Selected Podcast

Intestinal Rehabilitation: Living with Short Bowel Syndrome

Dr. Mark Corkins explores Short Bowel syndrome, intestinal rehabilitation, and how to help children afflicted with Short Bowel.
Intestinal Rehabilitation: Living with Short Bowel Syndrome
Mark Corkins, MD is Division Chief of Pediatric Gastroenterology and Professor at the University of Tennessee Health Science Center. 

Learn more about Mark Corkins, MD

Bill Klaproth: Rehab for your intestines? So, what is that? And why is intestinal rehabilitation such an important program in children's hospitals? Well, let's learn more about that in a condition called short bowel syndrome or short gut syndrome and how to best treat it with Dr. Mark Corkins, Division Chief of Pediatric Gastroenterology and professor at the University of Tennessee Health Science Center.

This is the Peds Pod by Le Bonheur Children's Hospital. I'm Bill Klaproth. Dr. Corkins, thank you so much for your time. We appreciate it. So what is short bowel or short gut syndrome?

Dr. Mark Corkins: Well, it's one of those few diagnoses in medicine that actually the name fits it. The bowel is shorter than it should be. Now, 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 intestines 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 your GI tract.

Bill Klaproth: So then what causes this?

Dr. Mark Corkins: In medicine, there are a lot of ways sometimes to get to one final pathway. There's a lot of ways to get to short bowel. Some kids are born with something called gastroschisis and the gut, it's hanging outside. There's a gap in their wall of their belly. And it soaks in that amniotic fluid, which affects how it grows, even though the babies in there, the gut is not supposed to be in there.

So we have kids that after they're born, they get an infection in the lining of their gut called necrotizing enterocolitis. And they have to have that area surgically removed because it is basically dead from the infection. We see other kids born with something called Hirschsprung's and the nerves that can help our GI tract work and move, migrate from the top to the bottom, and Hirschsprung's is where it didn't get all the way to the bottom and so that tends to affect the lower GI tract, the colon. But again, that's important and if it doesn't work, it can't be used. Like I said, there's a lot of different pathways to get to short bowel syndrome.

Bill Klaproth: So then Dr. Corkins, are there symptoms that can occur with this?

Dr. Mark Corkins: Well, there's a whole range of symptoms that can occur. It sort of depends on how short you are and what you've lost. For instance, if you lost your lower GI tract, your colon, the colon's main job is to reabsorb water and recycle water for us. So if you've lost a lot of colon, your main problem is going to be fluid and hydration. If you've lost some of your small intestine, which is the workhorse for digesting and absorbing nutrients, you're going to have more nutrient problems. So, again, it depends very much, the disease varies depending on how much you lost and what you lost, what your symptoms are. But in a way, short bowel is basically you don't have enough bowel to get all your nutrition in a normal fashion and you need help in one way or another, if you want to kind of a crude definition of what short bowel syndrome is.

Bill Klaproth: Right. So, is this curable?

Dr. Mark Corkins: It's not curable because we can't really put bowel back. Right now, we don't have a way to grow more bowel. Now, the bowel that's left does adapt. It gets better with time, it absorbs more. It has an increasing ability to absorb the nutrients and the water and those kinds of important nutrients. So over time, it will get better, the bowel adapts. But again, in theory, it's not curable, but with time, it will get better.

Bill Klaproth: Okay. And then how do you treat it?

Dr. Mark Corkins: Well, again, depends on what you've lost and how you have to intervene to get them to the nutrients they need. So treatment, there's some medicines that we will, for instance, sometimes slow down how fast things move through the bowel. So it's there longer, the more gets absorbed. You can do some different things with the feedings themselves. If your bowel is very short, sometimes you'll do something that's already a little bit broken down, so it doesn't have to be digested, it just has to be absorbed. So you can do things from medicine standpoint, you can do things from what you feed them standpoint.

And then to be honest, If there's not enough bowel to get all the nutrition, some of them need an intravenous catheter. In that catheter, we give them something called parenteral nutrition, nutrition by vein. And that helps make up the gap from what they can't get from their GI tract.

Bill Klaproth: So you said it's not curable, but you can treat it. So it sounds like this is something that someone would have to manage over their whole life then. Is that right?

Dr. Mark Corkins: That's right. They tend to have some sort of just concerns their entire life. Again, how much and how severe, and their cause of their short bowel syndrome.

Bill Klaproth: So you mentioned intravenous feeding. Is that mainly when the person is young, so they get the nutrition they need to properly grow?

Dr. Mark Corkins: That is absolutely correct. In children, you've got to get them growing. And you also have to get them the nutrition so that bowel can adapt. It's crucial. As they get older, the bowel adapts. The hope is that you can get them all parenteral nutrition or maybe minimal parenteral nutrition, just need it a couple of nights a week or something. Again, it varies patient to patient. No two patients are alike. No two people are alike. That's what makes this clinic kind of a challenge.

Bill Klaproth: Absolutely. So is short gut syndrome basically a childhood condition? I mean, you usually find this or diagnose this when a person is a child, is that right?

Dr. Mark Corkins: It's mainly in children. There are a few adults, motor vehicle accidents, those kinds of things, but it's much less common in adults.

Bill Klaproth: So then what role does intestinal rehabilitation play?

Dr. Mark Corkins: Well, again, what the intensive rehabilitation clinic does is we bring all the experts together. We have the gastroenterologist with the bowel on how it works and how it functions and the pharmacist who helps us with the medicines and the venous nutrition. And we have the dieticians who help us with the feedings and the formulas. And we have a nurse who helps with the central lines and all the feeding tubes and all that. And all those folks are there in that clinic and we all work together as a team to do the maximum function for that gut. And then support the child to get them to grow and gain like they need to gain and grow and to be as normal as possible and go to school and do those kinds of things.

Bill Klaproth: Yeah. So to be as normal as possible and go to school and all those things that kids do. So is that how a child's life is improved through intestinal rehab? You kind of get them back on the path to health and normalcy.

Dr. Mark Corkins: That's the goal. Absolutely.

Bill Klaproth: Wow. This is really interesting. How many people are affected by this?

Dr. Mark Corkins: I can't give you the national numbers, but I can tell you that we follow -- now, we're a regional center, but over like 200 kids in our group.

Bill Klaproth: Wow. Okay. Anything else you want to add, Dr. Corkins?

Dr. Mark Corkins: This is a team and it takes a team and I forgot to mention the parents and the grandparents that are part of the team too. They are absolutely part of the team and we work with the families and the families have to do a lot of the things. We get to see them in clinic and work with the families. Families are the ones that 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 they work very hard.

Bill Klaproth: Absolutely. Well, thank you for talking to us about short gut syndrome. Very informative. And I think many parents might not have known about this, so you certainly informed us on what this condition is and how it can be treated and certainly how the intestinal rehabilitation center, the role it can play. So, Dr. Corkins, thank you so much again for your time. We appreciate it.

Dr. Mark Corkins: My pleasure.

Bill Klaproth: And that's Dr. Mark Corkins. And to learn more, please visit and be sure to subscribe to the Peds Pod on Apple podcasts, Google podcasts or wherever you listen to your podcasts. You can also check out the podcast page for the full podcast library. And if you found this podcast helpful, please share it on your social channels. This is the Peds Pod by Le Bonheur Children's Hospital. Thanks for listening.