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The small intestine is the major site for the digestion (breakdown of nutrients from food and liquid) and absorption (passage into the bloodstream) of nutrients so they can be used by the body. The small intestine is about 10 feet long, starts at the end of the stomach, and continues until it empties into the colon or large intestine. It is divided into 3 parts. The first section is the duodenum (approximately 12 to 18 inches in length) and is followed by the jejunum and then the ileum. In the duodenum, the acid mixed with the food delivered from the stomach is neutralized by water and bicarbonate which is secreted by the pancreas. This is important because the digestive enzymes and processes of digestion in the small bowel occur in a neutral, not acidic, environment.

Small Intestine Disorders

Small Intestine Disorders

Duodenal Ulcer, Peptic Ulcer Disease

If a body fails to neutralize the acid from the stomach or if the stomach makes too much acid and overcomes the ability of the duodenum to neutralize it, an ulcer may develop in the first portion of the duodenum. The symptoms caused by an ulcer may be pain when the stomach is empty (often relieved when food or antacid is ingested), nausea, vomiting or digested blood in the stool (bowel movement). The stool would appear black, sticky and have a foul odor. If bleeding occurs, one should consult his physician immediately! Most ulcers can be treated medically with a variety of medications. Surgery is indicated for any of the four following reasons:

1. Intractable pain - pain uncontrollable with medication.
2. Obstruction - scar tissue associated with the ulcer that has caused a narrowing of the small intestine.
3. Hemorrhage - bleeding which cannot be controlled by medical means
4. Perforation - the ulcer has penetrated through the wall of the small intestine causing leakage of the contents into the abdominal cavity.
   
   

Lactose Intolerance

The normal small intestinal cells contain an enzyme called lactase which is necessary to digest the sugar called lactose contained in milk and dairy products. Many people in the United States, particularly as they get older, are unable to digest milk because of an inadequate amount of this enzyme. This is particularly true in blacks and people of Chinese, Eastern European and Mediterranean descent. It is now possible to provide the enzyme lactase which can be added to milk so some people can have milk without the symptoms of gas, cramps, abdominal bloating or diarrhea

Sprue, Celiac Disease, Gluten Enteropathy

A rather rare condition in which the small intestinal cells are sensitive to a substance called gluten which is contained in wheat and some other grains. Consumption of gluten causes damage to the lining of the small intestine and consequently prevents adequate absorption and digestion of nutrients. Symptoms include abdominal pain, cramps, gas, bloating and diarrhea with weight loss. The treatment is a gluten-free diet.

Crohn's Disease, Regional Enteritis

A disease named after Dr. Burrell Crohn who first described it. It is a disease of unknown cause which can affect any part of the intestinal tract from the mouth to the anus. It most commonly affects the last few inches of the small intestine (the terminal ileum). It may affect this area alone or in combination with other segments of the small intestine or colon. The disease process results in ulceration of the lining of the intestine. The ulcers may become deep and actually erode through the bowel wall into an adjacent structure. This communication is called a fistula. Fistulas can occur between loops of bowel, from the bowel into the urinary bladder or vagina or out the abdominal wall. Symptoms of Crohn's disease include abdominal pain, cramps, distention, and diarrhea often associated with weight loss. Medical treatment is usually sufficient to control the disease and will heal the ulceration present in the bowel. If medical treatment is unsuccessful or if a fistula has developed surgery may be necessary to remove a segment of the diseased bowel. Many patients with Crohn's disease have involvement of the anus. This can result in scarring and narrowing of the anus. Sometimes fistulas can occur starting in the rectum or anus and exiting through the skin near the anus.

Travelers Diarrhea, Turista, Tijuana Trots

Patients who travel outside the United States, particularly to Mexico or to third world countries, are very prone to develop traveler's diarrhea. This is often caused by a microorganism called E. coli. All of us in the United States have E. coli in our intestinal tract. However, the type of E. coli we have differs from that of people who live in other countries. It is not unusual to develop diarrhea when traveling abroad. If you are going to be traveling for a short time, medications are available that can significantly reduce your chances of developing this problem, and you should discuss this with your doctor before you leave. The symptoms frequently experienced are intense abdominal cramps, sometimes with fever, and watery diarrhea.

Historically, the small bowel has been a difficult place to visit. Conventional endoscopes such as the upper endoscope and the colonoscope could at best only view a very small portion of the small bowel. In the past, the only effective way to reach the small bowel was via operative endoscopy, in which the patient underwent a formal open surgical procedure of their abdomen, and then a scope was advanced through the small bowel with the aid of the surgeons hands, as the endoscopist visualized the small bowel. Today, in 2005, we have two new ways to look at the bowel in less invasive ways, Capsule Endoscopy and Double Balloon Enteroscopy.

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