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New Hope for Short Bowel Syndrome One of the most serious complications of surgical treatments for Crohn's disease is the condition known as short bowel syndrome or SBS. It is a result of the loss of a significant portion of the small bowel (small intestine) due to disease or surgery. Crohn's disease is the leading cause of SBS, however, it can also be caused by other diseases or traumatic injury to the small intestine.
The most serious effect of SBS is malabsorption -- the inability to properly absorb nutrients and fluid from the foods you eat. The symptoms include weight loss, chronic diarrhea, dehydration, abdominal bloating, fatigue, depression and fat in the stool. SBS may have a major impact on the quality of life of those who suffer from it. It is important to learn all that you can about SBS as the information will help you learn how you can adjust to the condition.
When part of your small intestine is removed, the remaining intestine adapts to compensate for this loss. However, it is possible that your body may not adapt quickly enough or sufficiently to restore all lost function. The degree of complications following surgery of the small intestine, also known as resection, is affected by what portion is removed. The small intestine has three sections: the duodenum (first part, which connects to the stomach), the jejunum (the middle), and the ileum (last part, which connects to the colon). The bulk of digestion and absorption take place in the duodenum and the first part of the jejunum. However, the entire jejunum can be removed without much disability except for lactose intolerance, because the ileum can compensate for this loss. In contrast, resection of the ileum results in most of the problems seen in SBS. The ileum is the specific site of absorption for bile acids, which are important for the digesting of food, vitamin B12 and some fats. Ileal resection also greatly decreases the capacity of the small intestine to absorb water and electrolytes.
Current treatments are designed to manage symptoms and provide nutrition. In severe SBS, parenteral nutrition (PN) is often required. PN is a solution of nutrients that is provided through a tube placed in a large vein to treat malnourishment or to provide "bowel rest." Other treatments include vitamin and mineral supplements; and medications such as corticosteroids, antidiarrheals, and antacids. The most severe cases may be candidates for intestinal transplant, although this is rare.
There is new hope on the horizon. Researchers have discovered a hormone, GLP-2, that plays a role in stimulating growth of the cells that absorb nutrients and fluids in the small bowel. NPS Pharmaceuticals has developed a biologic drug that is an enhanced version of the hormone GLP-2. In early clinical trials, this drug, known as teduglutide, was shown to promote the growth of cells in the remaining small intestine. This increases the mass and absorption potential in the small intestine.
A larger trial to confirm the promising early results is currently underway. For information about how you might participate in one of these trials, visit www.ccfa.org/trials. You may also want to visit http://www.shortbowel.com for more tips and ideas on how to cope with short bowel syndrome.
For more information on coping with parenteral nutrition, visit the the Oley Foundation at www.oley.org. The Oley Foundation is a national, independent, non-profit organization that provides information and psycho-social support to consumers of home parenteral and enteral nutrition (homePEN), helping them live fuller, richer lives. |
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