Gastroenterology

Gastroenterology

Volume 117, Issue 5, November 1999, Pages 1043-1050
Gastroenterology

Alimentary Tract
Long-term survival and parenteral nutrition dependence in adult patients with the short bowel syndrome

Presented in part at the 1996 American Gastroenterological Association meeting and the 1997 World Intestinal Transplantation Congress and published in abstract form (Gastroenterology 1996;110[suppl:A346]; Transplant Proc 1998;30:2548).
https://doi.org/10.1016/S0016-5085(99)70388-4Get rights and content

Abstract

Background & Aims: The short bowel syndrome (SBS) may be associated with either transient or permanent intestinal failure, presently treated by parenteral nutrition (PN). Survival and PN-dependence probabilities, taking into account both small bowel remnant length and the type of the digestive circuit of anastomosis, are not known in adult SBS patients. The aim of this study was to assess such prognostic factors. Methods: A total of 124 consecutive adults with nonmalignant SBS were enrolled from 1980 to 1992 at 2 home PN centers. They were analyzed for survival and PN-dependence probabilities using the Cox model and for PN dependence using linear discriminant analysis. Data were updated in April 1996. Results: Survival and PN-dependence probabilities were 86% and 49% and 75% and 45% at 2 and 5 years, respectively. In multivariate analysis, survival was related negatively to end-enterostomy, to small bowel length of <50 cm, and to arterial infarction as a cause of SBS, but not to PN dependence. The latter was related negatively to postduodenal small bowel lengths of <50 and 50–99 cm and to absence of terminal ileum and/or colon in continuity. Cutoff values of small bowel lengths separating transient and permanent intestinal failure were 100, 65, and 30 cm in end-enterostomy, jejunocolic, and jejunoileocolic type of anastomosis, respectively. Conclusions: In adult SBS patients, small bowel length of <100 cm is highly predictive of permanent intestinal failure. Presence of terminal ileum and/or colon in continuity enhances both weaning off PN and survival probabilities. After 2 years of PN, probability of permanent intestinal failure is 94%. These rates may lead to selection of other treatments, especially intestinal transplantation, instead of PN, for permanent intestinal failure caused by SBS.

GASTROENTEROLOGY 1999;117:1043-1050

Section snippets

Patients

From January 1980 to December 1992, all consecutive adult patients with short bowel syndrome defined as remnant postduodenal small bowel length of ≤150 cm, half the shortest normal small bowel length in adults,10 were included in the study. Data collection ended in April 1996. Bowel rehabilitation strategies, i.e., growth hormone treatment,13 surgically reversed small bowel loop,14 and intestinal transplantation, were then implemented at 1 of the 2 centers involved (Saint-Lazare Hospital). We

Patient characteristics

One hundred twenty-seven patients fulfilled inclusion criteria; 3 patients were lost to follow-up. Thus, 124 patients aged 52 years (range, 17–87) at time of short bowel constitution were available for analysis. Their demographic and digestive characteristics are shown in Tables 1 and 2, respectively.

. Demographic characteristics of 124 adult patients with nonmalignant short bowel syndrome

CharacteristicsNo. of patients (%)
Sex
 Male62 (50)
 Female62 (50)
Age at time of short bowel constitution (yr)
 ≤40

Discussion

We report survival and PN-dependence probabilities of 75% and 45% at 5 years, respectively, in a cohort of 124 adults with nonmalignant short bowel syndrome, enrolled within a 13-year period of study. In multivariate analysis, survival was negatively related to digestive circuit type 1 (end-enterostomy), to small bowel length of <50 cm, and to arterial infarction as a cause for bowel resection, but not to PN dependence. After correction taking into account other causes of death through use of

Acknowledgements

The authors thank J. Barbier, M. Beliah, J. J. Bernier, Y. Bouhnik, B. Coffin, M. Lémann, P. Hautefeuille, V. de Ledhingen, R. Modigliani, Y. Panis, J. C. Rambaud, and P. Valleur for follow-up of the patients; and J. Arsham and D. Pryce for the English revision of the manuscript.

References (44)

  • JA Vanderhoof et al.

    Short-bowel syndrome in children and adults

    Gastroenterology

    (1997)
  • DW. Wilmore

    Factors correlating with a successful outcome following extensive intestinal resection in new-born infants

    J Pediatr

    (1972)
  • I Nordgaard et al.

    Colon as a digestive organ in patients with short bowel

    Lancet

    (1994)
  • F Briet et al.

    Bacterial adaptation in patients with short bowel and colon in continuity

    Gastroenterology

    (1995)
  • I Nordgaard et al.

    Importance of colonic support for energy absorption as small bowel failure proceeds

    Am J Clin Nutr

    (1996)
  • EMM. Quigley

    Small intestinal transplantation: reflections on an evolving approach to intestinal failure

    Gastroenterology

    (1996)
  • AS Detsky et al.

    A cost-utility analysis of the HPN program at Toronto General Hospital: 1970–1982

    J Parenter Enteral Nutr

    (1986)
  • L Howard et al.

    Four years of North American registry home parenteral nutrition outcome data and their implications for patients management

    J Parenter Enteral Nutr

    (1991)
  • S Jarnum et al.

    Long term parenteral nutrition: clinical experience in 70 patients from 1967 to 1980

    Scand J Gastroenterol

    (1981)
  • JMD. Nightingale

    Clinical problems of short bowel and their treatment

    Proc Nutr Soc

    (1994)
  • JMD Nightingale et al.

    Colonic preservation reduces need for parenteral therapy, increases incidence of renal stones, but does not change high prevalence of gallstones in patients with a short bowel

    Gut

    (1992)
  • D Seguy et al.

    Growth hormone benefit in very short bowel patients: a randomized controlled trial

    Gastroenterology

    (1999)
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    Address requests for reprints to: Bernard Messing, M.D., Department of Hepatogastroenterology and Nutrition support, Hôpital Lariboisière, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France. e-mail: [email protected]; fax: (33) 01-4995-2544.

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