Does your child have Short Bowel Syndrome (SBS)? Let's talk about this simply!

Does your child often have diarrhea-like stomach problems? No matter how much food you give them, they don't seem to be eating enough, and they don't gain weight? Or have these symptoms appeared after some intestinal surgery? As a mother or father, it is normal for you to feel very scared and worried when you see things like this. Today we are going to talk about Short Bowel Syndrome (SBS), a condition that can cause these symptoms, but is not talked about much.

Simply put, what is Short Bowel Syndrome (SBS)?

Short Bowel Syndrome (SBS) is a condition in which your child's body is unable to absorb enough nutrients and fluids. This is because part of the child's small intestine is missing or does not function properly.

This condition can be present from birth. Also, sometimes SBS can occur after a large part of the small intestine has been surgically removed due to another medical condition. This is also called "Short gut syndrome".

So, what is the role of this small intestine?

To understand this better, let’s first learn a little about the small intestine, the hero of our digestive system. Think of the small intestine as a long conveyor belt in a factory. The food we eat turns into liquid in the stomach and then travels along this belt. Along the way, the walls of the intestine, which work like factory workers, separate all the good things in that food — that is, essential nutrients such as proteins, carbohydrates, fats, vitamins, iron, calcium, and fluids — and add them to the blood. The rest, which is not useful to the body, goes to the large intestine and is excreted as feces.

The small intestine has three main parts:

• Duodenum: This is the shortest part after the stomach.
• Jejunum: This is the middle part.
• Ileum: This is the longest part. It ends at the large intestine.

How does SBS affect the small intestine?

Now imagine, what would happen if we removed a large piece from the conveyor belt in that factory we mentioned? The goods (i.e. food) would run out of the conveyor belt too quickly. The workers (the walls of the intestines) wouldn't have enough time to separate the good stuff (nutrition) from the goods. The same thing happens in SBS.

Normally, a baby is born with a slightly longer intestine than normal. It's like an extra part. Even if a small part of the duodenum and jejunum is removed during surgery, the ileum can take over the work of both parts and balance the absorption of nutrients.

If this condition is left untreated, the child can develop serious conditions such as malnutrition and even be life-threatening.

How do you know if a child has SBS? What are the symptoms?

If you suspect your child has this condition, keep an eye out for these symptoms. If you have one or more of these symptoms in a row, see a doctor immediately.

Why do children have this condition?

As the name suggests, the main cause of this is intestinal obstruction. There are two main categories of causes that contribute to it:

1. Congenital problems: Some children are born with certain intestinal abnormalities.

• Congenital reduction in the length of the intestine.
• Being born without part of the intestine.
• Intestinal atresia is the medical term for failure of the intestine to develop completely in the womb.

2. As a side effect of surgery: Some severe medical conditions require surgical removal of part of a child's small intestine. SBS can also occur.

What are the conditions that require surgical removal of part of the intestine?

• Necrotizing enterocolitis: This occurs when blood flow to the intestinal walls is reduced, causing parts of the intestine to die. This condition is common in premature babies.
• Gastroschisis: This is when the intestines protrude outside the body while the baby is developing in the womb.
• Volvulus: A twisting of the intestine. This can cut off blood flow and damage that area.
• Crohn's disease: A chronic inflammatory condition of the digestive system.
• Intussusception: One part of the intestine becomes trapped inside another part.

What are the possible complications of SBS?

If SBS is not treated properly, the child can develop various complications, some of which can be very serious.

• Dehydration: Constantly retaining water in the body because the body is unable to absorb the required amount of fluid.
• Malnutrition: Weight loss and inability to gain weight due to poor absorption of nutrients.
• Vitamin and mineral deficiencies: Deficiency of essential vitamins (A, D, E, K, B12) and minerals (calcium, magnesium, zinc) for the body.
• Severe diaper rash: Severe skin irritation caused by frequent bowel movements and high acidity of stools.
• Liver disease: Liver damage due to prolonged IV nutrition and other causes.
• Kidney stones: Due to imbalances in calcium and oxalate absorption.
• Bacterial overgrowth: An overgrowth of harmful bacteria in the small intestine.
• Food intolerances: For example, the inability to digest dairy products containing lactose.

How do doctors diagnose this disease?

When you take your child to the doctor, he or she will first ask about the child's symptoms and family medical history. Then, the child will be examined. Several tests may be done to confirm the diagnosis and find the exact cause:

• Blood tests: Check the child's blood for things like vitamin and mineral levels, and anemia.
• Fecal fat test: Checks how much undigested fat is in the stool.
• X-rays: To look at the condition of the intestines. You may be given a special liquid, such as barium, and an X-ray may be taken.
• CT scan: Get a clearer picture of the intestines and other abdominal organs.

What are the treatments for SBS?

There are two main goals in treating a child with SBS. One is to somehow provide the child with the nutrition they need to grow. The other is to control symptoms such as diarrhea. Several treatment methods are used together to achieve this.

1. Nutritional changes

This is the most important part. Depending on the child's condition, doctors and nutritionists work together to create the most suitable nutrition plan for the child.

• Dietary changes: If your child is able to eat by mouth, your doctor may recommend feeding them small amounts of food several times a day . They may recommend reducing foods high in fat, simple sugars, and fiber and instead offering a higher-calorie diet rich in carbohydrates and protein.
• Total Parenteral Nutrition (TPN): This involves giving all the nutrients (fluid, sugar, protein, fat, vitamins) directly into a vein as a liquid, bypassing the child's digestive system entirely. This method is usually used after intestinal surgery or when the child is unable to take food by mouth.
• Enteral Nutrition: In this, a flexible tube is inserted through the nose or directly into the stomach or small intestine, and liquid nutrition is given through it. This method helps to provide more nutrition in addition to the amount of food eaten by mouth.

2. Medications

Various medications are used to control symptoms and improve nutritional absorption.

• Antibiotics: Control bacterial overgrowth in the gut.
• Stomach acid-reducing medications (proton pump inhibitors, H2 blockers): Reduce problems caused by stomach acid.
• Antidiarrheal medications: Slow down the rate at which food moves through the intestines, allowing more time for nutrients to be absorbed.
• Growth hormones: Improve the absorption of nutrients by the intestine.

3. Surgery

Some children may need further surgery to improve bowel function. These include:

• Increasing the length of the intestine (through special surgical methods).
• Slowing down the speed of food movement.
• Removing intestinal obstructions.

In very severe cases, the child may need to undergo an intestinal/liver transplantation.

The optimistic hope of intestinal adaptation

This is the greatest hope for parents of children with SBS. Intestinal adaptation is the process by which the remaining part of the intestine improves its function over time after a section of the intestine is removed.

In this, the inner wall of the remaining intestine thickens, and the finger-like structures called villi that absorb nutrients become longer and thicker. This allows the remaining small intestine to absorb nutrients more efficiently than before. This adaptation process can be particularly successful, as the intestines of young children continue to grow naturally until they reach a young age.

Recently introduced vaccines such as teduglutide are accelerating this adaptation process and helping to wean children off of intravenous nutrition such as TPN.

What can you do as a parent?

Although this journey is challenging, you are not alone. There is a great team to help you manage your child's health condition.

• Pediatrician
• Pediatric gastroenterologist
• Pediatric dietitian
• Pediatric surgeon

Your main task is to follow the instructions given by this medical team exactly. It is essential to take great care in feeding the child, giving medicines on time, and if you are using treatments like TPN, it is essential to take great care in keeping them clean.

SBS can be a lifelong condition for some children. However, for some children, the condition improves significantly over time. With proper medical treatment, good nutrition, and loving care, many of these children can live normal, happy lives.

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