Understanding Short Bowel Syndrome

Posted 3.1.11 | Mallory West

The bowel is made up of the small and large intestines. The small intestine includes three sections—the duodenum, jejunum, and ileum. As we’ve discussed in previous posts, short bowel syndrome (SBS) is a malabsorption syndrome that occurs in patients who have had a significant portion of their small intestine removed. In this post, I will explain a little more about how nutrient absorption works and why malabsorption is a problem for patients with SBS.

What exactly is Malabsorption?

Malabsorption is a difficulty in absorbing nutrients from food. There are 2 requirements for proper nutrition: 1) you must consume nutrients from food, supplements, formula etc. and 2) your body must absorb these nutrients from the digestive tract so that it can be used throughout the body. Without absorption, your body is not able to access any of the nutrients found in food that you consume.

The Small Intestine: The Absorption Hub of the Digestive Tract

The small intestine absorbs about 90 percent of the nutrients and fluids your body needs to function.Although it is smaller in width compared to the large intestine (hence the name small intestine), it is actually the longest portion of the digestive tract and composed of three sections: the duodenum, the jejunum and the ileum.

So what makes the small intestine so good at absorbing nutrients? The answer is its high quantity of surface area. Believe it or not, the small intestine has the surface area of a tennis court! The lining of the small intestine (known as the epithelium) is not flat; it has folds of skin called “mucosal folds”. It also has villi, which are small finger-like projections and microvilla, which are tiny, hair-like structures. The combination of these 3 features results in the small intestine’s vast quantity of surface area and its ability to absorb nutrients so well.

Short Bowel Syndrome, Intestinal Adaptation and Nutritional Stability

Since the small intestine is so important for nutrient absorption, removal of even a small portion can cause malabsorption, such is the case with SBS. The severity of malabsorption depends on how much and which portion of the small intestine was removed. There are two main goals in treating a patient with SBS:

  • Intestinal Adaptation: The hope is that over time, the remaining small intestine will adapt by growing longer and increasing its ability to absorb nutrients. With successful adaptation, the patient will eventually be able to digest and absorb foods normally.
  • Nutritional Stability: During this adaptation period (which may take years), amino acid-based formulas, such as Neocate, are used to provide nutritional stability. Because the nutrients in Neocate are in their simplest form, they are easiest to digest and absorb. Neocate provides all the necessary nutrients required for a child’s growth and development to support health and wellness until the small intestine adapts and begins to function properly. (Interestingly, children with SBS are more prone to food allergies which is another reason why Neocate may be used with children who have SBS).

Hopefully this explanation helps you to understand the underlying problem with SBS and how an elemental formula such as Neocate is used to manage SBS. Do any of your children have SBS? What has been your experience with adaptation and nutritional stability?


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Food Allergy Living is a resource for parents of children with food allergies, brought to you by Nutricia, the makers of Neocate. For more in-depth information about our purpose & authors, see our About Food Allergy Living page.