Short bowel syndrome (SBS) affects how well the small intestine absorbs nutrients. Surgery, medications, and nutritional support are all part of a comprehensive treatment plan for this condition.

SBS occurs when a large portion of the small intestine is missing or not functioning, either as a result of surgery or from birth.

Because the small intestine is responsible for nutrient absorption, SBS can cause a variety of symptoms related to nutrient deficiencies and impaired digestion, including gas, bloating, diarrhea, malnutrition, and dehydration, among others.

The goal of treatment in SBS is to ensure the body gets adequate essential nutrients while preventing complications from — and reliance on — parenteral nutrition. Parenteral nutrition is a method of providing nutrient-dense liquid through a special intravenous (IV) tube known as a central venous catheter (CVC), which doctors insert into the person’s chest.

Doctors determine the best treatment options for SBS by considering the extent of the small intestine remaining, the parts that are not longer present or functional, and individual patterns of nutrient absorption as the intestines adapt.

This article reviews the standard treatments for short bowel syndrome and their benefits.

The primary treatment for SBS is nutritional support. Nutrient-dense liquids and dietary modifications compensate for changes in digestion and nutrient deficiencies. Nutritional support for SBS varies depending on the stage and severity of SBS.

In the acute phase of SBS, known as the first phase, most people experience intestinal failure, which is when the small intestine can’t absorb enough nutrients to support the body’s functions.

During this stage, a person receives parenteral nutrition through a CVC. Doctors also use enteral nutrition, which provides liquid food through a feeding tube into the stomach or small intestine. Doctors encourage eating and drinking small amounts when possible to help stimulate intestinal absorption and promote intestinal adaptation.

As the small intestine adapts over time, the need for parenteral nutrition may decrease. Enteral nutrition may still be necessary, in addition to dietary modifications that prioritize easily digestible foods and small, frequent meals.

The final stage of SBS, known as the maintenance stage, occurs when the intestines have stopped adapting and nutrient absorption is no longer progressing. While many people in the maintenance stage of SBS are able to manage the condition using dietary adjustments and oral rehydration solutions, not everyone regains function of the small intestine.

If the small intestine does not regain enough functionality, a person may require lifelong parenteral or enteral nutrition.

Medications for SBS help improve nutrient absorption and reduce the severity of symptoms such as diarrhea and malnutrition.

Doctors may prescribe:

  • Antidiarrheals (Imodium, Lomotil): These slow intestinal transit time to allow for more nutrient absorption.
  • Bile acid sequestrants (cholestyramine): These help bind to excess bile acid that can contribute to diarrhea.
  • Teduglutide (Gattex): This is a glucagon-like peptide-2 (GLP-2) that improves intestinal absorption and stimulates the growth and repair of the intestinal lining. The Food and Drug Administration (FDA) approved it in 2012 for treating SBS in adults.
  • Proton pump inhibitors and histamine-2 receptor blockers (omeprazole, famotidine, lansoprazole): These help reduce excess gastric acid that can damage the intestinal lining.
  • Somatostatin analogue (octreotide): Doctors use this to help reduce diarrhea in severe cases or when other medications have been ineffective.

Sometimes, the small intestine of a person with severe SBS may not be able to absorb medications doctors prescribe for treatment. When this happens, the person may need to receive higher doses to compensate for the lack of absorption.

Doctors might also consider alternative delivery routes for a medication, such as transdermal patches, which deliver medication through the skin, or nasal sprays, which deliver medication through the nose.

Surgery is an important part of SBS treatment. Surgeries related to SBS include minor procedures, such as feeding tube and CVC insertions or maintenance, as well as bowel surgeries to help improve the function of the remaining intestine.

Bowel surgeries for the treatment of SBS can include:

  • Bowel lengthening procedures: Surgeries such as the Bianchi procedure, serial transverse enteroplasty (STEP), and jejunal-ileal interposition can help increase the functional surface area of the small intestine for better nutrient absorption.
  • Small bowel transplantation: Doctors typically perform transplantation of a donor’s small intestine when other treatments and bowel lengthening procedures have been ineffective.
  • Bowel resection: The removal of nonfunctional or damaged parts of the small intestine can help limit excessive fluid and nutrient loss when intestinal conditions or other complications affect the small intestine.
  • Ileostomy: This surgical procedure involves creating an opening in the abdomen to allow the removal of waste from the small intestine’s ileum into a stoma bag attached to the skin.
  • Colostomy: This is a surgical opening in the abdomen that diverts waste from the colon into a colostomy bag.

Diet, medications, and surgery are the primary treatments for SBS. However, doctors may sometimes also recommend additional therapies, such as pancreatic enzyme replacement therapy, antibiotic therapy, and secondary surgery.

Pancreatic enzyme replacement therapy involves using an oral supplement to provide the body with enzymes produced by the pancreas, including amylase, lipase, and protease. Pancreatic enzymes aid in the digestive process. However, in SBS, changes to the small intestine can reduce the time pancreatic enzymes have to mix with food.

Doctors sometimes use antibiotic therapy in SBS to manage small intestinal bacterial growth (SIBO) and infections related to CVC or feeding tube insertion. They may supplement antibiotic therapy with probiotic use to help restore the gut microbiome after treatment.

Some people with SBS may need to undergo secondary surgery to address complications, such as intestinal failure-associated liver disease (IFALD), a condition associated with long-term parenteral support. IFALD in SBS can lead to liver failure and the need for a liver transplant.

Research into innovative therapies for SBS is ongoing. FDA approval of the GLP-2 medication teduglutide (Gattex) has paved the way for additional GLP-2 drugs, such as:

Alternative therapies are also under investigation. For example, a rodent study from 2023 found fecal microbiota transplantation may improve nutrient absorption in SBS. Older research from 2018 reviewed novel types of tissue engineering that may one day replace traditional intestinal transplantation with stem cell-based tissue matrixes.

Small bowel syndrome (SBS) is a condition characterized by malabsorption. SBS occurs when a significant portion of the small intestine is missing or nonfunctional and the body becomes unable to absorb enough nutrients.

Treatment for SBS depends on a person’s stage of recovery and the severity of the condition. Medications, surgery, and dietary modifications make up the core components of a comprehensive treatment plan.