Patients With Severe Gastrointestinal Dysmotility Disorders Receiving Home Parenteral Nutrition Have Similar Survival As Those With Short‐Bowel Syndrome: A Prospective Cohort Study

Abstract

Introduction Severe gastrointestinal dysmotility disorder (GID) constitute approximately 20% of patients requiring home parenteral nutrition (HPN), whereas short‐bowel syndrome (SBS) remains the most frequent indication for HPN. This study's aim was to characterize GID patients and compare clinical parameters and survival to SBS patients. Similarly, clinical comparisons between sclerodermaand nonscleroderma patients were made. Methods Demographic and clinical data for all patients was extracted from the Canadian HPN Registry from January 1, 2003, to November 1, 2018. Kaplan‐Meier method was used to estimate the unadjusted survival probability, and log‐rank test was used to compare the survival probability between groups. Result 270 patients (52 GID and 218 SBS) were included in the analysis. For all patients, higher mortality was associated with age (hazard ratio [HR], 1.02 [1.00–1.04]; P = .05), PN dependence (HR, 1.01 [1.00–1.02]; P = .04), hospitalizations (HR, 1.21 [1.10–1.33]; P < .001), and use of immunosuppressant (HR, 1.97 [1.02–3.82]; P = .04). The 5‐ and 10‐year actuarial survival probabilities between GID and SBS were not significantly different (5‐year: 70.0% vs 59.2%; 10‐year: 79.6% vs 66.2% [P = .5], respectively). There was no difference in survival between scleroderma and nonscleroderma patients (P = .67). Conclusion T5‐ and 10‐ year survival probabilities were similar between GID and SBS patients. The diagnosis of scleroderma had no effect on survival. Use of immunosuppressant, older age, PN dependence, and number of hospitalizations per PN duration are risk factors for mortality in both the GID and SBS groups.

An international survey on clinicians' perspectives on the diagnosis and management of chronic intestinal pseudo‐obstruction and enteric dysmotility

“…Overall, long‐term PN was felt to be safe, with the majority of those surveyed reporting either similar or better survival outcomes compared to other causes of intestinal failure. The experiences of the survey participants are consistent with published survival outcomes from long‐term PN centers 3,12,36,37 . These data therefore suggest that long‐term PN should only be reserved for use as an important life sustaining treatment for patients with CIPO and ED related intestinal failure, and not used to treat symptoms alone.…”

“…The experiences of the survey participants are consistent with published survival outcomes from long-term PN centers. 3,12,36,37 These data therefore suggest that long-term PN should only be reserved for use as an important life sustaining treatment for patients with CIPO and ED related intestinal failure, and not used to treat symptoms alone.…”

Epidemiology, survival, costs, and quality of life in adults with short bowel syndrome

“…In this group, patient survival was not impacted by known intestinal anatomy, patient age, or sex. However, a separate report from a Canadian cohort found higher mortality with patient age, PN dependence, number of hospitalizations, and use of immunosuppressants 25 …”

“…However, a separate report from a Canadian cohort found higher mortality with patient age, PN dependence, number of hospitalizations, and use of immunosuppressants. 25 Comparing patients with SBS with those in the general population has been less frequently studied. A recent analysis of UK data indicates that individuals with SBS had a 6.8-fold higher mortality rate than for the general UK population.…”

Recent Advances in the Management of Severe Gastrointestinal Dysmotility

“…There is relatively recent data from a number of intestinal failure units internationally supporting this with 5-year survival rates on parenteral nutrition of 70–85%, 16 , 66–68 which are comparable to survival rates in patients with short bowel syndrome. 6 , 67 It is becoming apparent that parenteral nutrition requirements and long-term dependency are higher in patients with the CIPO sub-type, 4 , 16 , 17 therefore underlining the importance of recognising this sub-type separately to guide management.…”