Home Parenteral Nutrition

Summary Major advances in the understanding of the aetio‐pathogenesis and genetics of inflammatory bowel disease have been accompanied by an escalation in the sophistication of immunomodulatory inflammatory bowel disease therapeutics. However, the basic ‘triple’ therapy (5‐aminosalicylates, corticosteroids, azathioprine) and nutrition have maintained their central role in the management of patients with inflammatory bowel disease over recent decades. This review provides an overview of the supportive and therapeutic perspectives of nutrition in adult inflammatory bowel disease. The objective of supportive nutrition is to correct malnutrition in terms of calorie intake or specific macro‐ or micronutrients. Of particular clinical relevance is deficiency in calcium, vitamin D, folate, vitamin B12 and zinc. There is justifiably a growing sense of unease amongst clinicians and patients with regard to the long‐term use of corticosteroids in inflammatory bowel disease. This, rather than arguments about efficacy, should be the catalyst for revisiting the use of enteral nutrition as primary treatment in Crohn's disease. Treatment failure is usually related to a failure to comply with enteral nutrition. Potential factors that militate against successful completion of enteral nutrition are feed palatability, inability to stay on a solid‐free diet for weeks, social inconvenience and transient feed‐related adverse reactions. Actions that can be taken to improve treatment outcome include the provision of good support from dietitians and clinicians for the duration of treatment and the subsequent ‘weaning’ period. There is evidence to support a gradual return to a normal diet through exclusion–re‐introduction or other dietary regimen following the completion of enteral nutrition to increase remission rates. We also review the evidence for emerging therapies, such as glutamine, growth factors and short‐chain fatty acids. The future may see the evolution of enteral nutrition into an important therapeutic strategy, and the design of a ‘Crohn's disease‐specific formulation' that is individually tailored, acceptable to patients, cost‐effective, free from adverse side‐effects and combines enteral nutrition with novel pre‐ and pro‐biotics and other factors.

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“…Home parenteral nutrition is usually necessary when the length of the remaining small bowel is less than 100 cm 51 ,. 52 …”

Section: Home Parenteral Nutritionmentioning

confidence: 99%

Nutrition and adult inflammatory bowel disease

Goh

O’Moráin

2003

Aliment Pharmacol Ther

211

142

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“… 26 This has been found to be a useful alternative to improve nutrition in many patients especially those with short bowel syndrome, promote rehabilitation at home, and decrease long-term expenses compared to in-hospital PN therapy. 58 , 59 …”

Section: Resultsmentioning

confidence: 99%

“…Pharmacists were involved in patients’ education, provision of in-service training to nurses and house officers, coordination of patients’ transition to home care, testing and evaluating the equipment, development of a training manual, and editing a quarterly newsletter to patients on HPN. 58 Similarly, Lees et al 59 described pharmacists’ participation in patients training on HPN as part of a multidisciplinary team. Karnack et al 62 conducted a national survey in the USA to investigate pharmacists’ role in HPN programs and documented their involvement in the preparation of PN solutions, patient education, and monitoring patients’ laboratory results in collaboration with physicians.…”

Section: Resultsmentioning

confidence: 99%

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Role of pharmacists in providing parenteral nutrition support: current insights and future directions

Katoue¹

2018

IPRP

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BackgroundParenteral nutrition (PN) therapy is a complex and critical therapy that requires special clinical knowledge, skills, and practice experience to avoid errors in prescribing, compounding, and clinical management of patients. Pharmacists with adequate clinical training and expertise in PN therapy can have pivotal role in the care of patients receiving PN therapy.ObjectiveThe aim of this systematic review was to describe and evaluate the different roles of pharmacists and their provided services related to PN therapy.Materials and methodsA comprehensive systematic literature review on the topic was conducted via PubMed database using several keywords related to the topic (from 1975 to 2017). Additional resources included the standards of practice and clinical guidelines from recognized organizations such as the American Society for Parenteral and Enteral Nutrition (ASPEN) and the American Society of Health-System Pharmacists (ASHP).ResultsPharmacists have diverse roles in relation to PN therapy including the following: the assessment of patients’ nutritional needs; the design, compounding, dispensing, and quality management of PN formulations; monitoring patients’ response to PN therapy; supervision of home parenteral nutrition (HPN) programs; education of patients, caregivers, and other health care professionals on nutrition support and conducting PN-related research and quality improvement activities. These services seem to be variable across clinical settings and among different countries depending on the practice environment and pharmacists’ clinical practice in these settings. However, each of these practice domains helps to support the delivery of safe and effective PN therapy to patients.ConclusionPharmacists have been actively participating in providing PN-related services to patients. To fulfill the requirements of their essential role in this area of practice, pharmacists need adequate educational preparation and clinical training on nutrition support. Empowerment of pharmacists to assume a stronger leadership role in this dimension of pharmacy practice will enhance the quality of care provided to patients receiving PN therapy and improve PN services.

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“…HPN is an expensive therapy and must be used judiciously. 16 Since the advent of HPN, the number of people receiving HPN therapy more than 1 year has grown significantly, with some receiving HPN for >20 years. As such, these individuals have returned to their work and to their recreational activities.…”

mentioning

confidence: 99%