Recent advances in the management of intestinal failure-associated liver disease

Wiles, A; Woodward, Jeremy

doi:10.1097/mco.0b013e328329e4ef

Cited by 23 publications

(16 citation statements)

References 68 publications

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“…Triglycerides could, therefore, be used not only as a prognostic factor, but also as an observed indicator in a subsequent nutrition therapy study in patients with ACLF. Other studies have revealed that liver nutrition therapy may improve the prognosis [24]–[28]. Moreover, the association of triglycerides with mortality in patients with ACLF will be of interest in subsequent studies.…”

Section: Discussionmentioning

confidence: 97%

A Modified MELD Model for Chinese Pre-ACLF and ACLF Patients and It Reveals Poor Prognosis in Pre-ACLF Patients

et al. 2013

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Background & AimsAcute-on-chronic liver failure (ACLF) is one of the most deadly, prevalent, and costly diseases in Asia. However, no prognostic model has been developed that is based specifically on data gathered from Asian patients with ACLF. The aim of the present study was to quantify the survival time of ACLF among Asians and to develop a prognostic model to estimate the probability of death related to ACLF.MethodsWe conducted a retrospective observational cohort study to analyze clinical data from 857 patients with ACLF/pre-ACLF who did not undergo liver transplantation. Kaplan–Meier and Cox proportional hazards regression model were used to estimate survival rates and survival affected factors. The area under the receiver operating characteristic curve (auROC) was used to evaluate the performance of the models for predicting early mortality.ResultsThe mortality rates among patients with pre-ACLF at 12 weeks and 24 weeks after diagnosis were 30.5% and 33.2%, respectively. The mortality rates among patients with early-stage ACLF at 12 weeks and 24 weeks after diagnosis were 33.9% and 37.1%, respectively. The difference in survival between pre-ACLF patients and patients in the early stage of ACLF was not statistically significant. The prognostic model identified 5 independent factors significantly associated with survival among patients with ACLF and pre-ACLF: the model for end-stage liver disease (MELD) score; age, hepatic encephalopathy; triglyceride level and platelet count.ConclusionThe findings of the present study suggest that the Chinese diagnostic criteria of ACLF might be broadened, thus enabling implementation of a novel model to predict ACLF-related death after comprehensive medical treatment.

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Section: Discussionmentioning

confidence: 97%

A Modified MELD Model for Chinese Pre-ACLF and ACLF Patients and It Reveals Poor Prognosis in Pre-ACLF Patients

et al. 2013

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“…The somatostatin was also reported to be detrimental by reducing splanchnic blood flow and nutrient absorption [19]. EN, as opposed to PN, has been shown to improve intestinal barrier function, reduce the risk of bacterial translocation, and attenuate liver dysfunction [20]. EN is effective in downregulating inflammation response, reducing oxidative stress, and improving outcomes [21].…”

Section: Discussionmentioning

confidence: 99%

Fistuloclysis Improves Liver Function and Nutritional Status in Patients with High-Output Upper Enteric Fistula

Ren

Wang

et al. 2014

Gastroenterology Research and Practice

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Background. We aimed to determine the efficacy of fistuloclysis in patients with high-output upper enteric fistula (EF). Methods. Patients were assigned into the fistuloclysis group (n = 35, receiving fistuloclysis plus total enteral nutrition (TEN)) and the control group (n = 60, receiving TEN). Laboratory variables were measured during the four-week treatment. Results. At baseline, variables were similar between the two groups. Delta value was defined as the changes from baseline to day 28. Compared with the control group, the fistuloclysis group showed greater improvements in liver function (Delta total bilirubin (TB): 20.3 ± 9.7 in the fistuloclysis group versus 15.6 ± 6.3 in the control group, P = 0.040; Delta direct bilirubin (DB): 12.5 ± 3.4 versus 10.0 ± 3.6, P = 0.011; Delta alkaline phosphatase (ALP): 98.4 ± 33.5 versus 57.6 ± 20.9, P < 0.001); nutritional status (Delta total protein: 21.8 ± 8.7 versus 10.7 ± 2.1, P < 0.001; Delta albumin: 11.3 ± 2.5 versus 4.2 ± 1.3, P < 0.001). In the fistuloclysis subgroups, biliary fistula patients had the maximum number of variables with the greatest improvements. Conclusions. Fistuloclysis improved hepatic and nutritional parameters in patients with high-output upper EF, particularly in biliary fistula patients.

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“…Studies are ongoing on the role of omega-3 lipids (Omegaven) in treating and preventing PNALD and are very encouraging Rollins et al 2010;Premkumar et al 2013). Weaning patients off PN as early as possible by optimizing EN remains the only way to prevent PNALD (Wiles and Woodward 2009). …”

Section: Parenteral Nutrition Associated Liver Disease (Pnald)mentioning

confidence: 97%

Short bowel syndrome in infants: the critical role of luminal nutrients in a management program

Roy

Groleau

Bouthillier

et al. 2014

Appl. Physiol. Nutr. Metab.

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Short bowel syndrome develops when the remnant mass of functioning enterocytes following massive resections cannot support growth or maintain fluid-electrolyte balance and requires parenteral nutrition. Resection itself stimulates the intestine's inherent ability to adapt morphologically and functionally. The capacity to change is very much related to the high turnover rate of enterocytes and is mediated by several signals; these signals are mediated in large part by enteral nutrition. Early initiation of enteral feeding, close clinical monitoring, and ongoing assessment of intestinal adaptation are key to the prevention of irreversible intestinal failure. The length of the functional small bowel remnant is the most important variable affecting outcome. The major objective of intestinal rehabilitation programs is to achieve early oral nutritional autonomy while maintaining normal growth and nutrition status and minimizing total parenteral nutrition related comorbidities such as chronic progressive liver disease. Remarkable progress has been made in terms of survivability and quality of life, especially in the context of coordinated multidisciplinary programs, but much work remains to be done.

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Recent advances in the management of intestinal failure-associated liver disease

Cited by 23 publications

References 68 publications

A Modified MELD Model for Chinese Pre-ACLF and ACLF Patients and It Reveals Poor Prognosis in Pre-ACLF Patients

A Modified MELD Model for Chinese Pre-ACLF and ACLF Patients and It Reveals Poor Prognosis in Pre-ACLF Patients

Fistuloclysis Improves Liver Function and Nutritional Status in Patients with High-Output Upper Enteric Fistula

Short bowel syndrome in infants: the critical role of luminal nutrients in a management program

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