Short Gut Syndrome Patient, Family & Professional Support Groups

How is Short Gut Syndrome treated?

a girl in a hospital gown holding a teddy bear

Treatment of Short Gut Syndrome focuses on maximizing proper nutrition and hydration, minimizing complications and symptoms, and encouraging the intestine to adapt, so that it absorbs as much nutrition as possible. To meet these goals, doctors use a mix of nutrition support, diet management, medications, and surgical intervention.

The exact approach to treatment is as unique as each patient and depends on 1) which sections of the intestine were removed or lost, 2) what sections remain, and 3) how the remaining portion functions and adapts.

Mild cases are treated by managing diet, maintaining fluids and electrolytes, taking nutritional supplements, and using medications to control diarrhea and bacterial overgrowth. Moderate cases may also require tube feeding and/or IV fluid and electrolytes.

For severe short bowel syndrome, treatment often involves parenteral nutrition, a form of IV nutrition also known as TPN. In some cases, intestinal adaptation is possible and the patient can slowly be weaned off of TPN. Medication or surgery may be used as a part of intestinal rehabilitation. In the most severe cases, sometimes known as "ultra short gut," complete adaptation may not be possible and TPN must be used indefinitely. Intestinal transplant may be an option for some patients, particularly when other treatment options have failed or when long-term TPN causes life-threatening complications.

Even in severe cases of short bowel syndrome, patients may receive tube feeding, or enteral nutrition, and/or continue to eat by mouth, even though nutrition is not absorbed. Feeding, whether enterally or by mouth, may stimulate the remaining intestine, the liver, and other organs to function better. Feeding can also decrease oral aversion and increase social inclusion.

On this page, you will find information about:

Intestinal Rehabilitation

Intestinal rehabilitation is a multi-disciplinary approach to treating intestinal failure that combines nutrition support, diet, medication, and surgical treatment to help intestinal failure patients' intestines to adapt and absorb more. The goals of intestinal rehabilitation are maximizing intestinal absorption, managing symptoms, reducing dependence on TPN, and avoiding intestinal transplant by avoiding the complications that make it necessary, (namely, liver damage, lost central venous access, and recurrent sepsis.)

An intestinal rehabilitation program or IRP, as the name suggests, is a program that specializes in intestinal rehabilitation. An IRP team usually includes at least a gastroenterologist, a dietitian, and a surgeon. As these programs are rare in the United States, patients often travel to receive treatment from these experts.

Read more about the team members that make up an IRP here.

Find a list of Intestinal Rehabilitation and Transplantation Centers on Transplant Unwrapped

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Nutrition support

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Medications & homeopathic therapies

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Surgical treatments

Surgical treatment of Short Bowel Syndrome works to improve gut function. In SBS, sections of the intestine may not work as they should. This happens because of scar tissue or adhesions that can cause tie up or bind the gut, restricting its movement. It can also happen because the intestine is damaged in some way, essentially malfunctioning so it doesn't move as it should.

Peristalsis is a word for the wavelike, squeezing movement of the intestine wall. This squeezing motion moves food through the gut much in the same way that toothpaste is moved by squeezing a tube of toothpaste.

When there is an obstruction, whether physical or functional, the food and fluid in the gut will back up, causing it to become stretched out, or dilated. Once dilated, it is too wide for peristalsis to effectively move gut contents. The squeeze is too weak for the larger tube.

Surgery can help remove physical obstructions like scar tissue. But many of the surgical treatments commonly used for SBS decrease, therefore improving motility, absorption, and nutrition.

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Intestinal and multivisceral transplant

Occasionally, intestinal adaptation may not be possible, or at least may not be fast enough to outpace other life-threatening complications. In these cases, transplantation may be the best treatment option.

With intestinal transplant, the damaged or shortened small bowel is removed and replaced with a healthy bowel from a donor. A patient may receive an intestine alone or may receive multiple organs from the same donor, which is known as a multivisceral transplant. Because of the size of the intestine and its complicated associated vascular, nervous, and lymphatic systems, this is a complex and difficult procedure. Additionally, during the procedure, the stomach's shape is often changed surgically to help it to empty into the donor intestine. Sometimes the spleen and gallbladder will also be removed to make space for the donor organ, which will usually swell and take up space. Removing these organs can also head off other common complications. Doctors will create an ileostomy as part of the procedure, which makes it easier and more comfortable to perform biopsies. The ostomy will be reversed later, once there is less chance of rejection.

Isolated intestinal transplant vs. multivisceral transplant

Indications for intestinal transplant

Short bowel syndrome, even fully TPN-dependent SBS, is not an indication alone for transplant. Patients can live long, mostly typical lives while receiving parenteral nutrition. Below is a list of common indications for transplant.

Risks of transplant

Besides the risks of the surgery itself, there are many ongoing risks associated with intestinal transplants. Because of these risks, transplantation is not considered a cure for intestinal failure. Instead, transplant patients trade one set of problems and risks for another. Below is a list of some of the most severe complications of intestinal transplants.

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A note about transplant evaluation

It can be worrying and even scary when a doctor suggests a referral for transplant evaluation. Evaluation does not mean transplant. When a doctor suggests transplant evaluation, they usually recognize they don't have expertise in SBS and want to transfer the patient to a higher level of care.Any quality intestinal transplant program also includes an intestinal rehabilitation program. In fact, good intestinal transplant surgeons in general are the most committed of all doctors to avoiding the need for transplant. Transplant evaluation does not require, or even guarantee, that a patient will be listed for a transplant. However, an intestinal transplant evaluation may be helpful in a few other ways.

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