Intestinal failure in adults: Recommendations from the ESPEN expert groups

Abstract

Both AIF and CIF are relatively rare conditions and most of the published work presents evidence from small, single-centre studies. Much remains to be investigated to improve the diagnosis and management of IF and future studies should rely on multidisciplinary, multicentre and multinational collaborations that gather data from large cohorts of patients. Emphasis should also be placed on partnership with patients, carers and government agencies in order to improve the quality of research that focuses on patient-centred outcomes that will help to improve both outcomes and quality of life in patients with this devastating condition.

A framework to support quality of care for patients with chronic intestinal failure requiring home parenteral nutrition

“…The management of transition or transfer of care from one center to another has been identified as a source of variation in care (standard of care 9). The concept of transition relates to the process by which adolescents are handed over from pediatric to adult services for ongoing care . Transition is recognized as a source of anxiety for many patients and their families as a new, unfamiliar set of clinicians are introduced.…”

“…care distributed between single organ specialties in adult services vs oversight by an individual pediatric gastroenterologist or pediatrician) and greater expectations of the adolescent patient regarding involvement and responsibility for the self‐management of their chronic disease. This may exacerbate common challenges associated with other major (physical, emotional, social, and financial) life changes associated with moving into adulthood . Although no international guidelines (including age at which transition should occur) yet exist to inform this important process, suggested priorities involve checklists to assist practical aspects of clinical handover, use of a clinical coordinator for the transition process to facilitate communication, management of expectations and support aspects of transition, and psychological support to smooth the transition .…”

“…The concept of transition relates to the process by which adolescents are handed over from pediatric to adult services for ongoing care. 16 Transition is recognized as a source of anxiety for many patients and their families as a new, unfamiliar set of clinicians are introduced. It is often associated with different approaches to care (e.g.…”

“…16 Although no international guidelines (including age at which transition should occur) yet exist to inform this important process, suggested priorities involve checklists to assist practical aspects of clinical handover, use of a clinical coordinator for the transition process to facilitate communication, management of expectations and support aspects of transition, and psychological support to smooth the transition. 16 Transitions should be planned with introduction of the concept in early adolescence to both child and parent/carer and guided by pathways and agreed communication processes between HPN centers. Key factors in facilitating a smooth pediatric transition are also applicable to other transfers of care for HPN patients when a change to the HPN center managing their care is required.…”

Parenteral nutrition in adults during acute illness: a clinical perspective for clinicians

“…The European Society for Parenteral and Enteral Nutrition consensus guidelines define IF as a reduction in gut function below the minimum necessary for the absorption of nutrients from the GI tract to maintain health and growth . IF can be further categorised based on onset, metabolic condition and expected outcome.…”