ReviewOutcome on home parenteral nutrition for benign intestinal failure: A review of the literature and benchmarking with the European prospective survey of ESPEN
Section snippets
Background
Intestinal failure (IF) results from reduction in the functioning gut mass characterized by the inability to maintain protein-energy, fluid, electrolyte and/or micronutrient balance.1 It can be classified into four major pathophysiological conditions: short bowel syndrome (SBS), chronic intestinal pseudo-obstruction (CIPO), small bowel parenchymal disease, and intestinal fistula,2 which may originate from various gastrointestinal or systemic diseases.
SBS is the most frequent cause of IF, and
Literature search
For the purpose of the workshop, a review of the literature was performed by a PubMed search, associating the term HPN with the following additional terms: intestinal failure, SBS, CIPO, Crohn's disease, radiation enteritis, intra-abdominal desmoid tumor, congenital mucosal disease, intractable diarrhoea, and adults or children. The PubMed search was updated in September 2011. The completeness of the PubMed search with respect to the purpose of the review, was verified by repeating the search
Weaning from HPN after intestinal rehabilitation
In adult patients, the probability of weaning from HPN has been reported to be similar between SBS and CIPO in one study20 and more likely in patients with SBS (50%) than for those with CIPO (25%) in another report.6
Three studies in children, showed that the ability to successfully wean from HPN was greater in those with SBS (54%, 42% and 73%, respectively for Refs. 7, 21, 22) than for those with CIPO (38%, 25% and 29%).
Complete HPN weaning in patients with SBS is very unlikely to occur after
Conclusions
With care and support from a specialist team, HPN is a safe treatment with a high probability of long-term patient survival. However, patients with chronic IF may have an increased risk of death due to factors related to HPN, or to the underlying disease for which they require HPN.
Intestinal rehabilitation programs can reverse IF. Most of the patients who are weaned from HPN, will achieve this within the first 2 years after the diagnosis, but complete reversibility can also occur later. This
Conflict of interest
LP: consultancy for NPS/Nycomed; honoraria from Baxter and Fresenius Kabi; payment for educational presentation from B. Braun; travel expenses from Baxter. OG: board membership for Danone; consultancy for Biocodex; grants for research from Assistance Publique Hopitaux de Paris. AB: honoraria, payment for educational presentation and travel expenses from Baxter. SG: consultancy from NPS/Nycomed and Baxter; honoraria from Baxter; travel expenses from NPD/Nucomed. MP: board membership from
Statement of authorship
All authors have made substantial contributions and final approval of the conceptions, drafting, and final version. LP chaired the workshop, designed the review and the benchmarking and drafted the manuscript. OG co-chaired the workshop, contributed to and revised the manuscript. AB, BM, MC and ES contributed to the workshop and contributed and revised the manuscript. SG, GG, MP and ADP contributed to the workshop and revised the manuscript. AF and AVG contributed to the benchmarking and
Acknowledgments
The following members of the Special Interest Group on Home Artificial Nutrition and Chronic Intestinal Failure of the European Society of Clinical Nutrition and Metabolism (ESPEN), actively contributed to the prospective survey that was the aim of the benchmarking of the present study: Francisca Joly, Malgorzata Lyszkowska, Janet Baxter, Cristina Cuerda.
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