Intestinal Failure

Intestinal failure (IF) is a rare condition where your intestines stop absorbing nutrients and fluids from what you eat. Symptoms involve your gut and can affect your appetite and energy levels. Over time, this can lead to malnutrition and affect the health of other organs.

Certain conditions can cause intestinal failure, like short bowel syndrome and Crohn’s disease. It can also be a surgery complication.

Types of intestinal failure

There are three types of intestinal failure. Each type is based on how long IF lasts and how well it responds to treatment.

• Type 1: This type can happen after surgery or a severe illness. It only lasts a few weeks, and it doesn’t come back after treatment.
• Type 2: This is when intestinal failure happens after you have emergency surgery in your belly. Type 2 IF can go on for months with treatment.
• Type 3: You’ll need long-term treatment to manage this type. It can last for months to years, and some cases can be lifelong.

Types 1 and 2 are acute. That means they won’t come back after successful treatment. Type 3 is chronic, meaning you can have flare-ups.

Symptoms of intestinal failure

If you have intestinal failure, you may experience symptoms involving your GI tract. These include:

• Bloating
• Diarrhea
• Fatigue
• Loss of appetite
• Poops that are oily or smell bad
• Vomiting

Intestinal failure causes

Short bowel syndrome is the most common cause of IF. This is when your bowel is shorter than usual because part of it is missing or damaged. The syndrome can happen because of surgery to remove part of your bowel or GI conditions you were born with.

Conditions that inflame or damage your GI tract can cause IF. This is because they either prevent GI cells from working normally or keep your gut from moving the way it’s supposed to (dysmotility). These conditions include:

• Crohn’s disease
• Cancer
• Disorders that affect the way your GI muscles move
• Conditions that harm the lining of your digestive organs
• Fistulas

You’re also at higher risk for intestinal failure if you had emergency surgery in your abdomen.

Complications of intestinal failure

If intestinal failure doesn’t receive prompt treatment, it could lead to:

• Malnutrition
• Malabsorption
• Metabolic bone disease
• Kidney disease
• Intestinal failure-associated liver disease (IFALD)

How doctors diagnose intestinal failure

To diagnose intestinal failure, your provider may order blood tests, imaging tests and minimally invasive procedures. These help your provider look for signs that your gut isn’t working like it should.

Blood and imaging tests

Blood tests help your provider check your electrolyte levels, blood cells, and liver and kidney function. These tests include:

• Electrolyte panel
• Complete blood count (CBC)
• Kidney function test
• Albumin blood test

Imaging tests allow your provider to take a detailed look at what’s happening in and around your intestines. These tests include:

• Barium enema
• Computed tomography (CT) scan
• X-ray
• Gastric emptying study

Minimally invasive procedures

Minimally invasive procedures let your provider see the soft tissues and muscles in your GI tract. This can help them understand how your gut works and pinpoint areas of concern. Procedures include:

• Sigmoidoscopy or colonoscopy: A provider uses a scope with a light and camera at the end to examine your colon.
• Upper endoscopy: A scope takes a closer look at your esophagus, stomach and duodenum.
• Capsule endoscopy: You swallow a pill with a camera and transmitter inside it. As it travels through your small intestine, it takes pictures. Eventually, it leaves your body in the natural way.
• Esophageal manometry: Sensors placed inside your esophagus record pressure levels as it contracts and expands.

How is intestinal failure treated?

Treatments for intestinal failure include parenteral nutrition, medications, dietary changes and surgery.

Parenteral nutrition

Parenteral nutrition is when you get nutrition through a vein in your arm. You can receive it in a healthcare provider’s office or at home.

Parenteral nutrition allows your body to get the nutrients it needs as your intestines recover. But it comes with its own risks, like catheter-related bloodstream infections. Your provider will do everything they can to lower the chance of this happening.

Medications

Your provider might give you medications to:

• Ease your symptoms: H2 blockers, proton pump inhibitors (PPIs)
• Slow GI activity: Loperamide, clonidine, codeine, tincture of opium, diphenoxylate and atropine

These medications can help you feel better and keep your intestines from missing out on vitamins and minerals.

Eating plan

If you have short bowel syndrome, your provider may recommend making certain changes to your eating habits. These dietary changes can make it easier for your gut to absorb the nutrients you need after you stop receiving parenteral nutrition. Depending on your unique situation, your provider may suggest:

• Eating smaller, more frequent meals
• Eating meals and snacks that are low in fat and salt
• Restricting simple sugars, like those found in sweets and soda
• Drinking less at mealtimes

Surgery

If these treatments aren’t working as well as they should, your provider may consider surgery, like:

• Bowel lengthening: A surgeon makes your small intestine longer to help you absorb more nutrition from your food. Typically, kids with short bowel syndrome and intestinal failure have this surgery. But adults can have it, too.
• Intestinal transplant: In this rare operation, a surgeon removes your small intestine and replaces it with a healthy one from a donor.

Recovery time

How long it takes to recover from IF depends on the type you have.

If you have type 1, you can expect to feel better within a couple weeks. With type 2, your recovery may take anywhere from a few weeks to a few months. Type 3 is the most severe form of IF. You can have it for months or years, or even for the rest of your life.

When should I seek care?

Seek medical attention if you were treated for intestinal failure and your symptoms return or worsen. If you had surgery, get care if you experience:

• Fever
• Redness or swelling at the surgery site
• Loss of appetite
• Unplanned weight loss
• Nausea and vomiting
• Diarrhea
• Yellow eyes and skin
• Fatigue

What can I expect if I have intestinal failure?

If you have type 1 or type 2 intestinal failure, and any underlying causes are well-managed, you can expect to feel better within a few weeks or months of treatment. As your intestines heal, they’ll start to take in nutrients the way they’re supposed to.

Type 3 requires long-term care. Be sure to attend any follow-up appointments so your provider can keep an eye on your condition and adjust your treatment plan as needed.