Reversal of intestinal failure-associated liver disease (IFALD): emphasis on its multifactorial nature

Abstract

Patients with intestinal failure (IF) and home parenteral nutrition commonly develop abnormal liver function tests. The presentations of IF-associated liver disease (IFALD) range from mild cholestasis or steatosis to cirrhosis and decompensated liver disease. We describe the reversal of IFALD in an adult patient with IF secondary to severe Crohn's disease and multiple small bowel resections. The patient developed liver dysfunction and pathology consistent with IFALD. Multiple causal factors were implicated, including nutrition-related factors, catheter sepsis and the use of hepatotoxic medications. Multidisciplinary treatment in a tertiary IF referral centre included aggressive sepsis management, discontinuation of hepatotoxic medications and a reduction of parenteral nutrition dependency through optimisation of enteral nutrition via distal enteral tube feeding. Upon this, liver function tests normalised.

The relationship between hepatocytes and small bowel after early and short food restriction: What the results show in morphometry

“…In one study it was posited that obesity can be connected with neurotensin, which is predominantly localized in entero-endocrine cells of the small bowel (13). Another study shows that patients with intestinal failure commonly develop abnormal liver function tests (14). The authors document an adult patient with Crohn's disease and multiple small bowel resections in combination with developing liver dysfunction.…”

Actively implementing enteral nutrition to reduce parenteral nutrition-associated liver disease

“…Shores et al (10) reported that active enteral nutrition in children after intestinal surgery significantly reduces blood bilirubin concentrations, and mitigates the incidence of parenteral nutritionassociated liver disease and its severity. Furthermore, a recent study (11) suggested that parenteral nutrition in Crohn's patients caused severe liver damage, but the liver function can be gradually and significantly improved after the application of enteral nutrition. Some studies (12,13) have found that increasing the supply of enteral nutrition in critically ill patients, especially those at high-risk of malnutrition (NUTRIC score 6-9), reduces the 28-day mortality.…”

Metabolic Complications of Home Parenteral Nutrition

“…To minimize the risk of steatosis, the distribution of nonprotein calories should be 70%–85% carbohydrate and 15%–30% fat. Strict adherence to sterile catheter care protocols and precautions should always be followed to reduce the risk of CRBSI and sepsis 63 . In the case of a long‐term HPN‐dependent patient who has developed significant liver disease, an isolated intestinal transplant or combined intestinal/liver transplant should be considered.…”