Short bowel syndrome: A nutritional and medical approach

Abstract

A 40-year-old woman with a history of Crohn's disease presents with a 3-week history of intermittent abdominal pain, about 8 watery bowel movements a day and weight loss of 8 kg from her baseline weight of 50 kg. Three years previously, she required surgical intervention for a small bowel obstruction, and on that occasion about 130 cm of ileum and 30 cm of the colon were resected. She recovered from this surgery and gained weight, and she has been taking 5-amino salicylic acid, 4 g/day, to prevent a recurrence of her inflammatory bowel disease. You decide to admit the patient for investigation and treatment of a possible recurrence of her Crohn's disease. An upper gastrointestinal series with small bowel follow-through reveals multiple small intestinal strictures with dilatation of the small bowel between these strictures. In order to control the progression of the disease, the patient was prescribed prednisone starting at 40 mg/day and tapered by 5 mg/week. In addition, azathioprine, 100 mg/day, was started concurrently to allow withdrawal of the prednisone, but the patient develops vomiting, abdominal distension and worse abdominal pain and is judged to be suffering from a bowel obstruction. She is taken to the operating room, where another 120 cm of bowel are resected. After this surgery, she develops profuse, watery diarrhea after eating or drinking anything. How do you explain to her the origin of her diarrhea? Which vitamins and minerals could you expect her to be deficient in? From a nutritional perspective, what can be done to help minimize her diarrhea?