How is Short Bowel Syndrome treated?
The process that might lead to full recovery from loss of bowel is called Intestinal Adaptation or (IA) for short.
Surgery, diet and other treatments can help I.A. to happen and to speed up the process. Specific treatments depend on the severity of the disease. Several operations and patient treatments have been designed for short-bowel syndrome.
Inserting a Central Venous Catheter - (small tube placed into a larger vein) to enable artificial liquid feeding (TPN) to take place and supply vital nutrients to the body.
Surgery to increase the length of the remaining bowel.The aims of surgery using the patients own remaining bowel rather than a transplant are to slow the transit time or movement of food through the bowel that remains and to improve bowel contractions (peristalsis). Non transplant surgery started in Manchester UK by Mr A. Bianchi in 1984.
Intestinal Rehabilitation Programme - Today’s patients can benefit from a structured approach through the Intestinal Rehabilitation Programme that offers a tailored treatment solution to each patient we started this Programme in Manchester in 1997.
The main aim of the programme is to achieve life without liquid feeding, only normal feeding through the mouth and in order to do so your child will need surgery.
Patients with short bowel syndrome surviving on parenteral nutrition but who retain even a relatively small amount of residual (autologous) bowel, can realistically hope for a life without liquid feeding, following a structured program of Autologous Gastro-Intestinal Reconstruction or AGIR. Provided that there is no other bowel problems (lack of blood supply) the residual remaining (autologous) bowel is capable of significant adaptation (dilatation- increasing in size-, lengthening- increasing in length-, mucosal hyperplasia - growth of the bowel layer responsible for absorption) that occurs over a prolonged period of months or years.
Survival depends on a program of liver-sparing, (to protect liver function) total parenteral nutrition (TPN - high-protein, low-fat, moderate glucose) and careful central venous feeding line management to avoid or control sepsis (common line infections) and to maintain venous access sites. It must be acknowledge that TPN has been the key factor in survival for the short gut patients. However long term TPN could create severe liver complications and it is known that 40% to 60% of infants who required long term TPN suffered liver complications. This is the reason why the management of short bowel state during the first 4-12 months of life is critical to the child survival and long term future.
Initial bowel surgery should be as conservative as possible, retaining all possibly viable (useable) bowel. Once the patient is stable with a healthy liver, structured bowel reconstruction commences with Bowel Expansion (we allow the remaining bowel to be dilated by food) over several months to be followed by Autologous Gastro-Intestinal Reconstruction. It is difficult to say whether one single operation or more are needed as every patient is completely different.
The second aim of surgery is to have a stable, healthy child without any liver damage from the liquid feeding (TPN) that will be a healthy candidate for bowel transplant if this is required in the end.
All patients can try surgery to adapt their own bowel before they need a transplant.