How is SBS Treated?
The aims of treatment for SBS are to promote adaptation and get the best use out of the existing bowel, maintain adequate nutritional status, and manage symptoms and complications. Complications can arise not only as a result of the underlying condition, but also in connection with treatments.
The goal is for the patient to resume daily life as well as possible. Treatment involves some combination of:
- Nutrition planning
- Managing gastric acid secretions, bacterial overgrowth, bile salt malabsorption, and diarrhea
Treatment of SBS begins immediately after bowel loss. It starts with restoring fluid and electrolyte balance and quickly progresses to nutritional support. Nutritional support includes individualized meal plans and may involve the use of supplements, oral rehydration solutions, enteral nutrition, or parenteral nutrition. Treatment will often include medications, and in some instances surgery.
In situations where all other treatment approaches have failed, intestinal transplant is considered. The course of treatment will depend on how well the bowel is able to support individual fluid and nutrient needs.
Deciding on the Treatment
Deciding on a type of treatment requires knowledge about the remaining length of the small bowel. This may require diagnostic testing, which usually begins with x-rays and/or an enteroscopy (using an endoscope, a thin, flexible tube with a light and a lens on the end) to examine the esophagus, stomach, and small bowel.
In the average adult, the minimal length of small bowel required so that some nutrient absorption can be anticipated is 4 feet. Usually this is counted as 4 feet of jejunum beyond the point where the duodenum ends. Parenteral nutrition is always required if the remaining small bowel is less than 4 feet.
The length required for adequate fluid absorption and avoidance of dehydration will be influenced by whether the colon is intact. Parenteral nutrition is still required on many days for remaining bowel length of less than 10 feet.
Learn more about Nutrition Strategies for Short Bowel Syndrome
In recent years, pharmacological hormonal therapy (the use of hormones in medical treatment) has been introduced aiming to stimulate intestinal adaptation after intestinal resections. Clinical research involving growth hormone, glutamine, and glucagon-like peptide 2 growth hormone (GLP-2) have been studied for the treatment of SBS.
- Teduglutide (Gattex ®), a recombinant analog of human glucagon-like peptide 2, was approved by the U.S. Food and Drug Administration (FDA) for the treatment of adults with SBS who are dependent on parenteral support. Teduglutide works by regenerating cells in the intestinal lining, improving intestinal absorption of fluids and nutrients, and helping reduce the frequency and volume of parenteral nutrition.
- Apraglutide is a peptide analogue of GLP-2 which is currently under development for treatment of SBS-IF, which acts as a full agonist at the GLP-2 receptor.
Both of these medications are given by subcutaneous injection. A subcutaneous injection is a method of administering medication. Subcutaneous means under the skin. In this type of injection, a short needle is used to inject a drug into the tissue layer between the skin and the muscle. Medication given this way is usually absorbed more slowly, than if injected into a vein. Sometimes, it can take up to 24 hours to be fully absorbed.
The main goal of surgery for SBS is to increase the capacity for absorption by the existing bowel. Surgery is considered in patients who are dependent long-term on parenteral nutrition when medications have failed and where the goal is to try to avoid intestinal transplantation.
Several different surgical procedures are available depending on the existing bowel length and function. The goal of these procedures is to improve function of the existing bowel by slowing transit or increasing surface area. Different methods include reconnecting the remaining small bowel to the colon when continuity has been lost, attempting to increase transit time by reversing a segment of bowel, and intestinal lengthening procedures.
Intestinal transplantation becomes a necessary option when required life-long parenteral nutrition begins to fail. When this happens, the patient may experience any of the following:
- Significant evidence of liver injury
- The inability to maintain central venous access. Central venous access is used for parenteral nutrition (a long thin and hollow plastic tube called a ‘catheter’ or ‘line’ is placed in a vein to provide nutrition, medications and fluids).
- Frequent bloodstream infections with the line used for central venous access, which are becoming life threatening.
- Inability to keep up with excessive fluid loss (dehydration).
Isolated intestinal transplants are the preferred procedure in patients who have adequate liver function. However, a combined liver and intestinal transplant is required for those with liver failure. Management strategies for intestinal transplantation, both before and after the operation, require careful consideration involving a multidisciplinary team of specialists available at only a few centers.
workers, psychologists, and financial counselors to help deal with the complexities of organ transplants.
The most important member of the healthcare team is the person with short bowel syndrome. Family members or parents of children with SBS play essential roles as caregivers. Patients and caregivers need to have a thorough understanding of the condition and how it may best be managed based on individual needs. This will include recurring contact with healthcare providers, and use of outside resources, all aimed at helping navigate the complexities of managing SBS long term.
Manage Both Risk and Benefit of Treatments
All drugs and procedures have inherent risks. Some are unavoidable, while others can be avoided and managed. It is important for patients and families to talk to healthcare team members about both the benefit and risk of any treatment. Working together helps make treatment decisions that best fit individual needs.
Here are some questions to consider:
- What are the possible benefits of the treatment?
- How much benefit can reasonably be expected?
- What are the possible side effects of the treatment?
- What are the chances of experiencing a side effect?
- How can the chances of a side effect be reduced?
- What action should be taken if a side effect occurs?
Learn more about GI motility
You can take part in a treatment study
Participants are being sought to take part in studies on treating short bowel syndrome.
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Adapted from IFFGD publication #294- Managing and Treating SBS” Contributors: Evelin Eichler RD LD, Clinical Dietitian, University Medical Center Texas Tech University; Richard McCallum MD, Professor of Medicine and Founding Chair and Chief of Gastroenterology, Texas Tech University; Harold J. Boutté Jr. MD, Assistant Professor of Medicine, Northwestern University Feinberg School of Medicine