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Intestinal failure in adult

Geneviève Huard, M Isabel Fiel, Jang Moon, Kishore Iyer, Thomas D Schiano
INTRODUCTION: Intestinal failure-associated liver disease (IFALD) occurs commonly in intestinal transplant (ITx) candidates receiving parenteral nutrition (PN). The aim of this study is to establish the prevalence and risk factors for advanced liver fibrosis in adults at the time of ITx. METHODS: Retrospective chart review of all ITx was performed in adults between January 2000 and May 2014. Advanced liver fibrosis was defined as stage 3 or stage 4 fibrosis. RESULTS: Fifty-three patients met the inclusion criteria...
March 13, 2018: JPEN. Journal of Parenteral and Enteral Nutrition
Mitchell A Rees, Nikhil B Amesur, Ruy J Cruz, Amir A Borhani, Kareem M Abu-Elmagd, Guilherme Costa, Anil K Dasyam
Intestinal transplantation has evolved from its experimental origins in the mid-20th century to its status today as an established treatment option for patients with end-stage intestinal failure who cannot be sustained with total parenteral nutrition. The most common source of intestinal failure in both adults and children is short-bowel syndrome, but a host of other disease processes can lead to this common end-point. The development of intestinal transplantation has presented multiple hurdles for the transplant community, including technical challenges, immunologic pitfalls, and infectious complications...
March 2018: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Kwai Lam, Lauren Schwartz, Jennifer Batisti, Kishore R Iyer
BACKGROUND: Teduglutide is a glucagon-like peptide 2 (GLP-2) analog that has been approved for the treatment of adult short bowel syndrome (SBS)-associated intestinal failure (IF; SBS-IF). Teduglutide increases villus height and crypt depth in the small bowel mucosa, promoting nutrition absorption and enteral independence from parenteral nutrition (PN). We aim to report our single-center experience with teduglutide in adult patients with SBS to provide real-world context to its use. METHOD: We conducted a retrospective analysis on patients managed within our tertiary-level intestinal rehabilitation program to identify patients with SBS-IF treated with teduglutide from 2009-2015...
January 2018: JPEN. Journal of Parenteral and Enteral Nutrition
Christopher Filtenborg Brandt, Siri Tribler, Mark Hvistendahl, Rahim M Naimi, Per Brøbech, Michael Staun, Palle Bekker Jeppesen
BACKGROUND/AIMS: Catheter-related complications (CRCs) cause mortality and morbidity in patients dependent on parenteral support at home (HPN) due to intestinal failure (IF). This study describes the incidences of CRCs in an adult IF cohort over 40 years. It illustrates the evolution and consequences of CRCs, their association to demographic characteristics, and potential risk factors in an effort to provide the rationale for preventive precautions to the relevant patients with IF at risk...
January 2018: JPEN. Journal of Parenteral and Enteral Nutrition
Sanaa Kamal, Khaled K Aldossari, Dhalia Ghoraba, Sara Mahmoud Abdelhakam, Amgad H Kamal, Mohamad Bedewi, Leila Nabegh, Khaled Bahnasy, Tamer Hafez
Objective: Concomitant non-alcoholic fatty liver disease (NAFLD) and coeliac disease (CD) have not been adequately studied. This study investigated the frequency of CD among NAFLD patients and the clinicopathological and immunological patterns and outcome of concomitant NAFLD and CD. Design: This prospective longitudinal study screened patients with NAFLD for CD (tissue transglutaminase antibodies (TTGA); anti-TTGA and antiendomysial antibodies (EMA)). Patients with concomitant NAFLD and CD and patients with either NAFLD or CD were enrolled and followed...
2018: BMJ Open Gastroenterology
Sharon Carey, Michelle Kalachov, Lynn Jones, Cherry Koh
BACKGROUND AND AIM: To establish consensus on service delivery models for management of Type III intestinal failure (IF) and home parenteral nutrition (HPN) within the Australian health care system and to identify barriers and enablers in moving towards this ideal model. METHODS: A modified Delphi methodology was utilised to survey experts working in Type III IF HPN. The panel comprised physicians, dietitians, nurses and pharmacists from 18 of the 20 adult Type III IF HPN centres across Australia...
February 27, 2018: Journal of Gastroenterology and Hepatology
Piyush Kalakoti, Daniel M Sciubba, Andrew J Pugely, Matthew J McGirt, Kanika Sharma, Devi P Patra, Kevin Phan, Karthik Madhavan, Richard P Menger, Christina Notarianni, Bharat Guthikonda, Anil Nanda, Hai Sun
STUDY DESIGN: Retrospective, observational cohort study. OBJECTIVE: To investigate the impact of psychiatric diseases on short-term outcomes in patients undergoing fusion surgery for LDDD. SUMMARY OF BACKGROUND DATA: Limited literature exists on the prevalence and impact of psychiatric comorbidities on outcomes in patients undergoing surgery for lumbar degenerative disc disease (LDDD). METHODS: Adult patients (>18 years) registered in the Nationwide Inpatient Sample (NIS) database (2002-2011) and undergoing an elective spine fusion for LDDD that met inclusion criteria formed the study population...
February 23, 2018: Spine
Guosheng Wu, Ruy J Cruz
Background and aims: A co-transplanted liver allograft has been thought to protect other organs from rejection-mediated injury; however, detailed analyses of co-transplanted liver on intestinal allograft outcomes have not been conducted to date. The aim of the study was to compare immune-mediated injury, causes of graft failure and clinical outcomes between recipients who underwent either a liver-inclusive intestinal transplant (LITx) or liver-exclusive intestinal transplant (LETx). Methods: Between May 2000 and May 2010, 212 adult patients undergoing LITx ( n  =76) and LETx ( n  =136) were included...
February 2018: Gastroenterology Report
Kathleen M Gura, Andrew E Mulberg, Paul D Mitchell, John Yap, Clara Y Kim, Minjun Chen, Alexis Potemkin, Mark Puder
BACKGROUND: Intestinal failure-associated liver disease (IFALD) is complex and diagnosed by concurrent use of parenteral nutrition, clinical presentation, and alterations in hepatic biomarkers exclusive of other causes of liver disease. In comparison with individual measures, composite biomarkers may provide a more effective means for assessing disease progression and response to treatment than single parameters. Since IFALD is considered by some to be a type of drug-induced liver injury (DILI), those diagnostic criteria could potentially be used in this population...
February 2018: JPEN. Journal of Parenteral and Enteral Nutrition
Siri Tribler, Christopher F Brandt, Mark Hvistendahl, Michael Staun, Per Brøbech, Claus E Moser, Palle B Jeppesen
BACKGROUND: A common complication in patients receiving home parenteral nutrition (HPN) is catheter-related bloodstream infections (CRBSIs). The CRBSI incidence has been advocated as an outcome parameter assessing the quality of care. This study aimed to illustrate how the use of different CRBSI definitions affects the reported incidence. MATERIALS AND METHODS: In an observational study based on the Copenhagen intestinal failure database, all clinically reported CRBSIs from 2002-2013 were compared with data from the affiliated microbiological database according to recommended CRBSI criteria...
February 2018: JPEN. Journal of Parenteral and Enteral Nutrition
Manpreet S Mundi, Megan T McMahon, Jennifer J Carnell, Ryan T Hurt
BACKGROUND: Despite providing significant benefits, home parenteral nutrition (HPN) can be associated with complications such as infections, intestinal failure-associated liver disease, and metabolic abnormalities. Soybean oil (SO)-based intravenous lipid emulsion (ILE) has been noted to contribute to some of these complications, leading to the development of alternative sources of ILE. Mixed-oil (MO) ILE has recently been approved for use in adults with short-term studies revealing a benefit over SO ILE...
February 13, 2018: Nutrition in Clinical Practice
Palle Bekker Jeppesen, Kristian Asp Fuglsang
Intestinal failure (IF) is the reduction of gut function below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that parenteral support (PS) is required to maintain health and/or growth. This article critically revises the gaps in and evidence for providing general nutritional therapy recommendations in the Short Bowel Syndrome-IF population. It addresses the need for an individualized approach, aiming to reduce or even eliminate the need for PS, and emphasizes a need to focus on effects of dietary interventions on the quality of life of these patients...
March 2018: Gastroenterology Clinics of North America
A Lauro, A D Pinna, E Tossani, V Stanghellini, M Manno, G Caio, L Golfieri, C Zanfi, N Cautero, A Bagni, U Volta, M Di Simone, L Pironi, R F Cogliandro, M Serra, A Venturoli, S Grandi, R De Giorgio
BACKGROUND: Clinical and psychosocial outcomes of a multimodal surgical approach for chronic intestinal pseudo-obstruction were analyzed in 24 patients who were followed over a 2- to 12-year period in a single center after surgery or intestinal/multivisceral transplant (CTx). METHODS: The main reasons for surgery were sub-occlusion in surgery and parenteral nutrition-related irreversible complications with chronic intestinal failure in CTx. RESULTS: At the end of follow-up (February 2015), 45...
January 2018: Transplantation Proceedings
Gabriel E Gondolesi, Francisco Pattín, Hamed Nikkoupur
PURPOSE OF REVIEW: Intestinal failure is a life-threatening medical condition that remains as a rare or orphan disease in most countries. The prevalence of intestinal failure and the therapeutic options available in middle-income countries (MIC) remain unclear. We aim to provide an overview on the current differences in management of intestinal failure patients in MIC from Latin America and Asia. RECENT FINDINGS: In order to fulfil the challenge, and after facing the difficulties of going over a topic with scarce available data, from countries with an extreme variety of social and economic problems, which are closely related to the treatment of intestinal failure patients, we have used both the existing publications and personal surveys to draft this document...
January 30, 2018: Current Opinion in Organ Transplantation
Zhu-Le Wang, Shi-Zhou Wu, Zhi-Feng Li, Jin-Hai Guo, Yi Zhang, Jin-Kui Pi, Jun-Gen Hu, Xi-Jing Yang, Fu-Guo Huang, Hui-Qi Xie
Abdominal wall defects are a common medical problem, and inadequate repair methods can lead to serious complications. Abdominal wall reconstruction using autologous tissue, or non-biological, biological, or composite patches is often performed to repair defective areas. In particular, composite patches containing both polymeric and biological materials have gained increasing attention due to their good mechanical properties and biocompatibility. However, it is still unclear whether the quality of repairs using composite patches is superior to that of a biological patch...
January 29, 2018: Journal of Biomaterials Science. Polymer Edition
Iona Ashworth, Alexander Wilson, Samuel Aquilina, Raymond Parascandalo, Victor Mercieca, Jurgen Gerada, Sarah Macdonald, Venetia Simchowitz, Susan Hill
OBJECTIVES: To review long-term outcome of Intestinal Epithelial Dysplasia(IED)/tufting enteropathy(TE) patients treated with parenteral nutrition(PN) at home managed by an intestinal failure(IF) rehabilitation service METHODS:: Infants presenting from 1986-2010 with IF, and TE histology were retrospectively reviewed for up to 30 years. Data collected included: outcome, presentation, nutrition(parenteral/enteral), country of residence, race, EpCAM gene, growth, bone age, occupation. RESULTS: 13 patients (6 male) in Malta and the UK with TE histology were established on home PN...
January 13, 2018: Journal of Pediatric Gastroenterology and Nutrition
Irum Amin, Charlotte Rutter, Adam Barlow, Neil K Russell, J Andrew Bradley, Andrew Jackson, Andrew J Butler
AIM OF THE STUDY: Intestinal transplantation (IT) is a life-saving procedure for carefully selected patients with intestinal failure. We evaluated patients who had undergone simultaneous intestinal and kidney transplantation (SIKT) to determine whether UK guidelines for inclusion of a renal allograft (dialysis dependent or estimated glomerular filtration rate ((eGFR)) < 45 ml/min/1.73 m2) are justified. METHODS: A single centre analysis was undertaken of adults undergoing IT at the Cambridge Transplant Centre between December 2007 and January 2016...
January 15, 2018: Journal of Investigative Surgery: the Official Journal of the Academy of Surgical Research
Roberto Ria, Franco Dammacco, Angelo Vacca
The heavy chain diseases (HCDs) are rare B-cell malignancies characterized by the production of a monoclonal immunoglobulin heavy chain without an associated light chain. There are three types of HCD, defined by the class of immunoglobulin heavy chain produced: IgA (α-HCD), IgG (γ-HCD), and IgM (μ-HCD). Alpha-HCD is the most common and usually occurs as intestinal malabsorption in a young adult from a country of the Mediterranean area. Gamma- and μ-HCDs are rarer and associated with a B-cell non-Hodgkin lymphoma that produces an abnormal Ig heavy chain...
2018: Mediterranean Journal of Hematology and Infectious Diseases
Orawan Pichitchaipitak, Sineenuch Ckumdee, Siriluk Apivanich, Darunee Chotiprasitsakul, Prapimporn Chattranukulchai Shantavasinkul
OBJECTIVES: The aim of this study was to determine the incidence and predictive factors of catheter-related bloodstream infections (CRBSIs) acquired through a central venous catheter for delivery of home parenteral nutrition (HPN) therapy among a patient population in Thailand. METHODS: This retrospective review was conducted with adult patients with intestinal failure who received HPN from October 2002 to April 2014, at Ramathibodi Home Parenteral and Enteral Nutrition Referral Center in Bangkok...
February 2018: Nutrition
David J Hampson
Brachyspira pilosicoli is a slow-growing anaerobic spirochete that colonizes the large intestine. Colonization occurs commonly in pigs and adult chickens, causing colitis/typhlitis, diarrhea, poor growth rates, and reduced production. Colonization of humans also is common in some populations (individuals living in village and peri-urban settings in developing countries, recent immigrants from developing countries, homosexual males, and HIV-positive patients), but the spirochete rarely is investigated as a potential human enteric pathogen...
January 2018: Clinical Microbiology Reviews
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