Long-term survival and parenteral nutrition dependence in adult patients with the short bowel syndrome

Messing, Bernard; Crenn, Pascal; Beau, Philippe; Boutron-Ruault, Marie Christine; Rambaud, Jean–Claude; Matuchansky, C

doi:10.1016/s0016-5085(99)70388-4

Cited by 557 publications

(445 citation statements)

References 38 publications

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“…3 The etiology of the liver disease in these patients has not been clearly established, but is likely multifactorial. 3,[7][8][9][10] Several factors that correlate with its occurrence include duration of TPN therapy, 9 length of residual small bowel, 3 and the presence of residual colon. 3 Other factors that are implicated include bacterial overgrowth, 8 composition of TPN macronutrients (i.e., lipids, carbohydrates), 3 missing nutritional factors, 7 and hepatotoxic factors in TPN.…”

Section: Discussionmentioning

confidence: 99%

Mortality in candidates waiting for combined liver-intestine transplants exceeds that for other candidates waiting for liver transplants

Fryer

Pellar

Ormond³

et al. 2003

Liver Transplantation

141

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The United Network for Organ Sharing (UNOS) reports indicate that mortality on the intestine transplant waiting list is higher than on other transplant waiting lists. The goals of this study were (1) to determine whether most of the intestinal transplant candidate deaths have occurred in those who also need liver transplants, and (2) to compare the waiting list mortality in the liver-intestine candidate subset with the overall liver transplant candidate population. We found that 90% of intestine transplant waiting list deaths have occurred in candidates who also needed liver transplants. Since 1994, annual mortality has been higher in liver-intestine transplant candidates than in the overall liver transplant candidate population, and these differences have been statistically significant since 1996. These mortality differences applied to all age groups. Also, status 2B, 3, and 7 candidate mortality was significantly higher in liver-intestine candidates than in the overall liver transplant candidate population. Because there were so few liver-intestine transplant candidates listed as status 1 or 2A, a meaningful comparison was not possible in these statuses. These data indicate that liverintestine transplant candidates are a unique subset of liver transplant candidates with a significantly higher risk of dying on the waiting list. Recent changes in UNOS liver allocation policy that gives higher priority to liver-intestine candidates may help to reduce this discrepancy. However, further research into the etiology of liver disease in patients on long-term parenteral nutrition and earlier referral of high-risk short bowel syndrome patients to centers with special expertise in their management are needed for an ultimate solution to this problem. (Liver Transpl 2003;9:748-753.)

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Section: Discussionmentioning

confidence: 99%

Mortality in candidates waiting for combined liver-intestine transplants exceeds that for other candidates waiting for liver transplants

Fryer

Pellar

Ormond³

et al. 2003

Liver Transplantation

141

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“…45 Complications in patients with type 3 IF can be devastating with sepsis-related mortality being reported to be as high as 30% in one French series, half of which originate from infected CVCs. 46 CVC-related sepsis rates have recently been variably reported as 0.14-0.83 episodes/patient-year. [47][48][49][50][51] As outlined above, maintaining low sepsis rates requires careful catheter care protocols, with multiple studies reiterating the importance of a multidisciplinary nutrition support team in reducing CVC-related sepsis.…”

Section: Complications Of Long-term Pnmentioning

confidence: 99%

“…46,121 The presence of a retained colon (jejuno-colonic anastamosis) may allow patients to remain nutritionally autonomous with shorter lengths (sometimes <60 cm) of small intestine. 46,121 However, the length of residual small bowel only offers a relatively crude prediction of nutritional autonomy and, long-term PN dependency will also, of course, be determined by the presence of intestinal disease.…”

Section: Outcome Of Long-term Pnmentioning

confidence: 99%

Review article: the management of long‐term parenteral nutrition

Dibb

Teubner

Theis

et al. 2013

Aliment Pharmacol Ther

137

108

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SummaryBackgroundHome parenteral nutrition (HPN) is currently the management of choice for patients with chronic intestinal failure.AimTo summarise the major issues in delivering long‐term parenteral nutrition (>3 months) and assess outcome as per complications, mortality and quality of life. To assess the evidence for the therapeutic use of trophic factors such as teduglutide and to review evolving therapeutic options in the treatment of chronic intestinal failure.MethodsA literature search using PubMed and MEDLINE databases was performed.ResultsSafe delivery of HPN relies upon individualised formulations of parenteral nutrition administered via carefully maintained central venous catheters by trained patients or carers, supported by a skilled multidisciplinary team. Early diagnosis and treatment of complications including catheter‐associated blood stream infection (reported incidence 0.14–0.83 episodes/patient‐year on HPN) and central venous thrombosis (reported incidence 0.03 episodes/patient‐year) is important to minimise mortality and morbidity. There is a significant variation in the reported incidence of both hepatobiliary complications (19–75%) and advanced liver disease (0–50%). Five‐year survival rates in large centres are reported between 60% and 78% with survival primarily related to underlying diagnosis. Long‐term survival remains higher on HPN than with intestinal transplantation. The role of intestinal lengthening procedures is yet to be validated in adults.ConclusionsHome parenteral nutrition delivered by skilled nutrition teams has low incidences of catheter‐related complications. Most deaths relate to the underlying disease. Therapies such as teduglutide and small bowel transplantation appear promising, but home parenteral nutrition appears likely to remain the bedrock of management in the near term.

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“…Tais problemas têm sido relatados com freqüência de 15% a 65% dos pacientes em nutrição parenteral domiciliar. 24,25 Há evidên-cias de que pacientes com ausência total de intestino delgado e conseqüente anastomose direta do duodeno com o colo, este último com grande flora bacteriana, são mais propensos a desenvolver tal complicação 26 .…”

Section: Discussionunclassified

Síndrome do intestino curto na criança: tratamento com nutrição parenteral domiciliar

Tannuri¹

2004

Rev. Assoc. Med. Bras.

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INTRODUÇÃOA síndrome do intestino curto representa condição clínica muito grave, caracterizada pela deficiente absorção intestinal de nutrientes e que na criança leva ao óbito por desnutrição grave, se não adequadamente tratada. Alguns autores preferem a denominação de "síndrome do intestino encurtado", em virtude do problema ser geralmente decorrente de ressecção de extensos segmentos intestinais. As causas desta síndrome incluem afecções congênitas e adquiridas que resultam em perdas de grandes áreas de superfície de absorção intestinal, tanto in útero quanto pós-natal.Até o final da década de 60, praticamente todas as crianças com esta síndrome faleciam por impossibilidade de suporte nutricional adequado. A partir de 1968, com a descrição do primeiro caso de nutrição endovenosa por tempo prolongado em um recém-nascido com atresias intestinais múltiplas e conseqüente intestino curto congênito, passou-se a se obter índi-ces progressivamente maiores de sobrevida em crianças com esta afecção e outras disfunções intestinais graves. A seguir, graças ao melhor conhecimento dos mecanismos fisiopatológicos da absorção dos nutrientes, percebeu-se a utilidade do uso clínico das dietas elementares, quimicamente definidas e desprovidas de resídu-os, em pacientes com síndrome do intestino curto. Tais dietas foram primariamente formuladas para a primeira viagem do homem à Lua, em 1969.Em 1970, foi descrita pela primeira vez a possibilidade de utilização da nutrição parenteral prolongada no domicílio do paciente. Nos primeiros casos, as soluções nutrientes eram administradas através de shunts venoarteriais, semelhantes aos utilizados para hemodiálise em pacientes com insuficiência renal crônica. Este programa terapêutico foi Correspondência:Rua Barata Ribeiro, 483 -7º andar CEP: 01308-000 -São Paulo -SP crescimento e desenvolvimento satisfatórios, semelhantes aos obtidos durante nutrição oral. Obstruções do cateter, alterações hepáticas e infecção devida ao cateter foram as complicações mais freqüentes. Sete crianças (37%) sobreviveram e estão fora de tratamento. Doze crianças faleceram (dez com resecção total do intestino delgado), sendo 11 por complicações relacionadas à nutrição parenteral (nove por infecção sistêmica e dois por embolia pulmonar maciça) e uma por complicação neurológica, dois meses após transplante duplo de intestino e fígado.CONCLUSÃO. A nutrição parenteral domiciliar em crianças com síndrome do intestino curto traz indiscutíveis benefícios, permite redução do período de internação hospitalar, tornando possível a adaptação funcional do intestino remanescente e manutenção do estado nutricional com a via oral exclusiva.UNITERMOS: Nutrição parenteral domiciliar. Pediatria. Suporte nutricional. Síndrome do intestino curto.

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Long-term survival and parenteral nutrition dependence in adult patients with the short bowel syndrome

Cited by 557 publications

References 38 publications

Mortality in candidates waiting for combined liver-intestine transplants exceeds that for other candidates waiting for liver transplants

Mortality in candidates waiting for combined liver-intestine transplants exceeds that for other candidates waiting for liver transplants

Review article: the management of long‐term parenteral nutrition

Síndrome do intestino curto na criança: tratamento com nutrição parenteral domiciliar

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