saudigastro.com/patients/diet-short-bowel-intestinal-failure
Category
Serious
Red flags
6
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
Short bowel syndrome (SBS) happens when too much small intestine is missing or does not work, so the body cannot absorb enough fluid, salts, calories, vitamins and minerals through the mouth. When oral and tube feeding is not enough and the person needs intravenous fluids or nutrition to stay well, this is called intestinal failure. How you do depends on how much small bowel remains, which part (jejunum or ileum), whether the colon (large bowel) is present, and whether the ileocaecal valve was kept. Three common anatomies are: an end jejunostomy (small bowel ends in a stoma), jejunum joined to colon, and jejunum and part of ileum joined to colon.
How common is it?
SBS is rare. It is mostly caused by surgery for Crohn’s disease, blocked blood supply to the bowel, twisting of the bowel, injury or complications of surgery. Only a minority of patients with SBS need long-term intravenous support, but they require specialist care at centres with experience.
Why does it happen?
The small bowel is where most nutrients, fluid and salts are absorbed. Losing a large part, especially the ileum (which absorbs vitamin B12 and bile salts) or the colon (which absorbs water), leads to diarrhoea or high stoma output, dehydration, weight loss and deficiencies. The remaining bowel can adapt over 1 to 2 years by growing and absorbing better, which is why care changes over time.
Symptoms
- Frequent loose or watery stools, or high output from a stoma
- Thirst, dry mouth, dizziness, tiredness and little urine from dehydration
- Weight loss and muscle wasting
- Greasy, foul-smelling stools
- Cramps, bloating and heartburn
- Signs of deficiencies: pallor, tingling, easy bruising, night blindness, bone pain, muscle cramps
Red flags — seek urgent medical care
Very little urine, dizziness on standing, confusion, or you cannot keep fluids in
Severe dehydration or salt loss. Go to the emergency room; you may need intravenous fluids.
Fever or shivering, especially during or after using a central line (IV catheter)
Possible line infection or bloodstream infection. This is an emergency: go to hospital immediately and tell them you have a central line.
Confusion, slurred speech or a drunk feeling after meals rich in sugar or starch, with a bad smell of breath
Rare D-lactic acidosis, mainly if the colon is present. Seek urgent medical care.
Severe belly pain with vomiting and a swollen belly, or stoma stops working
Possible bowel obstruction. Go to the emergency room.
Yellow skin or eyes, dark urine, or severe flank pain
Possible liver or gallstone or kidney stone problem linked to intestinal failure. See a doctor urgently.
Progressive weight loss, new muscle cramps, or numbness
Possible malnutrition or low magnesium, calcium or vitamins. Contact your team within days.
How is it diagnosed?
Diagnosis rests on your surgical history and the measured length and anatomy of the remaining bowel. Monitoring uses weight and body composition, stool or stoma output records, urine volume and sodium, blood tests for salts, magnesium, kidney and liver function, vitamins (A, D, E, K, B12, folate), iron, zinc and selenium, and bone density. A dietitian takes a detailed diet history and you may keep a food, drink and output diary.
What the latest science says
ESPEN guidelines on chronic intestinal failure in adults (2016, updated 2023) and the AGA clinical practice update on short bowel syndrome set out the main principles. These are an individual plan by a multidisciplinary intestinal failure team; oral intake continues and hyperphagia (eating more than normal, often 1.5 to 2 times usual needs) is encouraged; people with an end jejunostomy need extra salt and an oral rehydration solution instead of plain water or sugary drinks; people with a colon in continuity benefit from a diet higher in complex carbohydrate and lower in fat, with attention to oxalate kidney stones; vitamin B12 and other micronutrients are monitored and replaced; and parenteral (intravenous) support is used when oral and enteral nutrition cannot maintain hydration and nutrition. Teduglutide, a long-acting GLP-2 analogue (a gut-growth hormone), can reduce dependence on intravenous support in selected adults in specialist centres. Many dietary details rest on expert consensus and small studies rather than large trials.
Outlook — what to expect
Many people adapt over 1 to 2 years and can reduce or stop intravenous support, especially if enough small bowel and the colon remain. Some need intravenous support long-term, and with good care at an experienced centre many live active lives. Complications such as line infections, liver disease and kidney stones are the main risks and are reduced by regular monitoring. Small bowel transplantation is reserved for those with life-threatening complications of intravenous nutrition.
Treatment
Habits & Lifestyle
Daily routines make a big difference to hydration and absorption.
- Record your weight, urine amount and stool or stoma output as your team asks, and share the record at clinic visits.
- Eat 6 or more small meals and snacks across the day, chewing slowly; keep snacks within reach.
- Sip fluids through the day instead of drinking large amounts at once.
- Keep central line care strictly clean if you have one: wash hands, follow your nurse’s technique, never use the line for anything else.
- Take supplements exactly as prescribed, and do not stop medicines without advice.
Diet
The diet is individual and changes over time. These principles apply to many people; your intestinal failure dietitian will tailor them.
- Eat more than you used to: most people need to eat well beyond normal appetite, including at night, to make up for lost absorption (hyperphagia).
- Include protein and some starchy food at every meal and snack: eggs, fish, chicken, lean meat, yoghurt, rice, potatoes, pasta, bread. Choose foods you can tolerate and enjoy.
- Drinks: with a stoma or high output, avoid large amounts of plain water, tea, coffee, juice, soft drinks and sugary or very hot or cold drinks, because they can increase output. Use an oral rehydration solution (a measured mix of salt, glucose and water, either pharmacy-made or prepared as your team shows you). Salty foods and soups can help.
- Some people find that drinking between meals rather than with meals reduces output; try it if your team agrees.
- Limit simple sugars (sweets, syrups, sugary desserts, juice), which pull water into the bowel; this is a common cause of watery stools.
- If your colon is connected (no stoma): favour complex carbohydrates and soluble fibre; fat does not have to be restricted but very fatty meals can worsen diarrhoea. Limit foods high in oxalate (spinach, beetroot, nuts, tea, chocolate, rhubarb, sesame paste in large amounts) and take calcium with meals to bind oxalate, to lower the risk of kidney stones. Keep fluids adequate.
- If you have an end jejunostomy: fat need not be restricted (fat does not usually raise output), salt and an oral rehydration solution are important, and your team will check magnesium.
- Vitamins and minerals: expect regular supplements (for example vitamin B12 by injection after ileal loss, vitamin D, calcium, magnesium, zinc, iron and others) based on blood tests. Do not self-prescribe high doses.
- Medical-grade oral nutrition drinks or feeding through a tube are added when food alone cannot maintain weight; intravenous (parenteral) nutrition is the next step when needed.
Medications
Medicines reduce losses and replace what is missing. Your specialist chooses and adjusts them; do not self-adjust.
- Anti-diarrhoeal medicines (such as loperamide) and acid-reducing medicines are often used to slow the gut and reduce output.
- Sodium, magnesium, calcium and vitamin supplements, and injections of vitamin B12, are given on the basis of blood tests.
- Teduglutide (a GLP-2 analogue given by daily injection) may be considered in specialist centres for adults who depend on intravenous support; it needs careful screening, including a colonoscopy.
- Bile-salt binding medicines may help with diarrhoea in some patients whose terminal ileum was removed but whose colon is present.
- Medicines should be checked by a pharmacist, as absorption of tablets can be reduced.
Procedures & Surgery
These are for feeding access, rehabilitating the gut, and complications.
- A central venous catheter (tunnelled line or port) is placed for home parenteral nutrition or fluids; you and your family are trained to look after it.
- A feeding tube through the nose or directly into the stomach may be used for extra nutrition.
- Reconnecting the bowel, lengthening or tapering procedures may be done in selected patients in specialist centres.
- Gallbladder removal or kidney stone treatment may be needed.
- Small bowel (with or without liver) transplantation is considered for selected patients with life-threatening complications.
Living with the condition
- Ask your hospital for contact with an intestinal failure unit and a nutrition nurse and dietitian.
- Carry a card or letter stating your diagnosis, medicines and central line, to show in emergencies.
- Plan for travel and hot weather: take enough fluids, rehydration sachets and supplies.
- Seek emotional and peer support; living with a tube or stoma can be hard and support helps.
In the Saudi context
Hot weather and outdoor activity raise the risk of dehydration, so always carry rehydration drinks. Traditional foods such as rice, bread, chicken, fish, eggs and laban are good base foods. Sweet drinks, dates in large amounts, juices and syrup-based desserts (for example kunafa, luqaimat, qatayef) are high in simple sugar and can worsen watery output, so try small portions with a meal. Fasting in Ramadan is usually unsafe for people who need intravenous support or have a high-output stoma, and many others need individual advice; do not decide alone. Speak to your intestinal failure team well before Ramadan.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- How much small bowel do I have left, and what does that mean for my diet?
- What should I drink, and how much oral rehydration solution do I need?
- Which vitamins and minerals should be checked and replaced?
- Will I need intravenous nutrition, and could teduglutide be an option?
- Is it safe for me to fast in Ramadan?
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Status: Approved for publication by SGA; individual clinician review is ongoing · Published 24/04/2026
For general education only; it does not replace your doctor’s advice. Individual clinician review of this guide is ongoing. SGA clinician? Review this guide