Complications icon

SBS Complications

The complications of SBS may include:

Dehydration1

Patients who are not receiving enough nutrition from eating food or who are not able to eat normally, particularly those with SBS, are at risk for fluid and electrolyte imbalance, which can lead to acute and chronic renal failure.

Diarrhea2

Diarrhea can be severe and can cause dehydration, unintended weight loss, a general feeling of poor health (malaise), lethargy, and eventually malnutrition.

Gallstones3

SBS patients with less than 180 centimeters of small bowel or an absent ileo-cecal valve are at increased risk of developing gallstones, frequently composed of calcium bilirubinate.

Bacterial overgrowth4

Consequences of bacterial overgrowth can include fatty acid and carbohydrate malabsorption as well as sepsis.

Catheter line infection1,5

For patients who require home parenteral nutrition (PN), vascular access with a central venous catheter (CVC) is needed. Because of this, one of the most common reasons for hospitalization in patients on home PN is catheter-related bloodstream infection (CRBSI).

Gastric acid hypersecretion6

Loss of segments in the small bowel results in a change in the levels of hormones involved with digestion (cholecystokinin or CCK, secretin, and gastrin) that results in continued acid secretion. This increased acid load causes erosion of the gut lining and an increased stool volume contributing to diarrhea, and electrolyte losses. In addition, it alters pancreatic enzymes and compromises bile salt function, making them less effective.

Liver disease3

Intestinal failure-associated liver disease (IFALD) is a complication of SBS. Histopathological findings include cholestasis, steatosis, steatohepatitis, ductopenia, and perivenular and portal fibrosis.

Renal failure and stones1,3

Renal complications, reduced kidney function, and renal stones are among the metabolic complications that patients who require long-term home PN may be up against.

Bone disease3

Almost all patients who require long-term home PN have metabolic bone disease that manifests as osteopenia, osteomalacia, or osteoporosis. Diagnosis and evaluation are done with mineral bone density, serum and urine mineral levels, vitamin D, parathyroid hormone (PTH), and markers of bone turnover.

Chronic intestinal pseudo-obstruction7

Permanent intestinal dysmotility is termed chronic intestinal pseudo-obstruction (CIPO), where the modifier “pseudo” is used to underline the absence of occluding lesions. Abdominal pain is one of the main symptoms of CIPO.

Image of HCP/patient consult with speech bubble saying "Ask your patient what medications they are on" and second image of patient showing something to HCP with speech bubble saying "Tell the healthcare team what medications you are on"

SBS patients may be on a variety of medications to help manage the symptoms and complications of SBS. The following are some of the medications that may be prescribed:

  • Antisecretory drugs1,8-11 – to help reduce the amount of acid made by the stomach
  • Antidiarrheal drugs1,12 – to help make the stools more solid and less frequent
  • Antibiotics1,13 – to help treat stomach and intestinal infections
  • Analgesic drugs7,14 – to help relieve pain
  • Glucagon-like peptide-2 (GLP-2) analogues15 – to improve the absorption of fluids from your remaining gut by increasing the surface area and function of your remaining gut

All types of medications can cause side effects and may not be suitable for everyone so it’s important to discuss options with the SBS specialist team.

References:

  1. Cuerda C, Pironi L, Arends J, et al. Home Artificial Nutrition & Chronic Intestinal Failure Special Interest Group of ESPEN. ESPEN practical guideline: Clinical nutrition in chronic intestinal failure. Clin Nutr. 2021 Sep;40(9):5196-5220.
  2. National Organization for Rare Disorders (NORD). Short Bowel Syndrome. Available at: https://rarediseases.org/rare-diseases/short-bowel-syndrome/
  3. Guillen B, Atherton NS. Short Bowel Syndrome. [Updated 2022 Jul 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Available at: https://www.ncbi.nlm.nih.gov/books/NBK536935/
  4. Jeppesen PB. Spectrum of short bowel syndrome in adults: intestinal insufficiency to intestinal failure. J Parenter Enteral Nutr. 2014 May;38(1 Suppl):8S-13S.
  5. Bering J, DiBaise JK. Home Parenteral and Enteral Nutrition. Nutrients. 2022 Jun 21;14(13):2558.
  6. International Foundation for Functional Gastrointestinal Disorders (IFFGD). Complications of Short Bowel Syndrome (SBS). Available at: https://iffgd.org/wp-content/uploads/292_Complications-of-SBS-.pdf
  7. Pironi L, Arends J, Bozzetti F, et al. ESPEN guidelines on chronic intestinal failure in adults. Clin Nutr. 2016;35:247-307.
  8. AA Pharma Inc. CIMETIDINE (Histamine H2-receptor antagonist) Product Monograph. January 17, 2019.
  9. Sanis Health Inc. PANTOPRAZOLE (pantoprazole as pantoprazole sodium sesquihydrate) Product Monograph. September 7, 2017.
  10. Apotex Inc. APO-OMEPRAZOLE (Omeprazole Delayed-Release Capsules) Product Monograph. March 5, 2018.
  11. Teva Canada Limited. OCTREOTIDE (synthetic octapeptide analogue of somatostatin) Product Monograph. August 17, 2020.
  12. Teva Canada Limited. TEVA-LOPERAMIDE (loperamide hydrochloride) Product Monograph. May 11, 2017.
  13. Prodoc Ltee. PRO-CIPROFLOXACIN (ciprofloxacin hydrochloride tablets, USP) Product Monograph. October 8, 2008.
  14. Eli Lily Canada Inc. HUMATROPE (somatropin for injection) Product Monograph. August 19, 2013.
  15. Takeda Canada Inc. REVESTIVE (teduglutide for injection) Product Monograph. December 30, 2020.