Abstract
Background/Objectives:
Patients with a short bowel and receiving parenteral nutrition (PN) have an increased risk of chronic cholestasis (CC). Restoration of bowel continuity after a mesenteric infarction results in PN requirements being reduced or stopped. This study aimed to determine the prevalence of CC and whether restoring bowel continuity reduced the risk of CC.
Subjects/Methods:
A retrospective review of patients with a short bowel owing to mesenteric infarction from 2000 to 2012. CC was defined as two of bilirubin, alkaline phosphatase and gamma-glutamyl transferase being 1.5 times the upper limit of normal for >6 months.
Results:
We identified 104 (55 females, median age 54 years) patients. Seventy-three (70%) patients had restoration of bowel continuity; of these, 25 (34%) had abnormal liver biochemistry (liver function test (LFT)), with 15 (21%) having CC. Following restoration of bowel continuity, 8 (53%) of 15 patients with CC and 10 (100%) of 10 patients with abnormal LFT but not CC had a return of liver function within normal range within a year. Univariate analysis showed restoring bowel continuity (P=0.002) and cessation of PN (P=0.006) were associated with a reduction in prevalence of CC. Multivariate analysis showed that cessation of PN was a significant factor in reducing CC (P=0.02).
Conclusions:
The prevalence of CC is 29% for patients with a short bowel receiving PN following a mesenteric infarction. CC resolves in 53% after continuity is restored, and this is most likely due to stopping or reducing the PN.
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References
Pironi L, Paganelli F, Labate AMM, Merli C, Guidetti C, Spinucci G et al. Safety and efficacy of home parenteral nutrition for chronic intestinal failure: a 16-year experience at a single centre. Dig Liver Dis 2003; 35: 314–324.
Bonifacio R, Alfonsi L, Santarpia L, Orban A, Celona A, Negro G et al. Clinical outcome of long-term home parenteral nutrition in non-oncological patients: a report from two specialised centres. Intern Emerg Med 2007; 2: 188–195.
Nightingale JM . Management of patients with a short bowel. Nutrition [Internet] 1999; 7: 741–751.
Scolapio JS, Fleming CR, Kelly DG, Wick DM, Zinsmeister AR . Survival of home parenteral nutrition-treated patients: 20 years of experience at the Mayo Clinic. Mayo Clin Proc 1999; 74: 217–222.
Jeppesen PB, Langholz E, Mortensen PB . Quality of life in patients receiving home parenteral nutrition. Gut 1999; 44: 844–852.
Lloyd DAJ, 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.
Baker ML, Nightingale JMD . Abnormal liver function test and parenteral nutrition. Clin Nutr 2004; 23: 864–865.
De Marco G, Sordino D, Bruzzese E, Di Caro S, Mambretti D, Tramontano A et al. Early treatment with ursodeoxycholic acid for cholestasis in children on parenteral nutrition because of primary intestinal failure. Aliment Pharmacol Ther 2006; 24: 387–394.
Cavicchi M, Beau P, Crenn P, Degott C, Messing B . Prevalence of liver disease and contributing factors in patients receiving home parenteral nutrition for permanent intestinal failure. Ann Intern Med 2000; 132: 525–532.
Goulet O, Joly F, Corriol O, Colomb-Jung V . Some new insights in intestinal failure-associated liver disease. Curr Opin Organ Transplant 2009; 14: 256–261.
Kaufman SS . Prevention of parenteral nutrition-associated liver disease in children. Pediatr Transplant 2002; 6: 37–42.
Vega R, Kalantzis CN, Georgios G, Lim W, Papadia C, Polymeros D et al. Chronic cholestasis and home parenteral nutrition: how much lipid is safe to give. Clin Nutr 2004; 23: 865–866.
Ellegård L, Sunesson Å, Bosaeus I . High serum phytosterol levels in short bowel patients on parenteral nutrition support. Clin Nutr 2005; 24: 415–420.
Buchman AL, Ament ME, Sohel M, Dubin M, Jenden DJ, Roch M et al. Choline deficiency causes reversible hepatic abnormalities in patients receiving parenteral nutrition: proof of a human choline requirement: a placebo-controlled trial. JPEN J Parenter Enteral Nutr 2001; 25: 260–268.
Thompson JS, Langnas AN . Surgical approaches to improving intestinal function in the short-bowel syndrome. Arch Surg 1999; 134: 706–709.
Adaba F, Rajendran A, Patel A, Cheung Y-K, Grant K, Vaizey CJ et al. Mesenteric infarction: clinical outcomes after restoration of bowel continuity. Ann Surg 2015, e-pub ahead of print 5 January 2015.
Lloyd DAJ, Zabron AA, Gabe SM . Chronic biochemical cholestasis in patients receiving home parenteral nutrition: prevalence and predisposing factors. Aliment Pharmacol Ther 2008; 27: 552–560.
Stanko RT, Nathan G, Mendelow H, Adibi SA . Development of hepatic cholestasis and fibrosis in patients with massive loss of intestine supported by prolonged parenteral nutrition. Gastroenterology 1987; 92: 197–202.
Langrehr JM, Reilly MJ, Banner B, Warty VJ, Lee KK, Schraut WH . Hepatic steatosis due to total parenteral nutrition: the influence of short-gut syndrome, refeeding, and small bowel transplantation. J Surg Res 1991; 50: 335–343.
Buchman AL, Iyer K, Fryer J . Parenteral nutrition-associated liver disease and the role for isolated intestine and intestine/liver transplantation. Hepatology 2006; 43: 9–19.
Salvino R, Ghanta R, Seidner DL, Mascha E, Xu Y, Steiger E . Liver failure is uncommon in adults receiving long-term parenteral nutrition. J Parenter Enter Nutr 2006; 30: 202–208.
Luman W . Prevalence, outcome and associated factors of deranged liver function tests in patients on home parenteral nutrition. Clin Nutr 2002; 21: 337–343.
Bianchi A . Longitudinal intestinal lengthening and tailoring: results. J R Soc Med 1997; 90: 429–432.
Hermans D, Talbotec C, Lacaille F, Goulet O, Ricour C, Colomb V . Early central catheter infections may contribute to hepatic fibrosis in children receiving long-term parenteral nutrition. J Pediatr Gastroenterol Nutr 2007; 44: 459–463.
Van Gossum A, Pironi L, Messing B, Moreno C, Colecchia A, D’Errico A et al. Transient elastography (fibroscan) is not correlated with liver fibrosis but with cholestasis in patients with long-term home parenteral nutrition. JPEN J Parenter Enteral Nutr 2014; 39: 719–724.
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Adaba, F., Uppara, M., Iqbal, F. et al. Chronic cholestasis in patients on parenteral nutrition: the influence of restoring bowel continuity after mesenteric infarction. Eur J Clin Nutr 70, 189–193 (2016). https://doi.org/10.1038/ejcn.2015.147
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DOI: https://doi.org/10.1038/ejcn.2015.147