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PTH-063 Nutritional requirements and prevalence of cholestasis in patients with a short bowel due to infarction
  1. G P Rafferty,
  2. S Gabe,
  3. M Small,
  4. J Eastwood,
  5. C UgarteCano,
  6. J Nightingale
  1. Intestinal Failure Unit, St Mark's Hospital, London, UK

Abstract

Introduction Patients with a short bowel and a retained colon due to ischaemia are now the most common indication for home parenteral nutrition in the UK.1 To date most studies have compared short bowel length and intravenous nutrition (IVN) requirements in patients with mixed aetiology of intestinal failure.2 IVN patients with <50 cm residual small bowel (SB) have increased risk of chronic cholestasis.3 This study primarily aimed to determine the frequency of IVN in patients with a short bowel secondary to ischaemia. The secondary aim was to determine the prevalence of chronic cholestasis.

Methods Retrospective data were collected using St Mark's Intestinal Failure database. Biochemical parameters obtained from computer lab system. Chronic cholestasis was considered to be two of bilirubin, alkaline phosphatise or γ-glutamyl transferase >1.5 times the upper limit of normal for >6 months.3

Results Since 2003 a total of 88 patients (male 47%) have been referred to St Marks Intestinal Failure Unit with SB infarction. 12-month follow-up data were available for 57 patients diagnosed with arterial SB infarction (46% male, mean age at diagnosis 56.3 years) and four patients with venous SB infarction (male 25%, mean age at diagnosis 35.5 years). Following continuity surgery 92% of patients with SB length <50 cm were still receiving IVN >12 months after initial diagnosis. In comparison only 28% with SB length >50 cm were receiving IVN. Comparing patients that were receiving and not receiving IVN there was a significant difference in residual SB length (p=<0.001). Residual SB length corresponds to number of days per week that IVN is given: 26% patients with SB length <50 cm managed three IVN free days per week compared to 60% patients with SB >50 cm. Following continuity surgery 31% with residual SB <50 cm had biochemical evidence of chronic cholestasis compared to 0% with SB length >50 cm. All five patients (4 patients <50 cm) that still had a jejunostomy >12 months following diagnosis had chronic cholestasis.

Conclusion Residual SB length corresponds to IVN requirements. Less than <50 cm residual SB will result in long-term and frequent IVN. SB <50 cm, and colon not in continuity, are chronic cholestasis risk factors.

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