Under a short bowel syndrome is a malabsorption as a result of extensive resection of the small intestine (typically more than two thirds of the small intestine length). Symptoms depend on the length and function of the remaining small intestine. Diarrhea can be severe and deficiencies are common. Treatment consists of small meals, anti-diarrheal agents and sometimes a total parenteral nutrition or rarely an intestinal transplant.
The short bowel syndrome is a Malabsorptionsstörung.
Under a short bowel syndrome is a malabsorption as a result of extensive resection of the small intestine (typically more than two thirds of the small intestine length). Symptoms depend on the length and function of the remaining small intestine. Diarrhea can be severe and deficiencies are common. Treatment consists of small meals, anti-diarrheal agents and sometimes a total parenteral nutrition or rarely an intestinal transplant. The short bowel syndrome is a Malabsorptionsstörung. Common reasons for an extended resection of Crohn’s disease, Mesenterialinfarkte, a radiation enteritis, cancer, a volvulus, and congenital anomalies. Because in the jejunum for most food ingredients takes place the essential digestion and absorption, a Jejunumresektion leads to a reduction of the absorbing surface and a reduction in absorption of nutrients. In response, the ileum tries to adapt by extending its length and by improving the absorptive function of its villi, which leads to a gradual improvement of nutrient absorption. In the ileum vitamin B12 and bile acids are added. Severe diarrhea and malabsorption of bile acids result when> 100 cm of ileum are resected. In particular, there is no compensatory adaptation the remaining jejunum (as opposed to the ileum at a resection of the jejunum). Therefore, a malabsorption of fat, fat-soluble vitamins and vitamin B12 is produced. In addition, the non-absorbed bile acids in the colon lead to a secretory diarrhea. The preservation of the colon can substantially reduce water and electrolyte loss. A resection of terminal ileum and the ileocecal valve predisposed to bacterial overgrowth. Total parenteral nutrition therapy may oral feeding when received> 100 cm jejunum remain anti-diarrheal agents, cholestyramine, proton pump inhibitors, vitamin supplements in the immediate postoperative period, there is a severe diarrhea with a strong electrolyte loss. Patients requiring parenteral nutrition and intensive monitoring of fluid and electrolytes (incl. Calcium and magnesium). An oral iso-osmotic solution of sodium and glucose (comparable to the oral WHO Rehydratationsformel, oral rehydration) is inserted slowly in the postoperative period, when the patient is stabilized and the amount of stool is <2 l / day. Patients with extensive resection (<100 cm of the remaining jejunum) and those with excessive fluid and electrolyte losses require life TPE. In contrast, patients with residual> 100 cm jejunum feed adequately by oral ingestion. Fat and protein are well tolerated in general, as opposed to carbohydrates, which represent a significant osmotic factor. Small meals reduce the osmotic problem. Ideally, 40% of the caloric needs should be covered with grease. Patients with diarrhea be postprandial with anti-diarrheal agents (eg. B. Loperamide) 1 h treated before meal. Cholestyramine, which is given in a dose of 2-4 g with meals, reduced diarrhea following ileum resection at a Gallensäurenmalabsorption. Monthly i.m. Injections of vitamin B12 are necessary in patients with documented deficiency. The majority of patients should take supplementary vitamins, calcium and magnesium. There may be a hypersecretion of gastric acid, which leads to deactivation of pancreatic enzymes; Therefore, most patients H2 blockers or proton pump inhibitors are administered. The small bowel transplantation is discussed in patients in whom an adaptation does not occur and which are not candidates for total parenteral long-term diet. Summary An extensive resection or a loss of the small intestine can cause severe diarrhea and malabsorption. Patients with residual <100 cm jejunum need a lifetime TPE; Patients with residual> 100 cm jejunum can survive with little fat and protein, but low-carb meals. Antidiarrheals, cholestyramine, proton pump inhibitors and vitamin supplements are necessary.