Chronic cholestasis in patients on parenteral nutrition: the influence of restoring bowel continuity after mesenteric infarction

Background/Objectives: Patients with a short bowel and receiving parenteral nutrition (PN) have an increased risk of chronic cholestasis (CC). Restoration of bowel continuity after a mesenteric infarction results in PN requirements being reduced or stopped. This study aimed to determine the prevalen...

Full description

Saved in:

Bibliographic Details
Published in:	European journal of clinical nutrition Vol. 70; no. 2; pp. 189 - 193
Main Authors:	Adaba, F, Uppara, M, Iqbal, F, Mallappa, S, Vaizey, C J, Gabe, S M, Warusavitarne, J, Nightingale, J M D
Format:	Journal Article
Language:	English
Published:	London Nature Publishing Group UK 01-02-2016 Nature Publishing Group
Subjects:	692/699/1503/1581 692/700/2814 Alkaline phosphatase Alkaline Phosphatase - blood Bile Bilirubin Bilirubin - blood Biochemistry Cholestasis Cholestasis - blood Cholestasis - epidemiology Cholestasis - etiology Clinical Nutrition Complications and side effects Epidemiology Female Gallbladder diseases gamma-Glutamyltransferase - blood Humans Infarction Infarction - etiology Infarction - physiopathology Infarction - surgery Internal Medicine Intestine Intestines - physiopathology Intestines - surgery Jejunostomy Liver Liver - physiopathology Liver Function Tests Malabsorption syndromes Male Medicine Medicine & Public Health Mesenteric Ischemia - complications Mesenteric Ischemia - physiopathology Mesenteric Ischemia - surgery Metabolic Diseases Middle Aged Multivariate analysis Nutrition Nutrition research original-article Parenteral nutrition Parenteral Nutrition - adverse effects Peritoneum - blood supply Prevalence Public Health Restoration Retrospective Studies Risk factors Risk reduction Short Bowel Syndrome - etiology Short Bowel Syndrome - therapy Small intestine Surgical outcomes Vein & artery diseases γ-Glutamyltransferase
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Background/Objectives: Patients with a short bowel and receiving parenteral nutrition (PN) have an increased risk of chronic cholestasis (CC). Restoration of bowel continuity after a mesenteric infarction results in PN requirements being reduced or stopped. This study aimed to determine the prevalence of CC and whether restoring bowel continuity reduced the risk of CC. Subjects/Methods: A retrospective review of patients with a short bowel owing to mesenteric infarction from 2000 to 2012. CC was defined as two of bilirubin, alkaline phosphatase and gamma-glutamyl transferase being 1.5 times the upper limit of normal for >6 months. Results: We identified 104 (55 females, median age 54 years) patients. Seventy-three (70%) patients had restoration of bowel continuity; of these, 25 (34%) had abnormal liver biochemistry (liver function test (LFT)), with 15 (21%) having CC. Following restoration of bowel continuity, 8 (53%) of 15 patients with CC and 10 (100%) of 10 patients with abnormal LFT but not CC had a return of liver function within normal range within a year. Univariate analysis showed restoring bowel continuity ( P =0.002) and cessation of PN ( P =0.006) were associated with a reduction in prevalence of CC. Multivariate analysis showed that cessation of PN was a significant factor in reducing CC ( P =0.02). Conclusions: The prevalence of CC is 29% for patients with a short bowel receiving PN following a mesenteric infarction. CC resolves in 53% after continuity is restored, and this is most likely due to stopping or reducing the PN.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0954-3007 1476-5640
DOI:	10.1038/ejcn.2015.147