Incidence and Outcomes of Home Parenteral Nutrition in Patients With Crohn Disease in Olmsted County, Minnesota

Abstract

Introduction We sought to estimate the incidence of home parenteral nutrition (HPN) use in a population-based cohort of patients with Crohn’s disease (CD), and to assess clinical outcomes and complications associated with HPN. Methods We used the Rochester Epidemiology Project (REP) to identify residents of Olmsted County, who were diagnosed with CD between 1970 and 2011, and required HPN. Results Fourteen out of 429 patients (3.3%) with CD received HPN (86% female). Eleven patients (79%) had moderate-severe CD and 12 patients (86%) had fistulizing disease. Thirteen patients (93%) underwent surgery, primarily due to obstruction.Among CD incidence cases, the cumulative incidence of HPN from the date of CD diagnosis was 0% at 1 year, 0.5% at 5 years, 0.8% at 10 years, and 2.4% at 20 years. Indications for HPN included short bowel syndrome (SBS) in 64%, malnutrition in 29%, and bowel rest in 21%. The median duration of HPN was 2.5 years. There was an average weight gain of 1.2 kilograms at 6 months, an average weight loss of 1.4 kilograms at 1 year, and a further weight loss of 2.2 kilograms at 2 years from the start of HPN. Patients were hospitalized a mean of 5 times after the start of HPN, mainly due to catheter-related bloodstream infections and thrombosis. Conclusion Less than 4% of patients with CD need HPN. Most have moderate to severe disease with SBS or malnutrition. Possible reason for the patients’ weight loss could be noncompliance, and increased metabolic needs because of active disease.

Management of Short Bowel Syndrome/Chronic Intestinal Failure – the Experience of a Single Portuguese Center

“…In Portugal, extensive intestinal resections that lead to Short Bowel Syndrome are generally performed in urgent situations due to acute mesenteric ischemia. Other pathological entities may require extensive intestinal resections performed on an elective or urgent basis, such in Crohn's disease (11)(12)(13), radiation enteritis (14), and severe complications of digestive, severe gastrointestinal dysmotility disorders (15), digestive surgical complications, or intestinal bypass preparations due to oncological disease ( 16) can also result in SBS. Our experience is minimal in those cases; we haven't experienced oncologic intestinal obstruction patients.…”

Management of Short Bowel Syndrome With Chronic Intestinal Failure: A Single-Center Experience in Portugal

“…In Portugal, extensive adult intestinal resections that lead to SBS are generally performed in urgent situations due to acute mesenteric ischemia. Other pathological entities may require extensive intestinal resections performed on an elective or urgent basis, such as Crohn's disease [ 8 - 10 ], radiation enteritis [ 11 ], and severe complications of digestive, severe gastrointestinal dysmotility disorders [ 12 ], digestive surgical complications, or intestinal bypass preparations due to oncological disease [ 13 ], which can also result in SBS. Our experience is minimal in those cases; we haven’t experienced oncologic intestinal obstruction patients.…”

“…Blood tests with a sizeable nutritional profile regularly follow the updated European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines on long-term HPN [ 8 ]. These tests allow the monitoring of adherence and therapeutic adequacy.…”