Short Bowel Syndrome Treatment Options
Children with short bowel syndrome (SBS) cannot absorb enough nutrients from the food they eat by mouth. They need other ways to get the nutrients their bodies need.
Many children with SBS need to be fed through a tube that goes into a vein (intravenous, or IV, feeding). This is called parenteral nutrition (PN). For some children, PN is a long-term treatment. But PN can lead to liver problems and bacterial infections. So doctors often work to wean children off PN if they can.
If we can get a child’s small bowel working again (restore function) by using diet, medicine and, in some cases, surgery, we may be able to wean them off PN. Weaning involves slowly adding some feedings by mouth or directly into the stomach while gradually lowering the amount of nutrition provided through the IV. To wean off PN, we may use these kinds of feeding tubes (enteral nutrition):
- Nasogastric tube, which goes from their nose into their stomach
- Gastrostomy, which goes through the skin of their abdomen (belly area) and into their stomach
- Jejunostomy, which goes through the skin of their abdomen and into their small bowel
For infants and young children with SBS, another important part of feeding is giving your child some food by mouth. This helps your child learn how to suck and eat. Even if they can’t absorb what they eat by mouth now, they need to learn these skills early so they are able to eat by mouth later in life. Your child’s healthcare team will make this part of your child’s care plan.
“Intestinal rehabilitation” is the process of trying to get your child’s small bowel working again (restore function) by using diet, medicines and, in some cases, surgery. This is a main focus of our Intestinal Care Program for children with SBS or other types of intestinal failure.
Diet. PN delivers all of the nutrients a child needs straight into the child’s bloodstream. But it means food does not pass through the child’s small bowel. Having some food pass through the bowel may help the bowel begin to work better. So treatment for SBS often means striking a balance — using PN while giving some food by mouth or directly into the stomach, if possible. Your child’s healthcare team will create a plan for your child to try giving food by mouth slowly over time.
Medicines. Medicines are used in children with SBS to:
- Lower the acid from the stomach
- Slow the movement of food through the bowel
- Decrease diarrhea
- Help them absorb more nutrients
- Control bacteria in the bowel
Hormones may be used to promote growth of the bowel lining (mucosa), which helps it absorb more nutrients.
Surgery. Surgery may be used in children with SBS to taper or to lengthen the small bowel.
- In children with SBS, a segment of the small bowel may enlarge (dilate). Fluid and bacteria can collect in this area. This can lead to infections and can keep nutrients from being absorbed. So surgeons may operate to make this area smaller. This is called intestinal tapering.
- Some children with SBS have enough small bowel that surgeons can lengthen it and restore function. The surgery we use is called STEP (serial transverse enteroplasty). The surgeon cuts notches in both sides of an enlarged segment of bowel and sews along the cut edges. The notches dovetail into each other, like the teeth of a zipper. This creates a zig-zag-shaped bowel. It’s narrower and longer than the bowel was before the surgery. This means that food will take longer to move through the bowel and will come into contact with the bowel lining for a longer period. This allows the child’s body to digest food better and create less stool.
Read more about our Intestinal Care Program.
If intestinal rehabilitation does not help your child enough, or if it’s not an option for your child, then an intestine transplant may be the next step.
Seattle Children’s has the only program in the Pacific Northwest and one of the few nationwide with specialists who can perform intestine transplants. If your child needs a transplant, our team will support you and your family throughout the process. Read more about our Liver and Intestine Transplant Clinic.
You can read about what to expect when your child visits a clinic at Children’s, has surgery here or needs to stay in the hospital. You can get practical details about topics like what to do and bring the day of surgery and who will be on your child’s care team.