Intestinal failure

Specialty of Gastroenterology

What is intestinal failure?

Intestinal failure occurs when a person’s intestines are unable to digest food properly and absorb fluids, electrolytes and nutrients essential for the body to function.

What are the symptoms of intestinal failure?

When the small intestine fails, the following symptoms can be experienced:

  • Bloating
  • Diarrhoea
  • Fatigue
  • Malabsorption of nutrients
  • Foul smelling stools
  • Poor appetite
  • Weakness
  • Weight loss
  • Vomiting

How is intestinal failure diagnosed?

A range of diagnostic tests can help to diagnose the degree of intestinal failure. Tests may include one or more of the following:

  • Abdominal computed tomography (CTscan; using x-rays and special computer software, 2 and 3D images are created of your intestines to give a clear picture of the bowels, pancreas and other organs.
  • Abdominal x-rays; simple x-rays of the abdomen can show any abnormalities
  • Barium enema; involves using x-rays and a barium dye to examine the rectum, large intestine and small intestine 
  • Blood test; a number of blood tests may be carried out, including a complete blood count, electrolyte and kidney function test to look for liver damage and albumin tests to look for nutritional deficiencies
  • Colonoscopy; a small tube and camera are inserted into the rectum and travel to the lower part of the colon 
  • Upper endoscopy; a small flexible tube and camera are passed through the mouth and oesophagus to examine the stomach for inflammation, ulcers and infection
  • Gastroduodenal manometry; a small tube and camera are passed through the mouth and down the oesophagus to measure stomach and small intestine muscle strength
  • Gastric emptying; advanced imaging techniques and tiny amounts of radioactive material are used to examine how food moves from the stomach into the small intestine after a meal
  • Scintigraphic gastric accommodation; looks at the volume of content in the stomach after a meal
  • Wireless capsule gastrointestinal monitoring system; a tiny pill is swallowed that has a monitoring system attached to look at intestinal activity

What causes intestinal failure?

The most common cause of intestinal failure is short bowel syndrome. This happens when people have had at least half of their intestines removed due to trauma or a condition such as Chron’s. The part of the intestine that is left isn’t capable of digesting all the nutrients that the body needs. Coeliac disease can also cause inflammation that leads to poor absorption of nutrients and can damage the intestines. 

Some people who undergo radiation for gastrointestinal cancer develop scar tissue which can cause intestinal damage that can lead to intestinal failure. Others are born with a malfunctioning small intestine.

Can intestinal failure be prevented?

Intestinal failure can’t be prevented but treatment can prevent further intestinal damage. If conditions like Chron’s and Celiac disease are caught early and managed, this can prevent further intestinal damage from an early stage. Following a healthy diet and lifestyle can also help.

How is intestinal failure treated?

Treatment will depend on the severity of the damage done to the intestines. Patients with very advanced intestinal failure must receive all or most of their nutrients with TPN, which stands for total parenteral nutrition, which provides liquid nutrition through a catheter inserted into a vein in the arm, groin, neck or chest. Patients on TPN can live for many years, but long-term use of TPN can result in complications in the future, such as liver disease and central venous catheter infections.

Other treatments offered include:

  • Pain management: using certain pain medications, stress management techniques and alternative medicine to ease pain caused by intestinal damage 
  • Motility care: this treats nerve-related pain in the digestive system, using nerve stimulation and medication
  • Bowel rehabilitation: to help your body get the nutrients that it needs
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