Short bowel syndrome is a condition that develops when the small intestine, also called the small bowel, is shortened or damaged and cannot absorb enough nutrients from the foods you eat to maintain health. The small intestine is where most of the nutrients you get from foods are absorbed by your body during digestion. Short bowel syndrome may be mild, moderate, or severe, depending on how well the small intestine is working.
How common is short bowel syndrome?
Experts aren’t sure how many people have short bowel syndrome. Chronic, or long-lasting, short bowel syndrome is rare because, in most cases, the intestines are able to heal and adapt.
Who is more likely to have short bowel syndrome?
Short bowel syndrome is more likely to affect people who
have had surgery to remove part of their small intestine, called a small bowel resection
were born with a small intestine that is not as long as normal
have a diseased or damaged small intestine that can’t absorb enough nutrients
Short bowel syndrome most often occurs in people who had a small bowel resection.
What are the complications of short bowel syndrome?
Short bowel syndrome and long-term treatment with parenteral nutrition may lead to complications.
Nutrition complications
In people with short bowel syndrome, the small intestine can’t absorb enough water, vitamins, minerals, protein, fat, calories, and other nutrients from foods and drinks, a condition called malabsorption. Malabsorption can lead to
small intestinal bacterial overgrowth, an increase in the number of bacteria or a change in the type of bacteria in the small intestine
problems with the movement of food through the digestive tract, which can lead to small intestinal bacterial overgrowth and chronic inflammation in the small intestine
too much stomach acid, which may occur for 6 to 12 months after a small bowel resection and can lead to peptic ulcers1
Other complications
Short bowel syndrome and treatment with parenteral nutrition may lead to complications in other parts of the body, including
Short bowel syndrome can lead to dehydration, which means your body doesn’t have enough fluids and electrolytes to work properly. Without treatment, dehydration can lead to problems such as organ damage, shock, coma, or even death.
People should seek medical care right away if they have symptoms of dehydration, such as
decreased skin turgor, meaning that when you pinch and release someone’s skin, it doesn’t flatten back to normal right away
extreme thirst and dry mouth
feeling tired, light-headed, or dizzy or fainting
sunken eyes or cheeks
Infants and young children may have the symptoms above, as well as signs such as
no wet diapers for 3 or more hours
no tears when crying
What causes short bowel syndrome?
Short bowel syndrome is most often caused by surgery to remove part of the small intestine, called a small bowel resection. People may need a small bowel resection to treat a variety of diseases and conditions. Less commonly, short bowel syndrome may have other causes.
Infants and young children
In infants and young children, short bowel syndrome most often occurs after surgery to treat
necrotizing enterocolitis, a condition in which the wall of the small or large intestine suffers serious damage
birth defects that affect the small intestine, such as
gastroschisis, in which an infant has a defect in the abdominal wall and the infant’s intestines are found outside the body
intestinal atresia, in which part of the small intestine is completely blocked or missing
malrotation that causes midgut volvulus, or twisting of the small intestine
In infants, short bowel syndrome most often occurs after surgery to treat necrotizing enterocolitis or birth defects.
Older children and adults
In older children and adults, short bowel syndrome most often occurs after surgery to treat
Infants born with a small intestine that is not as long as normal may have short bowel syndrome.
Short bowel syndrome may also occur in people who have a diseased or damaged small intestine that can’t absorb enough nutrients to maintain health or to support growth in children.
Diagnosis
How do doctors diagnose short bowel syndrome?
To diagnose short bowel syndrome, find out how severe it is, and check for complications, your doctor will ask about your medical history and symptoms, perform a physical exam, and order tests.
Medical history
Your doctor will ask about your symptoms and your medical history, including whether you ever had surgery to remove part of the small intestine.
Physical exam
During a physical exam, your doctor may examine your body for signs of malnutrition, dehydration, low levels of certain vitamins and minerals, or other complications of short bowel syndrome.
Your doctor will ask about your medical history and symptoms.
What tests do doctors use to diagnose short bowel syndrome?
Doctors may order blood, stool, or imaging tests to diagnose short bowel syndrome, check for complications, or help find the right treatment.
Blood tests
For a blood test, a health care professional will take a sample of your blood and send it to a lab. Doctors may use blood tests to check the levels of vitamins and minerals. Blood tests may also show signs of complications.
Stool tests
A health care professional will give you a container for catching and storing the stool. You will receive instructions on where to send or take the container for analysis. Doctors may use stool tests to check how well the small intestine is working.
Imaging tests
Doctors may order imaging tests to examine the small intestine or to check for signs of complications. Imaging tests may include
x-rays, which use a small amount of radiation to create pictures of the inside of the body
reduce your need for parenteral nutrition, in which you receive intravenous (IV) nutrients. Long-term parenteral nutrition increases the risk for complications.
Nutrition support
The main treatment for short bowel syndrome is nutrition support. The type and amount of nutrition support you need may depend on what stage your short bowel syndrome is in and how severe the syndrome is.
Your doctor may refer you to a registered dietitian to help make sure you get enough nutrients. Ask your doctor about the cost of a registered dietitian’s services. If you have health insurance, check your insurance company’s website or call customer service to find out if they will pay for some or all of these services.
Acute stage
The first stage of short bowel syndrome is the acute stage. This stage often lasts about 3 to 4 weeks.2 However, the length of this stage varies from person to person.
In the acute stage, most people have intestinal failure, meaning the small intestine cannot absorb enough nutrients to maintain health or to support growth in children. During this stage, your doctor may recommend
parenteral nutrition, in which you receive nutrients through an IV inserted into a vein.
enteral nutrition, in which you receive liquid food through a tube inserted into the stomach or small intestine. The tube may be inserted through your nose or through the wall of your abdomen.
eating and drinking small amounts. For infants and young children, eating and drinking as soon as they are able to may prevent problems with eating and drinking later in life.
Receiving enteral nutrition or eating and drinking can help your intestines heal.
The main treatment for short bowel syndrome is nutrition support, including parenteral nutrition.
Adaptation stage
The second stage of short bowel syndrome is the adaptation stage. During this stage, your remaining intestines adapt, or change to work better. In adults with short bowel syndrome, the adaptation stage lasts about 2 years.3 In children, the adaptation stage may last longer.3
How well your remaining intestines adapt may depend on
how much of the small intestine you have and how healthy it is
which parts of the small intestine were removed or are diseased or damaged
less parenteral nutrition, or, if your intestines adapt enough, stopping parenteral nutrition
As you reduce or stop parenteral nutrition, you may also need vitamin or mineral supplements. For safety reasons, talk with your doctor before using dietary supplements or any other complementary or alternative medicines or practices.
Maintenance stage
The last stage of short bowel syndrome is the maintenance stage. When your intestines have stopped adapting, you are in the maintenance stage. If your intestines still cannot absorb enough nutrients to keep you healthy, this condition is called chronic intestinal failure. Your doctor may recommend long-term parenteral nutrition or surgery to treat chronic intestinal failure.
Fluids and electrolytes
Short bowel syndrome can lead to dehydration, which means your body doesn’t have enough fluids and electrolytes to work properly. To prevent dehydration, doctors may recommend
IV fluids and electrolytes. As your intestines adapt and absorb more fluids and electrolytes, you may need to get less of these nutrients through an IV.
oral rehydration solutions—special drinks that contain glucose and electrolytes.
Talk with your doctor about what you should drink and what drinks you should limit or avoid. Doctors may recommend
avoiding sugary drinks, such as sodas and fruit juices. These drinks can make dehydration worse.
in some cases, limiting drinks that have low amounts of glucose and electrolytes, such as water, tea, or coffee. Drinking too much of these liquids may make dehydration worse, especially if your colon has been removed.
Medicines
Doctors may recommend or prescribe medicines to help treat short bowel syndrome, including
medicines, such as glucagon-like peptide-2 (GLP-2) analogs, which help increase the amount of nutrients your intestines can absorb
Surgery
In some cases, doctors recommend surgery to help treat short bowel syndrome. Doctors may recommend surgery to
place a tube, called a catheter, in a vein to provide parenteral nutrition and IV fluids
place a feeding tube through the abdominal wall and into the stomach or small intestine to provide enteral nutrition
repair or remove damaged areas or other problems in the intestines
lengthen or change the structure of the intestines to help them absorb more nutrients, if other treatments don’t work
Some people with short bowel syndrome may need an intestinal transplant. Doctors may recommend an intestinal transplant for people who have chronic intestinal failure, need long-term parenteral nutrition, and develop life-threatening complications.
How do doctors prevent or treat complications of short bowel syndrome?
If you develop or are at risk for specific complications, your doctor may recommend other treatments. Depending on the complication, treatments may include changes to what you eat and drink, dietary supplements, medicines, or surgery.
Some people with short bowel syndrome develop intestinal failure-associated liver disease, which is liver damage due to intestinal failure and parenteral nutrition. If the liver damage is severe, doctors may recommend a liver transplant. If needed, people with short bowel syndrome may have liver and intestinal transplants at the same time.
Can doctors prevent short bowel syndrome?
In some cases, doctors can lower the risk that patients will get short bowel syndrome. For example, during a small bowel resection, surgeons can try to save as much of the intestine as possible. Surgeons may also take steps to help the remaining small intestine work better.
However, in many cases, short bowel syndrome cannot be prevented.
References
Eating, Diet, & Nutrition
What should I eat and drink if I have short bowel syndrome?
If you have short bowel syndrome, talk with your doctor about what you should eat and drink. Your doctor may refer you to a registered dietitian to help you plan a healthy diet. Check on the cost of a dietitian’s services and whether your health insurance may pay for some or all of these services.
Your doctor or dietitian will recommend foods and drinks to
Different people with short bowel syndrome may need different diets. Health care professionals can recommend a diet that’s right for you based on many factors, including
which parts of your intestines are missing, and which parts are present and work well
your stage of short bowel syndrome and how much nutrition support you receive
your symptoms
If you have short bowel syndrome, talk with your doctor or dietitian about what you should eat and drink.
Clinical Trials
NIDDK conducts and supports clinical trials in many diseases and conditions, including digestive diseases. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.
What are clinical trials for short bowel syndrome?
Clinical trials—and other types of clinical studies—are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about disease and improve health care for people in the future.
Researchers are studying many aspects of short bowel syndrome, such as new treatments for this condition.
Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials.
What clinical studies for short bowel syndrome are looking for participants?
You can find clinical studies on short bowel syndrome at www.ClinicalTrials.gov. In addition to searching for federally funded studies, you can expand or narrow your search to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study.
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts.
NIDDK would like to thank:
Michael A. Helmrath, M.D., Cincinnati Children’s Hospital Medical Center
Short bowel syndrome most often occurs in people who had a small bowel resection.
