Parenteral Nutrition in Patients with Inflammatory Bowel Disease. Systematic Review, Meta-Analysis and Meta-Regression

Comeche, Jose Miguel; Comino, Iris; Altavilla, Cesare; Tuells, José; Gutiérrez-Hervás, Ana; Caballero, Pablo

doi:10.20944/preprints201910.0214.v1

Cited by 8 publications

(7 citation statements)

References 51 publications

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“…This study examined quality‐of‐life metrics in patients receiving home PN and found the scores comparable to those of patients on chronic hemodialysis 31 . Finally, a recent meta‐analysis has also demonstrated that home PN is associated with improved markers of disease activity and nutrition status in IBD patients, including CRP, serum albumin level, and Crohn's Disease Activity Index 32 …”

Section: Discussionmentioning

confidence: 77%

Clinical Characteristics of Inflammatory Bowel Disease Patients Requiring Long‐Term Parenteral Support in the Present Era of Highly Effective Biologic Therapy

Kurin

Anderson

Rivers

et al. 2020

J Parenter Enteral Nutr

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Background Despite advances in the medical management of inflammatory bowel disease (IBD), a subset of patients may require extensive surgery, leading to short‐bowel syndrome/intestinal failure requiring long‐term home parenteral nutrition (PN) or customized intravenous fluid (IVF) support. Our aim was to further define the characteristics of IBD patients requiring home PN/IVF. Methods This is an observational study from a prospective IBD research registry. Patients receiving long‐term home PN/IVF support during 2009–2015 were identified and compared with remaining IBD patients. Demographics, surgical history, smoking, narcotic use, IBD treatment, healthcare charges, and presence of biomarkers were reviewed. The IBD‐PN group was stratified into 3 groups based on median healthcare charges. Results Of 2359 IBD patients, there were 25 (1%, 24 with Crohn's disease) who required home PN/IVF, and 250 randomly selected IBD patients matched for disease type formed the control population. Median duration of PN use was 27 months (interquartile range, 11–66). PN use was significantly associated with smoking, narcotic use, IBD‐related operations, and lower quality‐of‐life scores. Among IBD‐PN patients, 7 of 25 (28%, 3 after use of teduglutide) were able to successfully discontinue this modality. Median healthcare charges in the IBD‐PN group were $51,456 annually. Median charges in the controls were $3427. Period prevalence mortality was 11.5% in IBD‐PN and 3.8% in controls. Conclusions IBD patients requiring long‐term home PN/IVF support are a small minority in the present era of immunomodulator/biologic therapy. These refractory patients have a 15‐fold increase in annual median healthcare charges compared with control IBD patients.

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Section: Discussionmentioning

confidence: 77%

Clinical Characteristics of Inflammatory Bowel Disease Patients Requiring Long‐Term Parenteral Support in the Present Era of Highly Effective Biologic Therapy

Kurin

Anderson

Rivers

et al. 2020

J Parenter Enteral Nutr

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“…Regarding nutritional treatment, for artificial nutrition, such as enteral and parenteral nutrition, there is evidence of efficacy [ 14 , 15 ], but for natural nutrition, it seems that a diet that is low in fiber, high in fat, and high in carbohydrates can lead to severe dysbiosis, while one richer in fruits, vegetables, and olive oil could prevent it. However, together with the role of certain foods such as meat, fish, and dairy products, their role in the development of the disease is controversial and uncertain in the absence of studies [ 16 , 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Predefined Diets in Patients with Inflammatory Bowel Disease: Systematic Review and Meta-Analysis

et al. 2020

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Inflammatory bowel disease (IBD) is a chronic disease mediated by the immune system and characterized by the importance of diet in pathological development. This study aims to understand how the use of predefined diets can affect the adult population diagnosed with IBD. We conducted a systematic review and meta-analysis. From the different databases (MEDLINE, Scopus, Cochrane, LILACS, CINAHL, and WOS), we found 4195 registers. After a review process, only 31 research studies were selected for qualitative synthesis and 10 were selected for meta-analysis. The variables used were Crohn’s Disease Activity Index (CDAI) for patients with Crohn’s Disease (CD) and fecal calprotectin (FC), C-Reactive Protein (CRP), and albumin (ALB) for patients with IBD. Predefined diets have been shown to have partial efficacy for the treatment of IBD and are compatible with other medical treatments. CDAI improved but with reasonable doubts due to the high heterogeneity of the data, while no differences were observed for ALB, FC, and CRP. More studies that evaluate the influence of predefined diets on IBD patients are needed due to the great variability in diets and the tools used to measure their effects.

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“…In a recent systematic review of 15 studies examining the effect of parenteral nutrition on IBD, CD activity scores improved, as did serum albumin, but interestingly, body weight did not change significantly. 24 …”

Section: Discussionmentioning

confidence: 99%

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

Bakhshi

Yadav

Salonen

et al. 2020

Crohn's &Amp; Colitis 360

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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.

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Parenteral Nutrition in Patients with Inflammatory Bowel Disease. Systematic Review, Meta-Analysis and Meta-Regression

Cited by 8 publications

References 51 publications

Clinical Characteristics of Inflammatory Bowel Disease Patients Requiring Long‐Term Parenteral Support in the Present Era of Highly Effective Biologic Therapy

Clinical Characteristics of Inflammatory Bowel Disease Patients Requiring Long‐Term Parenteral Support in the Present Era of Highly Effective Biologic Therapy

Predefined Diets in Patients with Inflammatory Bowel Disease: Systematic Review and Meta-Analysis

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

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