Reversal of intestinal failure associated liver disease fibrosis in a patient receiving long term home parenteral nutrition

Bond, Ashley; Hayes, Stephen; Abraham, Arun; Teubner, Antje; Farrer, K.; Pironi, Loris; Lal, Simon

doi:10.1016/j.clnesp.2018.09.002

Cited by 10 publications

(25 citation statements)

References 18 publications

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“…The case of this young adult female is consistent with the published research currently available on this topic. Although the cause of IFALD is not completely understood, it is associated with several factors, including duration of PN support, frequency of infectious complications, and use of soy oil–based intravenous fat infusions .…”

Section: Discussionsupporting

confidence: 89%

“…As of January 2019, there is only limited evidence from clinical trials supporting the ability of alternative fats such as SMOF to counter these effects; however, trials in the HPN population are few and of short duration, and more research is forthcoming. Case reports, although of weaker design, are encouraging.…”

Section: Discussionmentioning

confidence: 95%

“…Additionally, homogenous trial protocols including liver biopsy in PN patients to associate changes in biochemical indices with histopathology would be of benefit. Although invasive, authors such as Bond and Van Gossum have shown that LFTs are not always reflective of fibrotic changes . In light of the potential impact on quality and longevity of life that improvements in management of HPN has to offer, undertaking this research is critical.…”

Section: Discussionmentioning

confidence: 99%

“…After initial review, there were 38 full‐text studies assessed for inclusion, with the 8 applicable papers included in Table . Study strength was then evaluated using the Academy of Nutrition and Dietetics’ Evidence Analysis Library Quality Criteria Checklist (QCC) with studies assigned ratings of either positive or neutral based on adherence to the criteria. None of the studies earned a negative rating.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Since 2016, ILEs with alternative formulations, including fish oil, mixed soy and olive oil (OO) and a blend including soy, medium‐chain triglycerides, OO, and fish oils, have become available in the United States . Although still in its nascent stage, research on these novel oils has demonstrated that they are safe, well tolerated, and may offer benefits over IL relative to progression of liver disease …”

Section: Introductionmentioning

confidence: 99%

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Case Report: Transitioning to a Mixed‐Oil Intravenous Lipid Emulsion in an Adult Patient Receiving Home Parenteral Nutrition

et al. 2019

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A potential risk of long‐term parenteral nutrition (PN) is intestinal failure–associated liver disease (IFALD). One recommendation for mitigating risk is limiting the fat dose to reduce the harmful effects of the ω‐6 fatty acids, which are the main ingredient in traditional fats. SMOFlipid (SMOF) (Kabi‐Fresenius, Bad Homburg, Germany) is a combination of soybean oil, medium‐chain triglycerides, olive oil, and fish oil emulsion. This fat source may alleviate the risk of IFALD and improve liver function tests. A patient with a long history of PN reliance and IFALD is presented in this case report. After 4 months on SMOF, total and direct bilirubin levels improved.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Case Report: Transitioning to a Mixed‐Oil Intravenous Lipid Emulsion in an Adult Patient Receiving Home Parenteral Nutrition

et al. 2019

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Exploring the long‐term risk factors associated with intestinal failure–associated liver disease in pediatric and adult patients: The role of lipid injectable emulsions in the development of liver disease

Meléndez¹,

Yeh

2022

Nut in Clin Prac

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Background: Despite parenteral nutrition (PN) being life sustaining, one of the risk factors associated with its long-term use is intestinal failure-associated liver disease (IFALD), which increases the risk for morbidity and mortality. This review examines some of the risk factors associated with IFALD.Methods: A literature review using the databases PubMed, EMBASE, and CINAHL between 2010 and 2020 was performed using search terms, including long-term total PN and liver failure, serum plant sterols and liver failure, and complications and PN. Articles in English using both human and animal participants were included. Results:The pathophysiology associated with PN and liver disease is multifactorial and influenced by the remaining small-bowel length, presence of the ileal cecal valve, lack of enteral stimulation, type of lipid injectable emulsion (ILE), plant sterol content, and excessive calories. The type of ILE plays a major role because of the phytosterol (PS) content, affecting the microbiome composition and inhibiting key gut signals. The PS content is highest in soy oil (SO)-based ILE, which increases inflammation and impairs biliary flow. Conclusion:Serum PS correlates with liver biomarker abnormalities and is highest in SO-based ILE use compared with mixed-oil emulsions. Selection of a low-PS content ILE is recommended to reduce the risk of biliary cholestasis.Stimulation of the gut, if possible, is recommended to maintain gut integrity and reduce bacterial overgrowth. Fish oil (FO) shows promise in IFALD reversal however, large randomized controlled trials are needed to further establish support for the use of FO in adults.

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ESPEN guideline on chronic intestinal failure in adults – Update 2023

et al. 2023

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Reversal of intestinal failure associated liver disease fibrosis in a patient receiving long term home parenteral nutrition

Cited by 10 publications

References 18 publications

Case Report: Transitioning to a Mixed‐Oil Intravenous Lipid Emulsion in an Adult Patient Receiving Home Parenteral Nutrition

Case Report: Transitioning to a Mixed‐Oil Intravenous Lipid Emulsion in an Adult Patient Receiving Home Parenteral Nutrition

Exploring the long‐term risk factors associated with intestinal failure–associated liver disease in pediatric and adult patients: The role of lipid injectable emulsions in the development of liver disease

ESPEN guideline on chronic intestinal failure in adults – Update 2023

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