Chronic complications of the short bowel syndrome in adults
- John K DiBaise, MD
John K DiBaise, MD
- Professor of Medicine
- Division of Gastroenterology and Hepatology
- Mayo Clinic in Arizona
Short bowel syndrome (SBS) is a malabsorptive state that typically occurs following extensive resection of the small intestine. It is a functional definition, implying a significant amount of malabsorption of both macronutrients and micronutrients and is not necessarily dependent on the loss of bowel or a particular length of bowel. Patients with SBS are at risk for several complications. These complications may result from the underlying disease, altered bowel anatomy and physiology, or its treatment, including the need for parenteral nutrition and the use of a central venous catheter. Acute complications that can occur at any time include watery diarrhea, electrolyte disturbances, and catheter-related complications.
This topic will review the chronic complications of SBS in adults. The pathophysiology and management of SBS, including small bowel transplantation, are discussed separately.
ESOPHAGITIS/PEPTIC ULCER DISEASE
Gastric hypersecretion is common after SBS and may last 6 to 12 months postoperatively . In a minority of cases, gastric hypersecretion may lead to esophagitis and/or peptic ulcer disease and patients may present with symptoms of heartburn, regurgitation, dysphagia, or abdominal pain. (See "Pathophysiology of short bowel syndrome", section on 'Ileal versus jejunal adaptation' and "Clinical manifestations and diagnosis of gastroesophageal reflux in adults" and "Peptic ulcer disease: Clinical manifestations and diagnosis".)
Gastric hypersecretion is thought to occur as a result of the loss of inhibitory hormones produced in the proximal gut (eg, gastric inhibitory peptide and vasoactive intestinal peptide). The volume of secretions entering the small bowel increases and the pH of the secretions in the proximal gut is lowered, aggravating fluid losses and leading to peptic complications and impairment in the function of pancreatic exocrine secretions, further contributing to fat maldigestion. (See "Pathophysiology of short bowel syndrome", section on 'Ileal versus jejunal adaptation'.)
Antisecretory medications (eg, proton pump inhibitors or histamine 2-receptor antagonists) used in the early postoperative period in patients with SBS reduce gastric secretions, improve digestion and absorption, and can prevent peptic complications. In patients with gastroesophageal reflux disease or peptic ulcer disease, acid-suppressing medications are used to treat symptoms. However, acid-suppressing medications should be weaned or used at the lowest possible dose in patients with SBS as long-term use is associated with an increased risk of small intestinal bacterial overgrowth and other side effects . (See "Management of the short bowel syndrome in adults" and "Antiulcer medications: Mechanism of action, pharmacology, and side effects" and "Overview and comparison of the proton pump inhibitors for the treatment of acid-related disorders", section on 'Safety'.)
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- ESOPHAGITIS/PEPTIC ULCER DISEASE
- Small intestinal bacterial overgrowth
- - Diagnosis
- - Management
- HEPATIC STEATOSIS AND CHOLESTASIS
- Prevention and management
- ELECTROLYTE AND MICRONUTRIENT DEFICIENCIES
- METABOLIC BONE DISEASE
- Prevention and management
- D-LACTIC ACIDOSIS
- CATHETER-RELATED COMPLICATIONS
- SUMMARY AND RECOMMENDATIONS