acid can raise the amount of secretions enter-
`ing the shortened bowel, and interfere with normal
`absorption.
`
`
`
`Impact of SBS on Children
`In children, as in adults, short bowel syndrome is the
`result of too little intestinal surface to absorb nutrients
`from food. Typically, an affected child was either born
`with an abnormally short intestinal length, or much of the
`small intestine was surgically removed to correct another
`condition such as necrotizing enterocolitis (intestinal
`infection and inflammation).
`
`In either case, this can reduce the child’s ability to extract
`sufficient nutrients from food. Because children are still
`growing, they require a higher caloric intake than adults.
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`Supportive measures exist to treat the complications
`of short bowel syndrome.
`
`Many children with short bowel syndrome must utilize
`total parenteral nutrition (TPN), a system of providing
`nourishment intravenously (through a vein), thereby
`bypassing the GI tract. While some children stay on TPN
`for an indefinite period, others can be switched over to
`enteral (through a feeding tube) nutrition. With this ap-
`proach, nourishment is delivered through a feeding tube
`that is inserted through the nose into the stomach in the
`case of a nasogastric tube. Other types of feeding tubes
`are available.
`
`The severity of short bowel syndrome in children can vary
`depending on how much small intestine remains. How-
`ever, long-term follow-up care is necessary in most cases.
`Children with SBS need to be monitored regularly for
`nutritional deficiencies and other conditions associated
`with prolonged parenteral or enteral nutrition. These in-
`clude infections and complications in the liver and biliary
`tract (the pathway that carries bile from the liver to the
`small intestine).
`
`Impact of Short Bowel Syndrome
`on Pregnant Women
`Women who have had previous resection surgery do not
`appear to have any special problems while pregnant.
`However, adequate nutrition is always a concern both be-
`fore and during any pregnancy. For that reason, a chronic
`condition that affects absorption of nutrients—such as
`short bowel syndrome—warrants special attention.
`
`Intestinal Adaptation
`For some people, short bowel syndrome is a temporary
`problem. Even after extensive surgery, the remaining
`small intestine is sometimes able to adjust to the short
`bowel length. It does so by working harder than before.
`Although intestinal adaptation may begin soon after the
`onset of short bowel syndrome, it may take as long as two
`years before the small intestine has fully adjusted.
`
`• Overall health and age of the patient
`• Length of remaining small intestine
`• Presence or absence of inflammatory disease
`in the remaining portion of small intestine
`• Presence or length of large intestine
`• Presence or absence of the ileocecal valve
`
`Treatment
`Supportive measures exist to treat the complications of
`short bowel syndrome. Even for patients who eventually
`achieve intestinal adaptation, treatment is typically neces-
`sary to bridge the gap. Treatment varies, depending on
`a number of factors—including the amount and location
`of small intestine that is left after surgery, the severity of
`symptoms, and how well the remaining intestine adapts
`over time. Because the treatment plan is designed for each
`person, it also shifts as the person’s needs change. Re-
`gardless of the particular approach, the primary goals are
`the same for everyone: to relieve symptoms and ensure
`adequate nutrition (including proteins, carbohydrates,
`lipids, vitamins, minerals, and salts). The secondary goal
`is to treat and prevent complications resulting from short
`bowel syndrome, including infections and liver injury
`(sometimes related to total parenteral nutrition).
`
`True intestinal adaptation is achieved when a person can
`successfully digest and absorb all necessary nutrients
`through the GI tract. The adaptation capacity depends on
`several factors, including:
`
`Treatment often proceeds in small steps, beginning with
`the simplest options first. This typically means minimiz-
`ing the use of drugs and maximizing the ability of the
`person’s small intestine to absorb food and fluids.
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`The first step is to make dietary adjustments, bearing in mind that there
`is no single specific diet for people with short bowel syndrome.
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`Nutrition
`The first step is to make dietary adjustments, bearing in
`mind that there is no single specific diet for people with
`short bowel syndrome. As with any change in treatment,
`the patient should consult with their doctor. Working
`with a registered dietitian can be helpful in creating an
`effective eating plan based on the length and location of
`remaining small intestine and the degree to which it is
`functioning. Eating small, frequent meals (six to eight)
`throughout the day—rather than fewer larger ones—may
`enhance digestion and absorption. Keeping a food diary
`is helpful in determining which foods are causing diar-
`rhea and other symptoms. In general, people with short
`bowel syndrome should eat meals that are:
`• High in protein (fish, meat, poultry, eggs, dairy
`products, tofu)
`• Moderate in fat (butter, margarine, oils, mayonnaise)
`• High in low-fiber complex carbohydrates (white rice,
`pasta, white bread, unsweetened cereals)
`• Low in concentrated sweets (sugar, honey, corn syrup,
`molasses, sodas and fruit juices)
`
`Other recommendations:
`• Include beverages but limit intake during meals. Large
`amounts of fluid intake push food faster through the
`bowel, decreasing absorption of nutrients and increas-
`ing diarrhea. Water may not be absorbed as well as oral
`rehydration solutions that contain salts and sugar.
`• Low-oxalate diet. People who have had their ileum
`removed and still have an intact colon should consider
`a diet low in oxalates (compounds found in plant-based
`foods) in order to prevent the formation of kidney stones.
`Foods that are high in oxalates and should be avoided
`include alcohol, tea, coffee, cola, chocolate, nuts, soy,
`green leafy vegetables, sweet po tatoes, beets, rhubarb,
`berries, tangerines, and wheat germ/bran.
`• Eat a low-lactose diet (or use lactase supplements)
`if the patient is lactose intolerant.
`• In some cases, people with short bowel syndrome will
`need to consume more calories to maintain their weight
`than those with normal bowel length.
`
`In addition to dietary adjustments, other recommenda-
`tions may include the following:
`
`Vitamin and mineral supplements. A daily multivitamin
`is a good place to start, making sure that it contains all
`the recommended daily allowances (RDA). Delayed- or
`extended-release vitamins should be avoided in short
`bowel syndrome because the shortened transit time may
`lead to inadequate absorption. A doctor or dietitian can
`suggest particular multivitamins or other specific vitamin
`or mineral supplements. Folic acid, vitamin B12, and iron
`can be used in the treatment of or prevention of anemia.
`Injections of B12 are given if more than about one and a
`half feet of the ileum have been surgically removed. Cal-
`cium, potassium, and zinc may be necessary, but should
`only be taken if recommended by a doctor.
`
`Oral rehydration solutions. These solutions (specific
`mixes of water, sugar, and salts) are particularly helpful
`for people with short bowel syndrome who experience
`excessive diarrhea. They restore the fluid, potassium, and
`sodium that are lost in watery stool and help the intes-
`tines to better absorb the water. Commercial products
`such as Pedialyte®, Ceralyte®, or Liquilyte® are viable op-
`tions, and homemade solutions are simple to make. The
`World Health Organization (www.who.int/en/) publishes
`a popular recipe. It is important to note that while oral
`rehydration solutions are effective for fluid replacement,
`they do not decrease diarrhea.
`
`Nutritional supplements. These high-calorie drinks are
`useful for patients who are losing or having difficulty sus-
`taining weight. Specialty supplements are commonly rec-
`ommended over the commercially available versions, which
`have high sugar content.* Semi-elemental and soluble
`fiber-based formulas often work better than typical over-
`the-counter supplements and are usually well tolerated.
`
`Electrolyte supplements. These are preparations used
`to correct imbalances in the body’s electrolyte levels.
`Available as drinks, the supplements can also be mixed
`with enteral or parenteral formulas (for enteral tube feed-
`ings or intravenous feedings, respectively). (Please note:
`Although sports drinks are often marketed as electrolyte
`replacement solutions, they are formulated differently,
`are often high in sugar, too low in salt, and are not appro-
`priate for people with short bowel syndrome.)
`
`*High sugar content supplements can worsen diarrhea and other symptoms.
`
`
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`In addition to nutritional support, oral medications may also be used
`to relieve symptoms of short bowel syndrome.
`
`Oral Medications
`In addition to nutritional support, oral medications may
`also be used to relieve symptoms of short bowel syn-
`drome. (Please note: It is essential to check with a doctor
`before taking medications of any kind, whether they are
`prescription or over-the-counter.)
`
`Medications for short bowel syndrome include:
`• Anti-diarrheal or anti-motility medications. These slow
`down the normal movement of food through the small
`intestine. This allows the small intestine more time to
`absorb water and nutrients. Commonly used products
`for this purpose include:
` » Loperamide (Imodium®)
` » Diphenoxylate/atropine (Lomotil®)
` » Narcotic agents (codeine and tincture of opium)
` » Somatostatin: This relatively new treatment option
`is based on a naturally occurring hormone produced
`in the body known as somatostatin. This hormone
`works to slow down the action of the small intestine.
`Octreotide, the man-made form of somatostatin, has
`the same effect. It reduces secretion of gastric acid
`and decreases small bowel secretions. In addition,
`octreotide may enhance absorption of water and
`salts.
`• Gastric acid reducers. H2 blockers such as famotidine
`(Pepcid®) and ranitidine (Zantac®) and proton-pump
`inhibitors such as omeprazole (Prilosec®, Losec®) can
`help ease the discomfort and pain caused by excessive
`amounts of gastric acid in the stomach and intestines.
`These products may also aid in reducing intestinal fluid
`and possibly help with diarrhea.
`• Bile acid/salt resins. Cholestyramine and similar
`products work by binding excess bile salts, which can
`worsen short bowel syndrome. These products can re-
`duce bile-salt diarrhea after a small resection, but may
`be less effective after a larger resection.
`Delayed- or extended-release medications should be
`avoided because absorption rates of these products are
`based on a normal-length intestine. Depending on the
`type of delivery system used, some medications may be
`
`eliminated from the intestinal tract prior to releasing the
`active ingredient.
`
`Other Medications Used to Treat SBS
`
`• GLP-2 (glucagon-like peptide-2) is a hormone made in
`the small and large intestine that may result in im-
`proved absorption and increased fluid absorption by
`enhancing intestinal growth function. The pharmaceu-
`tical form is called teduglutide. Teduglutide (Gattex®)
`has been approved by the Food and Drug Administra-
`tion (FDA) for the treatment of adult patients with Short
`Bowel Syndrome who are dependent on parenteral sup-
`port. Teduglutide enhances absorption and increases
`the surface area of the lining of the small intestine.
`• L-Glutamine powder. This is a man-made form of glutamine,
`the most plentiful amino acid (building block of pro-
`tein) in the body. Glutamine helps regulate cell growth
`and can help to maximize absorption in the shortened
`intestine. Among its other functions is to protect the
`lining of the GI tract. The powder is mixed with water
`and made into an oral solution. L-Glutamine may be
`used together with human growth hormone (see below)
`and a specialized diet to treat short bowel syndrome.
`• Somatropin. Somatotropin, or human growth hormone,
`is made by the pituitary gland in the brain. It stimulates
`body mass growth and maintains organs and tissues.
`Somatropin (Zorbtive®) is a man-made injectable form
`of human growth hormone that, when used with a diet
`high in complex carbohydrates, may enhance the intes-
`tinal adaption process and help to increase the flow of
`water, electrolytes, and nutrients into the bowel.
`
`None of these three compounds will cure SBS, but they
`may result in some modest improvement in overall intes-
`tinal function. The timing of when these medications are
`given may determine how effective they are. A combina-
`tion of these therapies may have an added effect.
`
`Nutritional Support Therapy for SBS
`If the normal method of nutrition—by mouth—is not al-
`lowing enough nutrients to be absorbed, then another
`method must be used. These include enteral (through a
`feeding tube) and parenteral (through a vein) delivery.
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`If the normal method of nutrition—by mouth—is not allowing enough
`nutrients to be absorbed, then another method must be used.
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`than parenteral nutrition. However, certain situations
`prevent the use of enteral nutrition. Under those circum-
`stances, parenteral nutrition is required.
`
`Parenteral nutrition
`For situations in which the GI tract cannot be used, feed-
`ing is accomplished through a thin intravenous (IV) tube
`called a catheter. It is surgically inserted directly into a
`large vein—either in the chest, neck, or arm. This is called
`parenteral nutrition (PN). “Parenteral” means “outside of
`the digestive system.” The liquid nutrients are delivered
`directly into the bloodstream, instead of through the
`stomach or small intestine. The liquid mixture contains
`all the necessary proteins, carbohydrates, sugars, fats,
`vitamins, minerals, and other nutrients. In cases in which
`this is the exclusive form of nutrition, this method is
`referred to as total parenteral nutrition, or TPN. Parenteral
`nutrition is often tailored to deliver specific nutritional
`needs to the individual. Although TPN may be started in
`the hospital, many people with short bowel syndrome
`receive it at home. In these situations, it may be referred
`to as home parenteral nutrition, or HPN.
`
`A convenient way to administer parenteral nutrition is to
`do so at night. A pump and IV bag containing the liquid
`mixture are placed near the bed. Delivery of TPN usually
`takes 12 hours, or longer in some cases.
`
`Caring for the TPN catheter appropriately can be a
`significant challenge. In the hospital, nurses attend to
`the catheter. They will examine the insertion site, check
`the dressing, inspect for signs of leakage, and perform
`flushing of the catheter after each use. Once the person
`is discharged, however, those responsibilities fall to a
`caregiver at home, or in some cases to the patient. A home
`care service provider or infusion center is generally able
`to assist with training, care, and maintenance of the catheter.
`The dressing must stay dry to reduce the chance of infection.
`To prevent clogging, the catheter must be flushed every
`12 hours and after each use. The insertion site requires
`daily inspection for signs of swelling, redness, or leakage.
`
`Many people will use a combination of these methods over
`time while living with SBS. Both enteral nutrition and nor-
`mal eating stimulate the remaining intestine to function
`better and may allow patients to discontinue parenteral
`nutrition over time. Some people with severe short bowel
`syndrome require parenteral nutrition indefinitely.
`
`Enteral nutrition
`This form of nutrition is delivered through a feeding tube
`that is inserted directly into the stomach or small intes-
`tine. “Enteral” means “by way of the intestine.” A special
`liquid food mixture contains protein, carbohydrates
`(sugar), fats, vitamins, and minerals. Feeding can be ad-
`ministered through several different types of tubes. A na-
`sogastric (NG) tube leading down to the stomach or bowel
`can be placed through one of the nostrils. Another kind of
`tube is placed through a surgical incision in the skin into
`the stomach or bowel. This is called a gastrostomy or je-
`junostomy tube. Enteral nutrition provides food in a form
`that is easily digested. Most patients find the raw nutri-
`tional product to have an unpleasant taste, therefore, the
`feeding tube offers a more palatable delivery method.
`
`Intake of oral and/or enteral nutrition can help preserve
`or improve the absorption ability of the remaining small
`intestine. Whenever possible, enteral nutrition is pre-
`ferred over parenteral nutrition (see below). In addition,
`enteral nutrition is considered less expensive and safer
`
`Some patients’ intestines never fully adapt to short bowel
`syndrome and require TPN for the rest of their lives in
`order to prevent malnutrition and eventually death. When
`a person’s intestine is not able to adapt, it is referred to
`as intestinal failure.
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`8
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`A variety of surgical approaches are used to improve
`intestinal absorption and function.
`
`from home becomes an important concern. But diarrhea
`doesn’t necessarily have to dominate a person’s life. With
`proper medical care and the appropriate adjustment,
`many can return to a normal lifestyle.
`
`Other coping strategies include:
`• Staying active is an important part of staying healthy.
`Doctors can offer guidance on the appropriate level of
`activity for each patient, which can benefit both body
`and mind. Some people even take their parenteral nu-
`trition “to go,” using a portable backpack system
`for delivery.
`• Create a support network of people who can be called
`upon to help out during difficult times. These people
`should understand the occasionally serious nature of
`your disease and be ready to take you to the hospital
`or doctor if necessary. They may also be called upon to
`take care of tasks you are temporarily unable to handle,
`such as child care and grocery shopping.
`• Join CCFA’s online community (www.ccfacommunity.org)
`where you can share your story with others and partici-
`pate in discussion boards.
`• Support groups can be especially helpful. Probably the
`best help, advice, and understanding will come from
`people who know what you are going through from
`personal experience. Local CCFA chapters offer support
`groups as well as informational meetings. To find your
`local chapter, go online to www.ccfa.org/chapters.
`
`Still, for patients who experience significant emotional
`distress with SBS, or those who are eager to find more
`effective ways of coping, a referral to a psychologist or
`psychiatrist might be helpful. For more information and
`support regarding living with short bowel syndrome,
`please contact the Crohn’s & Colitis Foundation of
`America’s Information Resource Center at 888.MY.GUT.PAIN
`(888-694-8872) or at info@ccfa.org.
`
`Surgical Intervention for Short Bowel
`Syndrome
`A variety of surgical approaches are used to improve
`intestinal absorption and function and reduce depen-
`dence on parenteral nutrition. These include the following
`procedures:
`• Serial transverse enteroplasty (STEP). In this proce-
`dure, surgeons take a small section of intestine that is
`stretched too wide to be effective. They make a series
`of V-shaped cuts on either side of this section, creating
`an accordion-like or zigzag appearance. This approach
`increases bowel length and makes it into a narrower,
`longer, and more effective part of the digestive tract.
`• The Bianchi procedure. In this approach, surgeons
`cut the small intestine in half longitudinally (down its
`length). The pieces are then sewn into two narrower
`tubes and joined end to end. The result is a longer,
`narrower intestine.
`• Intestinal transplantation. In small bowel transplanta-
`tion, surgeons replace a diseased small intestine with
`a healthy one from an organ donor. Transplant surgery
`can involve just the small intestine, or the entire bowel
`plus the liver. Transplant surgery may be an option
`when other treatments have failed or for people who
`experienc