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Proceeding Paper

Long-Term Intestinal Failure and Home Parenteral Nutrition: A Single Center Experience †

1
PaMNEC—Grupo de Patologia Médica, Nutrição e Exercício Clínico, Centro de Investigação Interdisciplinar Egas Moniz, 2829-511 Almada, Portugal
2
Hospital Garcia de Orta, 2805-267 Almada, Portugal
*
Author to whom correspondence should be addressed.
Presented at the 5th International Congress of CiiEM—Reducing Inequalities in Health and Society, Online, 16–18 June 2021.
Med. Sci. Forum 2021, 5(1), 46; https://doi.org/10.3390/msf2021005046
Published: 29 July 2021
(This article belongs to the Proceedings of The 5th International Congress of CiiEM (IC CiiEM))

Abstract

:
Intestinal failure is the reduction in gut function below the minimum necessary for the absorption of macronutrients and/or water electrolytes. The based treatment for type II and III intestinal failure patients is home parenteral nutrition (HPN) and hydration (HPH). This is a case-series study of HPN/HPH patients of the Hospital Garcia de Orta, Portugal, where thirteen patients present different underlying disorders and various IVS needs of nutrition and/or hydration. Most presented type III failure and most of them survived a long period under HPN and/or HNH.

1. Introduction

The European Society for Clinical Nutrition and Metabolism (ESPEN) defines intestinal failure as the reduction in gut function below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous supplementation (IVS) is required to maintain health and/or growth [1]. On a pathophysiological perspective, intestinal failure might be divided in three types: type I, short term, with IVS over a period of days/weeks; type II, a long-term subacute condition where IVS is maintained for weeks/months; type III, a chronic condition, in which IVS is required over months/years [2]. Conversely, the clinical classification is based on the IVS requirements of energy and volume; from A to D as the energy IVS, and from 1 to 4 as the volume of the IVS [1]. Although oral nutrient intake is possible in most individuals with intestinal failure, home parenteral nutrition (HPN) and/or hydration (HPH) remain the base of treatment, to prevent malabsorption-associated morbidity. Intestinal failure patients with type II and type III need a multi-disciplinary care, which is given in the Hospital Garcia de Orta. The aim of this study is to evaluate the effectiveness of HPN and HPH in the treatment and prognostic of intestinal failure.

2. Materials and Methods

This study was a case-series study of HPN/HPH patients of the Hospital Garcia de Orta, Almada, Portugal. All clinical files of long-term HPN/HPH patients were selected. The only exclusion criteria was an incomplete file. The present study is a sub-analysis of a large study approved by the ethical committee and the administration of our hospital.

3. Results and Discussion

This study is based on the data of thirteen clinical files, organized and presented in Table 1.
Most patients presented type III failure and the majority survived the home parenteral nutrition and/or hydration long period, therefore indicating that these, in fact, are effective forms of treatment for intestinal failure. The deaths observed were most likely due to concomitant morbidities.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

Not applicable.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Pironi, L.; Arends, J.; Baxter, J.; Bozzetti, F.; Peláez, R.B.; Cuerda, C.; Forbes, A.; Gabe, S.; Gillanders, L.; Holst, M.; et al. ESPEN endorsed recommendations. Definition and classification of intestinal failure in adults. Clin. Nutr. 2015, 34, 171–180. [Google Scholar] [CrossRef] [PubMed]
  2. Pironi, L.; Arends, J.; Bozzetti, F.; Cuerda, C.; Gillanders, L.; Jeppesen, P.B.; Joly, F.; Kelly, D.; Lal, S.; Staun, M.; et al. ESPEN guidelines on chronic intestinal failure in adults. Clin. Nutr. 2016, 35, 247–307. [Google Scholar] [CrossRef] [PubMed] [Green Version]
Table 1. Thirteen patients were eligible for this study and classified under the aforementioned criteria.
Table 1. Thirteen patients were eligible for this study and classified under the aforementioned criteria.
PatientSexAgeWeightUnderlying DisordersPathophysiological ClassificationFunctional ClassificationClinical ClassificationHPH/HPNOutcome
InitialFinal
B.P.M7146.954.4Colon cancerShort boweltype IIID2HPNDeceased
P.S.F844560intestinal embolismShort boweltype IIID2HPNDeceased
I.D.M656373Crohn diseaseShort bowel + intestinal fistulatype IID2HPNAlive with no IVS
C.J.M688387Colon CancerShort boweltype IIIA2HPHDeceased
B.S.M694776Familial amyloidotic polyneuropathyShort boweltype IIIA2HPHAlive with IVS
M.G.F5853.847.3Malabsorption from rituximabExtensive bowel mucosal diseasetype IIID2HPNDeceased
M.C.F6366.372occlusion surgeryShort bowel + obstructiontype IIIA2HPHAlive with IVS
M.C.G.F9243.552umbilical herniaShort boweltype IIID2HPNDeceased
R.S.F8362.971hernioplasty prosthesis fistulaIntestinal fistulatype IID2HPNAlive with no IVS
C.B.F625743.3Intestinal dysmotilityIntestinal dysmotilitytype IIID2HPNAlive with no IVS
J.L.M2851.770.9Crohn’s diseaseShort boweltype IIID2HPNAlive with IVS
C.C.F475368.1Gynecological cancer surgeryShort boweltype IIID2HPNAlive with IVS
J.R.M436572F. adenomatous polyposisShort boweltype IIIA2HPHAlive with IVS
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MDPI and ACS Style

Padinha, M.; Oliveira, C.; Carlos, S.; Santos, A.P.; Brito, M.; Santos, C.A.; Fonseca, J. Long-Term Intestinal Failure and Home Parenteral Nutrition: A Single Center Experience. Med. Sci. Forum 2021, 5, 46. https://doi.org/10.3390/msf2021005046

AMA Style

Padinha M, Oliveira C, Carlos S, Santos AP, Brito M, Santos CA, Fonseca J. Long-Term Intestinal Failure and Home Parenteral Nutrition: A Single Center Experience. Medical Sciences Forum. 2021; 5(1):46. https://doi.org/10.3390/msf2021005046

Chicago/Turabian Style

Padinha, Mafalda, Cátia Oliveira, Sandra Carlos, Ana Paula Santos, Marta Brito, Carla Adriana Santos, and Jorge Fonseca. 2021. "Long-Term Intestinal Failure and Home Parenteral Nutrition: A Single Center Experience" Medical Sciences Forum 5, no. 1: 46. https://doi.org/10.3390/msf2021005046

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