The Use of Cyclic Home Hyperalimentation for Malabsorption in Patients with Scleroderma Involving the Small Intestines

Abstract

When scleroderma involves the small intestines, malnutrition with resulting immune incompetence and sepsis can occur. Two cases are presented in which patients with scleroderma involving the gastrointestinal tract were treated with cyclic home hyperalimentation, restoring their nutritional status and improving their quality of life.

Malnutrition Is Common in Systemic Sclerosis: Results from the Canadian Scleroderma Research Group Database

“…It is well known that the severe GI disease of SSc can cause malnutrition 6 , in most cases because of malabsorption likely secondary to bacterial overgrowth 10 . That parenteral nutrition has often been used in patients with SSc attests to the severity of the malnutrition [8][9][10]30 . However, there are to our knowledge no studies of a large number of SSc patients that have established the prevalence of malnutrition in an unselected population.…”

“…Gastrointestinal (GI) involvement in patients with systemic sclerosis (SSc) is common, and diffuse bowel involvement may result in bacterial overgrowth and malabsorption [1][2][3][4][5] . Prokinetic agents, antibiotics, and parenteral nutrition may be required [6][7][8][9][10][11] , but although malnutrition might be an expected consequence of these features, a systematic approach to assessment of nutritional status in patients with SSc has been undertaken infrequently, and then only in small numbers of patients 12,13 .…”

Long-term outcome of patients with systemic sclerosis requiring home parenteral nutrition

“…However, as demonstrated in this patient cohort, the efficacy and tolerance of enteral nutrition may be limited in patients with severe SSc-related small bowel involvement [21]. While this may reflect the severity of GI involvement seen in patients in this tertiary cohort of patients, other case series also report a high rate of progression from enteral to parenteral nutrition in patients with SSc-related small bowel dysmotility [9,13]. Indeed, published reports of successful outcomes with enteral nutrition in patients SSc largely relate to patients without small bowel involvement [6e8].…”

Home central venous hyperalimentation in fifteen patients with severe scleroderma bowel disease

“…Treatment has included antibiotics, nasogastric suction for bowel rest, hydration, venting enterostomy, and even surgical resection (4) of the atonic segment. However, when malnutrition and obstructive episodes become severe and all other treatment has failed, central venous hyperalimentation has been used (5,6).…”