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Intestinal Failure and Home Parenteral Nutrition

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (31 July 2020) | Viewed by 20910

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Special Issue Editors

Prof. Dr. Stéphane M. Schneider

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Guest Editor

Nutritional Support Unit, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, 06200 Nice, France
Interests: intestinal failure; parenteral nutrition; malnutrition; sarcopenia; cachexia; microbiota; inflammatory bowel diseases

Prof. Dr. Francisca Joly

E-Mail Website
Guest Editor

Centre for Gastroenterology and Nutrition Support, Hôpital Beaujon, Paris, France
Interests: intestinal failure; parenteral nutrition; malnutrition; intestinal adaptation; microbiota; inflammatory bowel diseases

Special Issue Information

Dear Colleagues,

Intestinal failure is the latest of the organ failures to benefit from a wider recognition, even though it is still underdiagnosed and therefore undertreated. It can be acute or sub-acute, found in hospitals, usually after surgery, but it can also be chronic, and most patients with chronic intestinal failure (most of them suffering from short bowel syndrome) are ambulatory, under the care of expert multidisciplinary teams.

Home parenteral nutrition is the key life-saving treatment of chronic intestinal failure, even though most HPN patients have a preserved intestinal function and should therefore receive another form of nutritional support (i.e., enteral nutrition). HPN is not without complications, and central line-associated bloodstream infections, loss of vascular access, and liver failure, among others, can be life-threatening. Complementary options exist for chronic intestinal failure, such as rehabilitative surgery, intestinal transplantation, and GLP-2 agonists.

This Special Issue seeks papers (original clinical studies and reviews) related to intestinal failure and home parenteral nutrition (whether for chronic intestinal failure or for other indications), including the following suggested topics. This invitation is addressed at all healthcare providers (i.e., gastroenterologists, surgeons, clinical nutrition experts, palliative care physicians, dieticians, nurses, pharmacists, and psychologists) involved in the care of home parenteral nutrition adult and pediatric patients.

Suggested topics:

Epidemiology of intestinal failure and intestinal insufficiency;
Radiation enteritis with intestinal failure;
Chronic intestinal pseudo-obstruction;
Crohn’s disease with intestinal failure;
Course and complications of acute, sub-acute, and chronic intestinal failure;
Gut microbiota in short bowel syndrome;
Central line-associated bloodstream infections;
Intestinal failure-associated liver disease;
Metabolic, renal, and bone complications of intestinal failure;
Dietetic care of short bowel patients;
Medications indicated in short bowel patients;
Central venous accesses for home parenteral nutrition;
Compounded versus commercial parenteral nutrition admixtures;
Complications of home parenteral nutrition;
Healthcare costs of parenteral nutrition;
Healthcare service organization for home parenteral nutrition;
Roles of HPN patient advocacy groups and expert HPN patients;
Indications and results of rehabilitative intestinal surgery in intestinal failure;
Indications and results of intestinal transplantation in intestinal failure;
Indications and results of GLP-2 agonists and other trophic factors;
Follow-up of patients weaned off HPN;
Monitoring of patients on HPN

Prof. Dr. Stéphane M. Schneider
Prof. Dr. Francisca Joly
Guest Editors

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Keywords

Intestinal failure
Intestinal insufficiency
Short bowel syndrome
Chronic intestinal pseudo-obstruction
Crohn’s disease
Parenteral nutrition
Home parenteral nutrition
Gut microbiota
Intestinal failure-associated liver disease
Central line-associated bloodstream infections
Intestinal transplantation
GLP-2
Teduglutide

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Research

14 pages, 1078 KiB

Open AccessArticle

Clinical Characteristics and Outcomes of S. Aureus Bacteremia in Patients Receiving Total Parenteral Nutrition

by Michelle Gompelman, Renée A. M. Tuinte, Marvin A. H. Berrevoets, Chantal P. Bleeker-Rovers and Geert J. A. Wanten

Nutrients 2020, 12(10), 3131; https://doi.org/10.3390/nu12103131 - 14 Oct 2020

Cited by 2 | Viewed by 3083

Abstract

Background: Patients on total parenteral nutrition (TPN) are at risk of developing central line-associated infections. Specifically, Staphylococcus aureus bacteremia (SAB) is feared for its high complication rates. This prospective cohort study compares characteristics, clinical course and outcome of SAB in patients with and without TPN support. Methods: Clinical and microbiological data from all patients with positive blood cultures for S. aureus from two facilities, including our referral center for TPN support, were retrieved (period 2013–2020). Primary outcome was overall mortality, and included survival analysis using a multivariate Cox regression model. Secondary outcomes comprised a comparison of clinical characteristics and outcomes between both patient groups and analysis of factors associated with complicated outcome (e.g., endocarditis, deep-seated foci, relapse and death) in patients on TPN specifically. Results: A total of 620 SAB cases were analyzed, of which 53 cases received TPN at the moment the blood culture was taken. Patients in the TPN group were more frequently female, younger and had less comorbidity (p < 0.001). In-hospital death and overall mortality were significantly lower in TPN patients (4% vs. 18%, p = 0.004 and 10% vs. 34%, p < 0.001, respectively). Positive follow-up blood cultures, delayed onset of therapy and previous catheter problems were associated with a higher incidence of complicated SAB outcome in patients on TPN. Conclusion: Our data show that patients on TPN have a milder course of SAB with lower mortality rates compared to non-TPN SAB patients. Full article

(This article belongs to the Special Issue Intestinal Failure and Home Parenteral Nutrition)

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17 pages, 759 KiB

Open AccessArticle

Nutritional Status and Quality of Life in Hospitalised Cancer Patients Who Develop Intestinal Failure and Require Parenteral Nutrition: An Observational Study

by Marina Plyta, Pinal S. Patel, Konstantinos C. Fragkos, Tomoko Kumagai, Shameer Mehta, Farooq Rahman and Simona Di Caro

Nutrients 2020, 12(8), 2357; https://doi.org/10.3390/nu12082357 - 7 Aug 2020

Cited by 8 | Viewed by 4381

Abstract

(1) Background: Malnutrition in cancer patients impacts quality of life (QoL) and performance status (PS). When oral/enteral nutrition is not possible and patients develop intestinal failure, parenteral nutrition (PN) is indicated. Our aim was to assess nutritional status, QoL, and PS in hospitalised cancer patients recently initiated on PN for intestinal failure. (2) Methods: The design was a cross-sectional observational study. The following information was captured: demographic, anthropometric, biochemical and medical information, as well as nutritional screening tool (NST), patient-generated subjective global assessment (PG-SGA), functional assessment of cancer therapy-general (FACT-G), and Karnofsky PS (KPS) data. (3) Results: Among 85 PN referrals, 30 oncology patients (56.2 years, 56.7% male) were identified. Mean weight (60.3 ± 16.6 kg) corresponded to normal body mass index values (21.0 ± 5.1 kg/m²). However, weight loss was significant in patients with gastrointestinal tumours (p < 0.01). A high malnutrition risk was present in 53.3–56.7% of patients, depending on the screening tool. Patients had impaired QoL (FACT-G: 26.6 ± 9.8) but PS indicated above average capability with independent daily activities (KPS: 60 ± 10). (4) Conclusions: Future research should assess the impact of impaired NS and QoL on clinical outcomes such as survival, with a view to encompassing nutritional and QoL assessment in the management pathway of this patient group. Full article

(This article belongs to the Special Issue Intestinal Failure and Home Parenteral Nutrition)

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21 pages, 2635 KiB

Open AccessArticle

Serum Scoring and Quantitative Magnetic Resonance Imaging in Intestinal Failure-Associated Liver Disease: A Feasibility Study

by Konstantinos C. Fragkos, María Claudia Picasso Bouroncle, Shankar Kumar, Lucy Caselton, Alex Menys, Alan Bainbridge, Stuart A. Taylor, Francisco Torrealdea, Tomoko Kumagai, Simona Di Caro, Farooq Rahman, Jane Macnaughtan, Manil D. Chouhan and Shameer Mehta

Nutrients 2020, 12(7), 2151; https://doi.org/10.3390/nu12072151 - 19 Jul 2020

Cited by 6 | Viewed by 3710

Abstract

(1) Background: Intestinal failure-associated liver disease (IFALD) in adults is characterized by steatosis with variable progression to fibrosis/cirrhosis. Reference standard liver biopsy is not feasible for all patients, but non-invasive serological and quantitative MRI markers for diagnosis/monitoring have not been previously validated. Here, we examine the potential of serum scores and feasibility of quantitative MRI used in non-IFALD liver diseases for the diagnosis of IFALD steatosis; (2) Methods: Clinical and biochemical parameters were used to calculate serum scores in patients on home parenteral nutrition (HPN) with/without IFALD steatosis. A sub-group underwent multiparameter quantitative MRI measurements of liver fat fraction, iron content, tissue T1, liver blood flow and small bowel motility; (3) Results: Compared to non-IFALD (n = 12), patients with IFALD steatosis (n = 8) demonstrated serum score elevations in Enhanced Liver Fibrosis (p = 0.032), Aspartate transaminase-to-Platelet Ratio Index (p < 0.001), Fibrosis-4 Index (p = 0.010), Forns Index (p = 0.001), Gamma-glutamyl transferase-to-Platelet Ratio Index (p = 0.002) and Fibrosis Index (p = 0.001). Quantitative MRI scanning was feasible in all 10 sub-group patients. Median liver fat fraction was higher in IFALD steatosis patients (10.9% vs 2.1%, p = 0.032); other parameter differences were non-significant; (4) Conclusion: Serum scores used for non-IFALD liver diseases may be useful in IFALD steatosis. Multiparameter MRI is feasible in patients on HPN. Full article

(This article belongs to the Special Issue Intestinal Failure and Home Parenteral Nutrition)

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10 pages, 274 KiB

Open AccessArticle

Vitamin C in Home Parenteral Nutrition: A Need for Monitoring

by Julienne Grillot, Sabrina Ait, Charlotte Bergoin, Thomas Couronne, Emilie Blond, Catherine Peraldi, Didier Barnoud, Cécile Chambrier and Madeleine Lauverjat

Nutrients 2020, 12(6), 1667; https://doi.org/10.3390/nu12061667 - 3 Jun 2020

Cited by 4 | Viewed by 3553

Abstract

To date, there are no recommendations about screening plasma vitamin C concentration and adjust its supplementation in patients on long-term home parenteral nutrition (HPN). The aim of this study was to evaluate vitamin C status and determine if a commercial multivitamin preparation (CMVP) containing 125 mg of vitamin C is sufficient in stable patients on HPN. All clinically stable patients receiving HPN or an intravenous fluid infusion at least two times per week for at least 6 months, hospitalized for nutritional assessment, were retrospectively included, for a total of 186 patients. We found that 29% of the patients had vitamin C insufficiency (i.e., <25 µmol/L). In univariate analysis, C-reactive protein (CRP) (p = 0.002) and intake of only 125 mg of vitamin C (p = 0.001) were negatively associated with vitamin C levels, and duration of follow-up in our referral center (p = 0.009) was positively associated with vitamin C levels. In multivariate analysis, only CRP (p = 0.001) and intake of 125 mg of vitamin C (p < 0.0001) were independently associated with low plasma vitamin C concentration. Patients receiving only CMVP with a low plasma vitamin C level significantly received personal compounded HPN (p = 0.008) and presented an inflammatory syndrome (p = 0.002). Vitamin C insufficiency is frequent in individuals undergoing home parenteral nutrition; therefore, there is a need to monitor plasma vitamin C levels, especially in patients on HPN with an inflammatory syndrome and only on CMVP. Full article

(This article belongs to the Special Issue Intestinal Failure and Home Parenteral Nutrition)

15 pages, 3252 KiB

Open AccessArticle

Chyme Reinfusion in Intestinal Failure Related to Temporary Double Enterostomies and Enteroatmospheric Fistulas

by Denis Picot, Sabrina Layec, Eloi Seynhaeve, Laurence Dussaulx, Florence Trivin and Marie Carsin-Mahe

Nutrients 2020, 12(5), 1376; https://doi.org/10.3390/nu12051376 - 11 May 2020

Cited by 22 | Viewed by 5381

Abstract

Some temporary double enterostomies (DES) or entero-atmospheric fistulas (EAF) have high output and are responsible for Type 2 intestinal failure. Intravenous supplementations (IVS) for parenteral nutrition and hydration compensate for intestinal losses. Chyme reinfusion (CR) artificially restores continuity pending surgical closure. CR treats intestinal failure and is recommended by European Society for Clinical Nutrition and Metabolism (ESPEN) and American Society for Parenteral and Enteral Nutrition (ASPEN) when possible. The objective of this study was to show changes in nutritional status, intestinal function, liver tests, IVS needs during CR, and the feasibility of continuing it at home. A retrospective study of 306 admitted patients treated with CR from 2000 to 2018 was conducted. CR was permanent such that a peristaltic pump sucked the upstream chyme and reinfused it immediately in a tube inserted into the downstream intestine. Weight, plasma albumin, daily volumes of intestinal and fecal losses, intestinal nitrogen, and lipid absorption coefficients, plasma citrulline, liver tests, and calculated indices were compared before and during CR in patients who had both measurements. The patients included 185 males and 121 females and were 63 ± 15 years old. There were 37 (12%), 269 (88%) patients with EAF and DES, respectively. The proximal small bowel length from the duodeno-jejunal angle was 108 ± 67 cm (n = 232), and the length of distal small intestine was 117 ± 72 cm (n = 253). The median CR start was 5 d (quartile 25–75%, 2–10) after admission and continued for 64 d (45–95), including 81 patients at home for 47 d (28–74). Oral feeding was exclusive 171(56%), with enteral supplement 122 (42%), or with IVS 23 (7%). Before CR, 211 (69%) patients had IVS for nutrition (77%) or for hydration (23%). IVS were stopped in 188 (89%) 2 d (0–7) after the beginning of CR and continued in 23 (11%) with lower volumes. Nutritional status improved with respect to weight gain (+3.5 ± 8.4%) and albumin (+5.4 ± 5.8 g/L). Intestinal failure was cured in the majority of cases as evidenced by the decrease in intestinal losses by 2096 ± 959 mL/d, the increase in absorption of nitrogen 32 ± 20%, of lipids 43 ± 30%, and the improvement of citrulline 13.1 ± 8.1 µmol/L. The citrulline increase was correlated with the length of the distal intestine. The number of patients with at least one liver test >2N decreased from 84–40%. In cases of Type 2 intestinal failure related to DES or FAE with an accessible and functional distal small bowel segment, CR restored intestinal functions, reduced the need of IVS by 89% and helped improve nutritional status and liver tests. There were no vital complications or infectious diarrhea described to date. CR can become the first-line treatment for intestinal failure related to double enterostomy and high output fistulas. Full article

(This article belongs to the Special Issue Intestinal Failure and Home Parenteral Nutrition)

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