Le syndrome de l’intestin court chez l’adulte

Definition

SIC short bowel syndrome is a disease of the digestive tract defined by severe malabsorption occurring following extensive resection of the small intestine. A small intestine is called short when it measures less than 200 cm. Since the majority of carbohydrate, lipid and protein nutrients are absorbed within the first 150 cm of the intestine, this explains the malabsorption associated with SIC. This malabsorption results in the presence of diarrhea and / or steatorrhea and can lead to malnutrition and metabolic changes which can be fatal. Finally, SIC generally requires the use of parenteral and / or enteral nutrition, because following surgery, the intestine is often more able to maintain adequate levels of different nutrients and hydration.ydratation.

Etiology

There are many causes of CIS in adults. These include, but are not limited to, surgical resection of a large section of the small intestine, Crohn's disease, cancer, mesenteric ischemia, interruption of blood flow to the intestine, volvulus the coiling of the intestine and radiation lenteritis inflammation of the intestine. caused by radiation therapy.radiothérapie).  

Symptoms

The main symptoms of SIC are diarrhea and nutritional deficiencies caused by malabsorption. However, the symptoms of SIC depend on the anatomy and function of the remaining small intestine.t.

Resection, surgical removal of the small intestine and malabsorptionion

The small intestine is a section of the digestive tract comprising the duodenum, jejunum, and ileum. Depending on the part of the small intestine that has been removed, the consequences on absorption vary.ent.

With the resection of the jejunum, the number of disaccharidases, the enzymes responsible for the digestion of disaccharides certain sugars, chemically composed of the union of two types of sugars, decreases. Reducing these enzymes leads to a decrease in the breakdown of disaccharides, a type of carbohydrate of which lactose is a part. As undecomposed disaccharides are not absorbed, this can lead to lactose malabsorption and diarrhea.e.

With ileum resection, the movement of intestinal contents is accelerated and the absorption of vitamin B B12 and bile salts is reduced. The malabsorption of bile salts, involved in the digestion of lipids, causes a decrease in the absorption of lipids and liposoluble vitamins A, D, E and K. In addition, lipids and bile salts not absorbed in the large intestine increase and they can be altered by the action of intestinal bacteria. Impaired bile salts can lead to fat malabsorption and may be the cause of steatorrhea. Finally, removal of the ileum also causes a decrease in the absorption of water and electrolytes by the large intestine, which can be the cause of diarrhea and steatorrhea. stéatorrhée.

Intestinal adaptatione

The bowel of people with CIS usually undergoes adaptation following surgical resection. The degree of bowel adaptation depends on a number of factors including the length of the bowel resection, the section of bowel that was removed, the condition of the remaining small bowel, bowel continuity, the underlying disease, malnutrition, and the patient's age. Usually, intestinal adaptation occurs when the ileum and large intestine are present, but there is little or no adaptation in the jejunum. Intestinal adaptation includes various modifications such as an increase in the number of intestinal cells, an increase in the volume of the ileum villi, the lengthening of the intestine, and the modification of motility and hormonal changes. All its modifications have the effect of increasing the absorption of nutrients and thus limiting malabsorption. Intestinal adaptation generally lasts more than a year and is promoted by various elements such as enteral nutrition.a nutrition entérale.

The case of oxalates

Oxalates are compounds that occur naturally in some foods and are normally eliminated by the body. However, when the ileum has been removed, the oxalates are no longer eliminated and are absorbed by the large intestine. This increases the presence of these compounds in the urine and promotes urinary stones. Oxalates are found in foods like beets, spinach, nuts, tea, chocolate, strawberries, rhubarb, and wheat bran. People who have had an ileum resection usually need to eat a diet restricted in oxalates, ensure adequate hydration, and take calcium supplements, which bind to the oxalates and allow their elimination.ion.

Nutritional approach

The nutritional approach for CIS in adults is to prevent fluid and electrolyte loss and to initiate parenteral nutrition providing all the necessary macronutrients and micronutrients carbohydrates, fats, proteins, vitamins and minerals. This is because immediately after surgery, diarrhea is often very severe and people need to receive their parenteral nutrition intravenously to replace the losses. The fluids are then gradually reintroduced orally when the patient stabilizes and the quantity of stool decreases. Finally, people whose bowel resection has left less than 100 cm of jejunum, as well as those who continue to have excessive losses of nutrients, water and electrolytes often need to receive parenteral nutrition throughout their lives. For people whose remaining jejunum measures more than 100 cm, oral feeding may be resumed.e orale.

Nutritional recommendations

Nutritional recommendations for CIS in adults who can resume oral feeding include:

  • Eat small, frequent meals. This helps reduce the risk of diarrhea.
  • Drink fluids between meals.
  • Have more protein intake, which is generally well absorbed, and lower in simple sugars, which promote diarrhea.
  • Observe a low oxalate diet when the ileum has been removed..
  • Consumemultivitamin according to nutritional needs eg. : magnesium, calcium, iron, vitamin BB12, etc ...

Short bowel syndrome is a disease of the digestive tract that can have a dramatic impact on individuals who have it. In addition, these individuals can have very different profiles depending on the anatomy of the remaining small intestine and the intestinal adaptation which varies from person to person. Therefore, each individual has different needs and professional follow-up for short bowel syndrome is essential.nsable.

References 

  1. Bouthillier, Lise. January 2019. Diseases of the digestive tract. NUT 2047 Clinical nutrition 2. Montreal: University of Montreal.al.
  2. DAoust, Louise. January 2019. Hail is short. NUT 2047 Clinical nutrition 2. Montreal: University of Montreal.éal.
  3. https://www.merckmanuals.com/fr-ca/professional/troubles-gastro-intestinaux/syndromes-de-malabsorption/syndrome-du-grC3AAle-courtrt
  4. https://www.merckmanuals.com/fr-ca/accueil/troubles-digestifs/malabsorption/syndrome-de-l-intestin-court

 

Article written by:

Marie-Noël Marsan, Nutritionist

 

S