Short Bowel Syndrome and Food Allergy
What is Short Bowel Syndrome?
Short Bowel Syndrome (SBS) occurs when a significant portion of the small intestine is taken out. The definition of short bowel syndrome is: “inadequate length or function of the small bowel (small intestine) to support nutrition and fluid requirements needed for health and growth”. The reaction of infants and children to the loss of any section of the small bowel varies and depends on the amount of bowel lost and the part of the small bowel that is lost.
The small bowel is a very important part of the digestive process. It absorbs about 90% of the nutrients and fluids your body needs to function.
Loss of any part of the small bowel reduces the area available for absorbing nutrients and fluids. When a part of the small bowel is lost the route that the nutrients take to get through the intestinal tract is disrupted. This means, it is no longer a smooth process from the stomach to the end of the intestine, which can cause problems for the infant or child.
Food allergies, especially cow milk allergy, tend to be more prevalent in infants and children with Short Bowel Syndrome. This may be due to damage to the inner lining of the intestine causing the body to react to intact protein. Such reactions are typically allergic reactions.
What are the challenges of short bowel syndrome?
When greater than 50% of the small bowel is lost in infants and children, they will need special formulas, medical procedures, and medications to help their body adapt to the reduced length of the small bowel.
These children may experience diarrhea, dehydration, poor growth, and may need to have nutrition given through their veins (total parenteral nutrition).
What causes short bowel syndrome?
In infants and children, the cause of short bowel syndrome can be one of the following:
- Necrotizing enterocolitis: an infection or inflammation of the intestinal system of premature or low birth weight infants that can result in a necrosis (dying) of the intestinal tract
- Mid-gut volvulus: twisting of the bowel upon itself
- Intestinal atresias: malformation where there is a narrowing or absence of a portion of the intestine
- Intussusception: a situation in which a part of the intestine has prolapsed into another section of the intestine, similar to the way in which parts of a collapsible telescope slide into one another
- Aganglionosis: absence of nerve cells in the colon
- Congenital anomaly: condition present at birth that could be hereditary or result from a problem during pregnancy or birth
- Hirschsprungs: absence or marked decrease in the number of nerve endings that cause the bowel to move feces
What are the goals for short bowel syndrome patients?
There are two main therapy goals:
- To help the gut adapt to the damage that has been done
With time, the gut adapts by growing longer, increasing its ability to absorb nutrients and digest formulas and foods normally.
Through adaptation, the remaining small bowel will do the work of the lost bowel and absorb nutrients with a smaller work space.
Studies have shown that enteral nutrition (tube feeding) can help the gut adapt. Special infant formulas, may be needed to help with the absorption of nutrients.
- Nutritional stability
Through a diet that agrees with the child with short bowel syndrome, the body can obtain the nutrients and fluids needed for optimal growth.
The diet may consist of parenteral nutrition initially and then advance to enteral (oral or tube) nutrition and use of infant formulae to integrate the diet and to support the growth.
Eventually some children will be able to eat an oral diet and use infant formulae as a supplement.