What determines the severity of the condition?
Three factors are of primary importance. The first is the length of the remaining small intestine: the smaller it is, the more difficult it is to manage without intravenous support. The second is which part is removed: the ileum is especially important because it is where vitamin B12 and bile acids are absorbed, and its loss is more difficult to bear than the loss of the jejunum. The third is whether the colon and ileocecal valve are preserved: the colon absorbs water and salts and partially compensates for losses, and the valve prevents bacteria from being thrown into the small intestine.
- Length of remaining small intestine
- Remote section: jejunum or ileum
- Colon preservation
- Presence of ileocecal valve
- Condition of the remaining intestine in Crohn's disease
- Age and comorbidities
Symptoms
The leading symptom is profuse, frequent loose stools, due to which water, sodium, potassium and magnesium are lost. Hence thirst, dry skin, weakness, dizziness when standing up, muscle cramps. Weight progressively decreases, signs of deficiency appear: anemia, numbness due to lack of B12, bone pain due to deficiency of vitamin D and calcium, swelling due to decreased protein, blurred vision at dusk due to lack of vitamin A. Bloating and intolerance to certain foods are also characteristic.
- Copious watery diarrhea
- Dehydration and thirst
- Losing weight and muscle mass
- Weakness and dizziness
- Muscle cramps due to loss of electrolytes
- Anemia and signs of vitamin deficiency
Gut adaptation
After the operation, the remaining intestine is gradually rebuilt: the height of the villi increases, the absorption area increases, and the passage of contents slows down. This process takes place over one to two years and largely determines the outcome. It is the intake of food through the mouth that helps adaptation: even small portions stimulate the mucous membrane. Therefore, if possible, they try to return to enteral nutrition as soon as possible, gradually reducing the amount of intravenous support. Drastic food experiments, on the contrary, can worsen diarrhea.
- Restructuring of the mucosa in the first 1–2 years
- Stimulation of mucous food through the mouth
- Gradual expansion of the diet
- Reducing the volume of intravenous nutrition as adaptation occurs
- Regular weight monitoring and tests
Nutrition and drinking regime
Eat frequently and in small portions, 6–8 times a day, chewing thoroughly. The liquid is drunk separately from food, in small sips, giving preference to saline solutions for rehydration: plain water and sweet juices with severe diarrhea can increase losses. Limit concentrated sugary drinks and products with sorbitol. If your colon is intact, reduce the amount of fat and foods rich in oxalates to reduce the risk of kidney stones. Meals must be prepared together with a doctor or nutritionist, taking into account the length and section of the remaining intestine.
- 6–8 small meals per day
- Liquid separately from food, in small sips
- Saline solutions for rehydration instead of plain water
- Limiting sugary drinks and sorbitol
- Sufficient amount of protein
- Individual selection of fats and fiber
Treatment and observation
The doctor prescribes drugs that slow down the passage of contents and drugs that reduce the volume of discharge. If there is loss of the ileum, regular administration of vitamin B12 is required, and if there is a deficiency of bile acids, bile acid binders are prescribed. Be sure to replenish vitamin D, calcium, magnesium, iron and fat-soluble vitamins. Some patients require home parenteral nutrition through a venous catheter, which requires strict adherence to the rules of care. There are drugs that stimulate intestinal adaptation, and transplantation is considered in selected cases. All treatment is carried out by a doctor.
- Drugs that slow motility, as prescribed by a doctor
- Regular administration of vitamin B12 during ileal resection
- Replenishment of vitamin D, calcium, magnesium, iron
- Secretolytic drugs for large losses
- Parenteral nutrition if necessary
- Regular monitoring of tests and weight
- Prevention of kidney and gallstones
