Who needs a gut anyway?
This is an up-to-date review on Chronic Intestinal Failure (CIF) and Parenteral Nutrition (PN) as a management strategy for CIF.
CIF and long-term PN are important subjects, but are superficially covered in undergraduate curricula due to the perception that they are relatively specialist areas. PN, as well as being a form of acute nutritional support, is used as a life-sustaining measure for patients with CIF due to conditions such as bowel ischaemia and Crohn’s disease. Currently, around 500 patients receive long-term PN in the UK and the numbers are expected to rise with the aging population1. It is a costly service, requiring a multidisciplinary team effort, along with high frequency patient-healthcare interaction.
This article aims to discuss the current evidence on the causes, management and prognosis of CIF, with a particular focus on PN as a form of nutritional management. While PN seems to improve the prognosis of patients with CIF from a medical point of view, we will also explore how it affects other aspects of a patient’s life, such as their social life and mental health.
2. Vargas JH. Short Bowel Syndrome/Intestinal Failure. Journal of Pediatrics. 2013;163(5):1243–6.
3. O’Keefe SJD, Buchman AL, Fishbein TM, Jeejeebhoy KN, Jeppesen PB, Shaffer J. Short Bowel Syndrome and Intestinal Failure: Consensus Definitions and Overview. Clinical Gastroenterology and Hepatology. 2006;4(1):6–10.
4. Nightingale J. Definition and classification of intestinal failure. In: Nightingale J, ed. Intestinal Failure. London: Greenwich Medical Media Limited. 2001: xix–xx.
5. Nightingale J, Woodward JM. Guidelines for management of patients with short bowel. Gut.2006;55(suppl IV):iv1–iv12.
6. Buchman AL, Scolapio J, Fryer J. AGA technical review on short bowel syndrome and intestinal transplantation.Gastroenterology.2003;124: 1111–34.
7. Van Gossum A, Espen-Han Group. Home parenteral nutrition (HPN) in adults: a multicentre survey in Europe in 1993.Clin Nutr.1996;15:53–58.
8. Nightingale JM, Lennard-Jones JE, Gertner DJ, Wood SR, Bartram CI. Colonic preservation reduces need for parenteral therapy, increases incidence of renal stones, but does not change high prevalence of gall stones in patients with a short bowel. Gut.1992;33:1493–7.
9. Baumgart DC, Sandborn WJ. Crohn's disease. The Lancet. 2012;380 (9853): 1590–605.
10. Nightingale JMD, Lennard-Jones JE, Walker ER, Farthing MJ. Jejunal efflux in short bowel syndrome. Lancet. 1990;336:765–68.
11. Stanghellini V, Cogliandro RF, De Giorgio R, Barbara G, Salvioli B, Corinaldesi R. Chronic intestinal pseudo-obstruction: manifestations, natural history and management. Neurogastroenterology & Motility.2007;19: 440–52.
12. Enteral Nutrition
13. Enteral Nutrition. In Mosby (8th ed.) Mosby's Medical Dictionary Elsevier Health Sciences. 2009.
14. Lloyd DAJ, Powell-Tuck J. Artificial Nutrition: Principles and Practice of Enteral Feeding. Clin Colon Rectal Surg [Internet]. 2004 May [cited 2014 Feb 5];17(2):107–18.
15. Gramlich L, Kichian K, Pinilla J, Rodych NJ, Dhaliwal R, Heyland DK. Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature. Nutrition. 2004;20(10):843–8.
16. Matarese LE. Nutrition and fluid optimization for patients with short bowel syndrome. J Parenter Enteral Nutr. 2013;37(2):161–70.
17. Olieman JF, Penning C, IJsselstijn H, Escher JC, Joosten KF, Hulst JM, et al. Enteral Nutrition in Children with Short-Bowel Syndrome: Current Evidence and Recommendations for the Clinician. Journal of the American Dietetic Association [Internet]. 2010 Mar [cited 2014 Feb 5];110(3):420–6.
18. Kelly DG, Tappenden KA, Winkler MF. Short Bowel Syndrome: Highlights of Patient Management, Quality of Life, and Survival. J Parenter Enteral Nutr 2013 Nov
19. Hofstetter S, Stern L, Willet J. Key issues in addressing the clinical and humanistic burden of short bowel syndrome in the US. Curr Med Res Opin. 2013;29(5):495–504.
20. Satish K. Nutrition. The Gastrointestinal System . 1st ed. Gosport, UK: Blackwell Science Ltd; 2004. p. 55.
21. Bastian L, Weimann A. Practical aspects of early enteral feeding. Anaesthesiol Reanim. 1999;24(4):95–100.
22. Kompan L, Kremzar B, Gadzijev E, Prosek M. Effects of early enteral nutrition on intestinal permeability and the development of multiple organ failure after multiple injury. Intensive Care Med. 1999;25:157-61.
23. Unknown. Enteral Nutrition [Internet]. Patients on Intravenous and Naso-Gastric Nutrition Therapy (PINNT). [accessed 18 February 2014]. Available from: http://pinnt.com/therapies/enteral-nutrition.aspx
24. Unknown. What is Enteral Nutrition? [Internet]. American Society for Parenteral and Enteral Nutrition (ASPEN). ©2013. [accessed 18 February 2014]. Available from: https://www.nutritioncare.org/wcontent.aspx?id=266
25. Staun M, Pironi, L, Bozzetti, F, Baxter, J, Forbes A, Joly F, Van Gossum A. ESPEN Guidelines on Parenteral Nutrition: home parenteral nutrition (HPN) in adult patients. Clinical nutrition. 2009:28(4):467-79.
26. Versleijen M, van Achterberg T, Jansen JB, Sauerwein H, Schoonhoven, L and Wanten G. Psychosocial Complaints Are Associated With Venous Access–Device Related Complications in Patients on Home Parenteral Nutrition. Journal of Parenteral and Enteral Nutrition.2011;35(5):588-96.
27. Wanten G, Calder PC, Forbes A. Managing adult patients who need home parenteral nutrition. BMJ. 2011;342:d1447
28. Williford WO. Perioperative total parenteral-nutrition in surgical patients. New England Journal of Medicine 1991;325(8):525-32.
29. Cotogni P, Pittiruti M, Barbero C, Monge T, Palmo A, Bertinet DB. Catheter-related complications in cancer patients on home parenteral nutrition a prospective study of over 51,000 catheter days. Journal of Parenteral and Enteral Nutrition. 2013;37(3):375-83.
30. Meguid MM, Akahoshi MP, Jeffers S, Hayashi RJ, Hammond WG. Amelioration of metabolic complications of conventional total parenteral nutrition: a prospective randomized study. Archives of Surgery. 1984;119(11):1294
31. Persoon A, Huisman-de Waal G, Naber TA, Schoonhoven L, Tas T, Sauerwein H, Achterberg T. Impact of long-term HPN on daily life in adults. Clin Nutr. 2005; 24: 308–12.
32. Baxter JP, Fayers PM, Mckinlay AW. A review of the quality of life of adult patients treated with long-term parenteral nutrition. Clin Nutr. 2006; 25: 546–553.
33. Naber T, Schoonhoven L, Persoon A, Sauerwein H, & van Achterberg T. Problems experienced by patients receiving parenteral nutrition at home: results of an open interview study. Journal of Parenteral and Enteral Nutrition. 2006;30(3):215-21.
34. Health Quality Ontario. Small bowel transplant: an evidence-based analysis. Ont Health Technol Assess Ser. 2003;3(1):1-72. (Review Article)
35. Pironi L, Joly F, Forbes A, Colomb V, Lyszkowska M, Baxter J, et al. Long-term follow-up of patients on home parenteral nutrition in Europe: implications for intestinal transplantation. Gut 2011; 60:17-25. (Primary Research Article)
36. Beyer-Berjot L, Joly F, Dokmak S, Bretagnol F, Corcos O, Bouhnik Y, Belghiti J, Panis Y. Intestinal transplantation: Indications and prospects. J Visc Surg 2012; 149: 380-84. (Review Article)
37. Nickkholgh A, Contin P, Abu-Elmagd K, Golriz M, Gotthardt D, Morath C, Schemmer P, Mehrabi A. Intestinal transplantation: review of operative techniques. Clin Transplant 2013; 27 (25): 56-65. (Review Article)
38. Grant D, Abu-Elmagd K, Reyes J, Tzakis A, Langnas A, Fishbein T, Goulet O, Farmer D. 2003 Report of the Intestine Transplant Registry. Ann Surg 2005; 241 (4): 607–13. (Review Article)
39. Unknown. Multivisceral Transplantation. The Free Dictionary. ©2014. [accessed 19 March 2014]. Available from: http://medical-dictionary.thefreedictionary.com/Multivisceral+Transplantation (Webpage)
40. Colomb V, Dabbas-Tyan M, Taupin P, Talbotec C, Révillon Y, Jan D, De Potter S, Gorski-Colin AM, Lamor M, Herreman K, Corriol O, Landais P, Ricour C, Goulet O. Longterm outcome of children receiving home parenteral nutrition: a 20-year single-center experience in 302 patients. J Pediatr Gastroenterol Nutr. 2007;44:347-353.
41. Lloyd DA, Vega R, Bassett P, Forbes A, Gabe SM. Survival and dependence on home parenteral nutrition: experience over a 25-year period in a UK referral centre. Aliment Pharmacol Ther. 2006;24:1231-1240.
42. Mullady DK, O’Keefe SJ. Treatment of intestinal failure: home parenteral nutrition. Nat Clin Pract Gastroenterol Hepatol. 2006; 3(9): 492-504.
43. Pironi L, Goulet O, Buchman A, Messing B, Gabe S, Candusso M, Bond G, Gupte G, Pertkiewicz M, Steiger E, Forbes A, Van Gossum A, Pinna AD; the Home Artificial Nutrition and Chronic Intestinal Failure Working Group of ESPEN. Outcome on home parenteral nutrition for benign intestinal failure: A review of the literature and benchmarking with the European prospective survey of ESPEN. Clin Nutr. 2012;31:831–845.
44. Wales PW, de Silva N, Kim JH, Lecce L, Sandhu A, Moore AM. Neonatal short bowel syndrome: a cohort study. J Pediatr Surg. 2005;40:755-762.
45. Newell KA. Transplantation of the intestine: is it truly different? Am J Transplant. 2003;3:1–2.
46. Cicalese L, Sileri P, Green M, Abu-Elmagd K, Kocoshis S, Reyes J. Bacterial translocation in clinical intestinal transplantation. Transplantation. 2001;71:1414–17.
47. Image 1: Parenteral & Enteral Nutrition; Tube Feeding. Reinstein A. Enteral and Parenteral Nutrition, Amy Speech & Language Therapy Inc. [image on the Internet]. 2011 [cited 2014 March 19]. Available from: http://www.amyspeechlanguagetherapy.com/dysphagia-diagnosis.html
48. Image 2: HPN bag. Components are mixed together before use.
Boston Children's Hospital. [image on the Internet]. 2005 [cited 2014 March 19]. Available from: http://www.childrenshospital.org/centers-and-services/home-parenteral-nutrition-program/faq
49. Image 3: Intestinal Transplantation (Drawn by Esther Park and Matthew Wood)
Adapted from: Intestinal transplantation: review of operative techniques. [image on the Internet]. 2013 [cited 2014 March 19]. Available from: http://onlinelibrary.wiley.com/doi/10.1111/ctr.12190/full
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