The chronic intestinal pseudo-obstruction subtype has prognostic significance in patients with severe gastrointestinal dysmotility related intestinal failure
| Autor: | Peter Paine, Simon Lal, Dipesh H. Vasant, Ashley Bond, Darren Green, Joanne Ablett, Arun Abraham, Ramya Kalaiselvan, Antje Teubner |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male 0301 basic medicine Intestinal pseudo-obstruction medicine.medical_specialty Multivariate analysis Gastrointestinal Diseases Critical Care and Intensive Care Medicine Gastroenterology 03 medical and health sciences 0302 clinical medicine Internal medicine Humans Medicine Gastrointestinal dysmotility 030109 nutrition & dietetics Nutrition and Dietetics business.industry Incidence (epidemiology) gastro-intestinal dysmotility parenteral nutrition intestinal failure Chronic Intestinal Pseudo-obstruction Enteric dysmotility Intestinal Pseudo-Obstruction Prognosis medicine.disease Chronic intestinal failure Catheter Parenteral nutrition Chronic Disease Cohort Female 030211 gastroenterology & hepatology Blind Loop Syndrome Gastrointestinal Motility Parenteral Nutrition Home business |
| Zdroj: | Vasant, D, Kalaiselvan, R, Ablett, J, Bond, A, Abraham, A, Teubner, A, Green, D, Paine, P & Lal, S 2018, ' The Chronic Intestinal Pseudo-obstruction subtype has prognostic significance in patients with severe gastrointestinal dysmotility related Intestinal Failure ', Clinical Nutrition, vol. 97, no. 6A, pp. 1967-1975 . https://doi.org/10.1016/j.clnu.2018.09.008 |
| ISSN: | 0261-5614 |
| Popis: | Summary Background & aims Severe gastrointestinal dysmotility (GID) is a significant cause of chronic intestinal failure (CIF) with unclear benefits of sub-classifying into Chronic Intestinal Pseudo-obstruction (CIPO) and non-CIPO sub-types. We compared outcomes between CIPO and non-CIPO sub-types in a tertiary cohort of patients with CIF resulting from severe GID. Methods Adults with primary GID, commenced on home parenteral nutrition (HPN) over a 16-year period at a national referral centre, were included. All patients satisfied GID clinical criteria which mandated evidence of small bowel involvement either objectively (abnormal antroduodenal manometry) or pragmatically (failure to progress on small bowel feeding). Clinical outcomes including HPN dependency and survival were compared between CIPO and non-CIPO sub-types. Results Patients with primary GID requiring HPN (n = 45, age 38 ± 2, 33 females, 23/45 (51%) CIPO, 22/45 (49%) non-CIPO) were included. Patients with CIPO had more surgical interventions (P = 0.03), higher incidence of bacterial overgrowth (P = 0.006), greater parenteral energy (P = 0.02) and volume requirements (P = 0.05). Overall, during a mean 6 years’ follow-up, 36/45 (80%) patients remained HPN dependent. Multivariate analyses confirmed that the non-CIPO sub-type (P = 0.04) and catheter related blood stream infections/1000 days (P = 0.01) were predictive factors for time to discontinuing HPN. Overall 5-year survival on HPN was 85%, with no difference between sub-types (P = 0.83). Conclusions The CIPO sub-type is associated with higher HPN dependency and should be recognized as a separate entity in severe GID. In multidisciplinary settings with continuous close monitoring of risks and benefits, our data confirm HPN is a safe, life-preserving therapy in severe GID related CIF. |
| Databáze: | OpenAIRE |
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