Short Bowel Syndrome

What is Short Bowel Syndrome (SBS)?

• A condition where a portion of the small or large intestine has been surgically removed or damaged

• Results in reduced absorption of nutrients and fluids

Which nutrients are commonly poorly absorbed in Short Bowel Syndrome?

Reduced absorption can affect:

• Fatty acids, leading to decreased absorption of fat-soluble vitamins:

  • Vitamin A

  • Vitamin D

  • Vitamin E

  • Vitamin K

• Vitamin B12

• Calcium

• Iron

• Magnesium

• Zinc

Why are hydration problems common in Short Bowel Syndrome?

• Reduced intestinal length causes decreased absorption of water alone

• This can lead to dehydration

What fluids are recommended to improve hydration in Short Bowel Syndrome?

• Glucose/salt solutions (oral rehydration solutions)

• Oral rehydration should be used when needed

Which medications can be used to improve absorption in Short Bowel Syndrome?

Medications that reduce gut motility, allowing more absorption:

• Loperamide → preferred non sedative, no dependence or fat malabsorption

• Codeine

When can Colestyramine be used?

intact colon and less than 100cm of ileum resected colestyramine can be used to bind unabsorbed bile salts and reduce diarrhoea
Monitor for fat malabsorption

What dietary advice is recommended for patients with Short Bowel Syndrome?

• Eat foods high in energy and protein

• Use oral rehydration solutions if needed

Why should high-fibre foods be reduced in Short Bowel Syndrome?

• High-fibre foods can increase stoma output

Foods to reduce/avoid include:

• Fruit

• Nuts

• Seeds

• Raw vegetables

Why should caffeinated drinks be reduced in Short Bowel Syndrome?

• Caffeinated drinks may increase stoma output

• Decaffeinated alternatives are preferred

What is a stoma and why is it common in Short Bowel Syndrome?

• A surgically created opening on the abdomen

• Allows urine or faeces to be diverted out of the body

• Many patients with Short Bowel Syndrome may have a stoma

Why are EC/MR not suitable?

• insufficient effect from drug

  • Use forms with quicks action: liquids, capsules and uncoated or soluble tablets

What can cause diarrhoea with ileostomy?

sorbitol, magnesium, antacids, iron

What can cause constipation with colostomy?

Opioids, calcium antacids, iron

What medications can cause GI irritation and bleeding

Aspirin + NSAIDs

What is the risk of use of diuretics and laxatives?

• dehydration → hypokalaemia

  • Use K-sparing diuretics or potassium supplements

What is the main issue with absorption and stoma?

Incompletely absorbed → may need to be prescribed at much higher doses