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Case report
Reversal of intestinal failure-associated liver disease (IFALD): emphasis on its multifactorial nature
  1. Christian Hvas1,2,
  2. Kamelia Kodjabashia2,
  3. Emma Nixon2,
  4. Stephen Hayes2,
  5. Kirstine Farrer2,3,
  6. Arun Abraham2,
  7. Simon Lal2
  1. 1Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus C, Denmark
  2. 2Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, UK
  3. 3Department of Dietetics, Salford Royal, Salford, UK
  1. Correspondence to Dr Christian Hvas, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus C 8000, Denmark; Christian.Hvas{at}auh.rm.dk

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.

  • CROHN'S DISEASE
  • DRUG INDUCED HEPATOTOXICITY
  • INTESTINAL FAILURE
  • ENTERAL NUTRITION
  • PARENTERAL NUTRITION

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