Characteristics of adult patients with chronic intestinal failure due to short bowel syndrome: An international multicenter survey

Abstract

Background and aims: The case-mix of patients with intestinal failure due to short bowel syndrome (SBS-IF) can differ among centres and may also be affected by the timeframe of data collection. Therefore, the ESPEN international multicenter cross-sectional survey was analyzed to compare the characteristics of SBS-IF cohorts collected within the same timeframe in different countries. Methods: The study included 1880 adult SBS-IF patients collected in 2015 by 65 centres from 22 countries. The demographic, nutritional, SBS type (end jejunostomy, SBS-J; jejuno-colic anastomosis, SBS-JC; jejunoileal anastomosis with an intact colon and ileocecal valve, SBS-JIC), underlying disease and intravenous supplementation (IVS) characteristics were analyzed. IVS was classified as fluid and electrolyte alone (FE) or parenteral nutrition admixture (PN). The mean daily IVS volume, calculated on a weekly basis, was categorized as <1, 1e2, 2e3 and >3 L/day. Results: In the entire group: 60.7% were females and SBS-J comprised 60% of cases, while mesenteric ischaemia (MI) and Crohn' disease (CD) were the main underlying diseases. IVS dependency was longer than 3 years in around 50% of cases; IVS was infused !5 days/week in 75% and FE in 10% of cases. Within the SBS-IF cohort: CD was twice and thrice more frequent in SBS-J than SBS-JC and SBS-JIC, respectively, while MI was more frequent in SBS-JC and SBS-JIC. Within countries: SBS-J represented 75% or more of patients in UK and Denmark and 50-60% in the other countries, except Poland where SBS-JC prevailed. CD was the main underlying disease in UK, USA, Denmark and The Netherlands, while MI prevailed in France, Italy and Poland. Conclusions: SBS-IF type is primarily determined by the underlying disease, with significant variation between countries. These novel data will be useful for planning and managing both clinical activity and research studies on SBS.

Characteristics of chronic intestinal failure in the USA based on analysis of claims data

“…Overall, we found that women were more affected by CIF than men, as was noted in previous studies 15 . The predominant age group was adults >45 years of age.…”

Malnutrition with Low Muscle Mass Is Common after Weaning off Home Parenteral Nutrition for Chronic Intestinal Failure

“…Using the current definition of temporary SBS, it was possible to distinguish those who were weaned after (or even before) reconstructive surgery and with the use of EN in some. While an end-ostomy as a temporary solution led to beneficial outcomes [ 5 , 15 ], a longer IVS duration was needed in those with post-operative complications (e.g., fistulas). Nevertheless, increased BW and albumin were found in all of the temporary SBS patients during FU, with even increased FFMI or muscle mass in those with repeated BIA.…”

“…Patients with <2 m of SB after resection were classified as jejuno-colic (SBS-JC) or jejuno-ileal anastomosis (SBS-JIC) with colon-in-continuity [ 4 ]. Patients with >2 m of SB, but with an impaired function and no remnant colon, were classified as ileostomy (SBS-I) [ 5 ]. Remnant SB length was measured from the ligament of Treitz during surgery and colon-in-continuity was expressed as a percentage, according to Cummings et al [ 18 ].…”

“…This is especially the case for short bowel syndrome (SBS), which is the most common cause of chronic IF [ 4 ]. SBS is defined as <2 m of remaining small bowel (SB) after surgical resection; however, it can also occur due to an impaired function of >2 m of the SB [ 5 ]. The restoration of intestinal continuity (RC) is indicated, if possible, as this will increase the odds of weaning off HPN and regaining full nutritional autonomy [ 6 , 7 , 8 , 9 ].…”

Estudio epidemiológico de la prevalencia del síndrome de intestino corto en España

“…De hecho, Underhill (1955) informó sobre la longitud del intestino delgado en varones en un rango entre 488 -785 (media 637) cm y en mujeres de 335 -716 (media de 592) cm (20) . En este sentido, un reciente estudio internacional multicéntrico, en el que también había reclutados 21 pacientes españoles señaló, en adultos, una ratio de 2:1 (21) . Lamentablemente en este trabajo, los datos respecto al sexo solo se han informado en un número muy escaso de pacientes sin que haya permitido sacar conclusiones al respecto.…”