Teduglutide (TED) is widely used in patients with short-bowel-syndrome-associated intestinal failure (SBS-IF) to enhance intestinal adaptation and reduce the need for parenteral support (PS). There are limited data on the effects of discontinuing TED. In this study, we describe the changes in parenteral nutrition (PN) requirements and body mass index (BMI) in a 9-year follow-up of patients receiving home parenteral nutrition after discontinuation of the TED treatment. We performed a retrospective analysis of changes in weekly PN orders and BMI in all patients with PN-dependent SBS from two Polish home parenteral nutrition (HPN) centers who received teduglutide between 2009 and 2013 and still required HPN 9 years after discontinuation of the TED treatment. Data included in the analysis were collected prospectively at mandatory visits to the HPN centers at 12, 24, 60, 84, and 108 months after drug discontinuation and compared with values before and after TED treatment. Weekly PN volume values varied significantly between all of the above time points from baseline to 9 years after TED discontinuation (χ2 = 34.860, p < 0.001). After an initial increase within the first year after treatment discontinuation (not statistically significant), the PN volume requirements remained stable for 4 years and increased 5–9 years after treatment discontinuation. The rate of patients requiring an increase in PN volume was 84.62% at 60 and 84 months and 92.30% at 108 months. At 9 years after cessation of the TED treatment, 53.85% of the study group required a 21.21% increase in PN volume compared with values before treatment. The need for PN volume in patients with PN-dependent SBS who discontinued the TED treatment increased within the first year and 4–5 years after treatment cessation, and in some cases might even exceed pretreatment values after 9 years.

Background/Aim: End jejunostomy syndrome is a type of short bowel syndrome (SBS) in which the jejunum forms the end of the bowel, as a result of resection or exclusion of the ileum and colon. It is associated with a high risk of dehydration, electrolyte imbalance, and malnutrition due to excessive stomal losses. Patients and Methods: In this retrospective study, we analyzed the medical records of sixteen adult patients with SBS and high-output end jejunostomy syndrome who received thickened fluids during their hospitalization in the home parenteral nutrition unit. The main parameter considered was daily stoma excretion volume, measured by 24-h collection. Values were compared between days when patients drank the daily amount of 600 ml of water, and days when patients ingested the same amount of water but mixed with thickening powder to achieve a mildly thick consistency. Results: Median volumes of end jejunostomy output were significantly lower when patients consumed the mixture of water and thickening powder, compared with drinking water without additives (550.0 ml/d vs. 811.9 ml/d, p=0.002). Conclusion: These preliminary results demonstrate a potential benefit of thickening powder for the nutritional management of patients with SBS type I, and point to the need for further randomized clinical studies with larger patient groups.End jejunostomy syndrome refers to a condition following surgical resection or structural or functional exclusion of the ileum and colon, in which jejunum forms the end of the intestine (1). It is considered the type of SBS associated with the highest risk of total parenteral nutrition (TPN) dependence, as it leads to the most severe malabsorptive complications compared to other SBS types (2, 3). Patients with end jejunostomy are most likely to develop high output stoma (HOS) (4, 5). Due to a significant shortening of the jejunum, its poorer adaptability after resection (compared to that of the ileum) and impaired neuroendocrine "ileo-colonic brake" leading to accelerated gastrointestinal motility, the secretion of fluids and electrolytes in this group of patients tends to extend the absorption ('net secretors'), putting them at risk of dehydration and dyselectrolytaemia (2, 6,7). Further consequences of electrolyte depletion and nutrient malabsorption in high output end jejunostomy patients include malnutrition, renal and hepatic complications, gallstones, and secondary osteoporosis (2, 8, 9). In addition, the end jejunal anatomy of the remaining bowel is considered a risk factor for mortality related to short bowel syndrome (1). Accurate definition of the incidence of both SBS and end jejunostomy syndrome is difficult, and available estimates are mostly based on the number of patients receiving total parenteral nutrition. According to available data, the prevalence of SBS in European countries varies between 0.4 and 30 cases per million (10,11). High-output stoma occurs in up to 17% stoma patients and is most commonly associated with the formation of end jejunostomy (5). Treatment prin...

Total parenteral nutrition (TPN) is a life-saving nutritional therapy in conditions where enteral nutrition is contraindicated or inadequate. However, it has been associated with side effects, one of which is parenteral nutrition–associated liver damage (PNALD). The main features of PNALD are cholestasis, fatty liver disease, and early fibrosis, followed by disease progression, cirrhosis, and liver failure. Risk factors for parenterally fed patients include short bowel syndrome, bacterial overgrowth and translocation, disturbances in hepatobiliary circulation and lack of enteral nutrition, and the choice of an inappropriate fat mixture. The source of the oil present in lipid emulsions is believed to play an important role in the development of long-term complications. This review analyzes the current literature and research on the pathogenesis of PNALD. Likewise, possible options for preventing this complication were discussed.

Total parenteral nutrition (TPN) is a life-saving therapy for patients with intestinal failure, but it carries the risk of complications, including an increase in liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST) after long-term use. Patients receiving chronic TPN are also exposed to metabolic stress from both the underlying disease and parenteral nutrition. The aim of this study was to compare the concentration of liver transaminases AST and ALT in relation to the rate of oxygen consumption in platelet mitochondria in patients receiving long-term TPN with the degree of oxidative stress induced by lipid emulsions, and to explain their role in cellular energy metabolism and changes in the liver based on the percentage of genomic DNA damage. The study group consisted of 86 TPN patients, while the control group consisted of 86 healthy volunteers who were fed only orally. The results of the study showed that the percentage of molecular oxygen depended on the type of lipid emulsion supplied. Analyzing time on TPN as a factor, we observed a decrease in percentage genomic DNA damage and an increase in percentage molecular oxygen in cells. It remains unclear whether TPN has a direct effect on genomic DNA damage and the level of molecular oxygen in cells during the course of treatment. In conclusion, this study provides important insights into the potential effects of TPN on liver enzymes and cellular metabolism. Further research is needed to better understand the underlying mechanisms and to develop strategies to minimize the risk of complications associated with TPN.

Aim of the study: Parenteral nutrition associated liver disease (PNALD) is a frequently reported complication of long-term parenteral nutrition. Early diagnosis and treatment of PNALD can help prevent end-stage liver disease. The aim of the study was to evaluate the activity of aminotransferases as a marker of liver dysfunction in patients receiving home parenteral nutrition under the care of a reference center. Material and methods: A comprehensive analysis of patients' medical records from a 9-year period (December 2012 -December 2021) was conducted and the following parameters were evaluated: parenteral nutrition mixture composition, total plasma bilirubin, activity of the liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST), standardized time factor prothrombin (international normalized ratio [INR] factor) and serum albumin. The analysis covered 630,537 days of parenteral nutrition. The study included 251 patients (140 women and 111 men) included in the Home Parenteral Nutrition Program. Results: PNALD was diagnosed in 11 parenteral fed patients, which gives the frequency of 8.3%/9 years of treatment. Two deaths were classified as cause of death related to liver disease but not related to PNALD. None of the patients included in the analysis developed end-stage liver failure. Conclusions:The above analysis shows that individual selection of the composition of the mixture for intravenous nutrition significantly reduces the risk of PNALD and may prevent liver failure in this context.