Managing Short Bowel in Children

Children sometimes lose part of their intestines from malformation or infection. When the non-functional portion of the intestine is removed, children and their families must manage the condition of short gut or short bowel.

Dr. Mark Corkins, Le Bonheur Children's Division Chief of Pediatric Gastroenterology and professor at the University of Tennessee Health Science Center, sheds light on this condition.

“Our GI tract is how we get our nutrition. So, a lot of our nutrition, which includes water, comes into our body through our GI tract. When you don’t have as much intestine as you should, your bowel is too short, and it affects your ability to get your nutrition and your fluid and all those nutrients that come in through the GI tract.”

Challenges from Short Bowel

Short bowel is typically diagnosed in children. Some adults may have a short gut after car accidents or other conditions that require surgical removal of a portion of the bowel.

Different parts of the bowel serve different functions. The colon reabsorbs and recycles water, which means fluids and hydration are an issue for those missing part of the colon. The small intestine absorbs nutrients, so getting proper nutrition can be a problem.

“Short bowel is basically when you don’t have enough bowel to get all your nutrition in a normal fashion and you need help in one way or another,” notes Dr. Corkins.

Caring for Short Bowel

“We don’t have a way to grow back bowel,” explains Dr. Corkins. “However, the bowel that’s left does adapt. It gets better with time, it absorbs more. It has an increasing ability to absorb nutrients and water.”

Of course, the adaptation in the bowel takes time. “In children, you’ve got to get them growing,” Dr. Corkins urges. “And, you have to get them the nutrients so the bowel can adapt. It’s crucial. The hope is that you can get them all parenteral [intravenous] nutrition or maybe minimal parenteral nutrition, just to need it a couple of nights a week or something.”

Medicines can slow down how quickly food moves through the bowel, so that more nutrients are absorbed. Food that is a little broken down already won’t require digestion. Intravenous catheters are an option for nutrients. Every individual is different, and the team works to develop the best plan for each patient.

Intestinal Rehabilitation

The intestinal rehabilitation clinic at Le Bonheur Children's assembles experts for a holistic approach to ensure maximum gut function in patients. The gastroenterologist advises on gut function. A pharmacist addresses medicines and venous nutrition. Dieticians help with feedings and formulas. Nurses take care of central lines and feeding tubes.

“This is a team, and it takes a team. The parents and the grandparents are part of the team, too. They are absolutely part of the team, and we work with families. We get to see them in clinic and work with them,” shares Dr. Corkins. “Families are the ones who have to do it at home and are really on the front line of taking care of that kid every day. These are complex kids, and they do a lot of work—and work very hard.”

**To listen to an in-depth conversation on this topic with Dr. Mark Corkins, Division Chief of Pediatric Gastroenterology and professor at the University of Tennessee Health Science Center, follow this link: https://radiomd.com/lebonheur/item/45694