Short bowel syndrome and home parenteral nutrition

Dino Faraguna, M. Candusso, D. Dragovich

Research output: Contribution to journalArticle

Abstract

Parenteral nutrition (PN) is the main therapy in children suffering from short bowel syndrome for maintaining normal growth and adequate nutritional status. The aim of this report is to analyse our historical casistry in order to compare complications of PN and outcome in short bowel syndrome (SBS) and other causes of chronic diarrhoea (CD). From 1982 to 2002 we have treated 38 children, 23 males and 15 females; indications for PN were short bowel syndrome in 21 patients, intractable diarrhoea in 14 cases, cystic fibrosis in 2 cases and biliary atresia waiting for liver transplantation in 1 case (Tab. 1). The indication for PN was SBS in 21 children (55.2 %). The mean intestinal remaining length was 33 cm (ranging from 5 to 80 cm), the ileo-cecal valve (ICV) was in situ in 5 patients (26.3%), the colon in 11 (58%). Eight patients (38%) were weaned off PN after on average of 16.5 months; 10 (47.6%) are still on PN and 3 (14.2%) patients died. Patients affected by short bowel syndrome and by intractable diarrhoea seem to face different outcomes. In ID patients, the mortality rate is higher (28.5% vs. 15.8%); the incidence of CVC-related complications is lower (3.7 vs. 4.74 × 1000 CVC days); the incidence of sepsis is lower (1.5 vs. 1.9 × 1000 CVC days) and weaning off PN is less likely (28.5% vs. 42.1%). When compared to the other patients, the incidence of sepsis in the patients who died was 5 times higher. Cholestasis represented the most frequent reported complication in SBS, being detected in 13 cases (68.4%). The longest PN duration (93 months, range 18 months - 19 years) is reported in ongoing patients. The fact that cholestasis is mainly present in patients affected by short bowel syndrome underlies the relevance of the disease in determining such complication. In conclusion, long-term parenteral nutrition appears to be a safe technique, it requires a well-experienced team (paediatrician, surgeon, pharmacist, nurses) to keep complications to a minimum and allows normal growth in SBS. Life-threatening complications are more likely to be related to poor clinical conditions, surgery and to underlying diseases rather than parenteral nutrition.

Original languageEnglish
JournalRivista Italiana di Nutrizione Parenterale ed Enterale
Volume20
Issue numberSUPPL. 4
Publication statusPublished - Jul 2002

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Keywords

  • Parenteral nutrition
  • Short bowel

ASJC Scopus subject areas

  • Food Science
  • Anatomy
  • Critical Care and Intensive Care Medicine
  • Nutrition and Dietetics

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