A century of home parenteral nutrition for Crohn's disease

Article Abstract:

Total parenteral nutrition (TPN) is the delivery of all of an individual's caloric and nutritional needs intravenously; it is used when the intestinal tract does not function adequately. TPN can improve remission rates for patients with Crohn's disease, a chronic, inflammatory bowel disease, but the effects of prolonged TPN in these patients have not been studied extensively. To better assess this, investigators evaluated the medical charts of 41 patients (average age, 39) with Crohn's disease who had received home parenteral nutrition (HPN). The periods pre-HPN, during HPN, and post-HPN (for patients able to discontinue HPN), were compared. Of interest were the number of surgical procedures required for Crohn's disease; the drugs patients took; their nutritional status; and their quality of life. The main reason why HPN had been instituted was short bowel syndrome (the result of multiple, or extensive, surgical resections) in 66 percent of the patients, and a high-output stoma (a surgically created opening through which the intestinal contents pass) in the rest. HPN was administered through a permanent catheter and was decreased or discontinued (in 11 patients) as tolerated. Results showed that the incidence of surgery during the pre-HPN and HPN periods did not differ. Two indices of nutritional status improved during the HPN period; they were serum albumin and serum transferrin, two blood proteins. Fewer patients (29.3 percent) took prednisone, a steroid medication, during HPN than during pre-HPN (54 percent). Measurements of the quality of life showed a significant improvement for the HPN period, in large part because the pain associated with eating ceased. More than half the patients experienced complications of HPN, including catheter sepsis (bloodborne bacterial infection resulting from contamination of the catheter) in 19 patients. The overall mortality of the group was approximately 20 percent, with three patients dying of catheter-related sepsis, and five dying as a result of Crohn's disease. Although HPN improves the quality of life and the patient's nutrition while also reducing the need for medications, it is associated with considerable morbidity and mortality. However, the authors believe that without HPN, all of the 41 patients would have died from malnutrition or dehydration. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Crohn's disease

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Nutritional support in surgical practice: part 2

Article Abstract:

Various groups of high-risk patients who are potential surgical candidates may be identified at the time of admission to the hospital. Some of these patients may benefit from the prompt initiation of nutritional support. This support may be either enteral, meaning into the digestive tract, or parenteral, directly into the blood stream. In both types of nutritional support, the patients' complete requirements for calories and nutrients can be supplied while they are unable to eat. Among the high-risk patients are those with inflammatory bowel disease, gastrointestinal fistulas and pancreatitis. A review of these disorders and their nutritional management is given. In these patients, the nutrition itself causes no change in the disease process, but the discontinuation of normal oral intake may result in benefits. If the patient's nutrition is built up, he is better able to tolerate the therapies, to heal, and to recover from illness than if he is malnourished. Organ system failures that are discussed in which nutritional support is beneficial include: acute renal failure; chronic liver disease and hepatic encephalopathy; and acute respiratory failure. In organ system failure, the nutritional support helps the body tolerate and manage the metabolic abnormalities caused by the organ failure, until the organ is able to return to proper function. Correction of malnutrition, either before or during treatment of the patient's disease, is very likely to be beneficial. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery, Food and nutrition, Enteral feeding, Enteral nutrition, Artificial feeding, Feeding methods, Chronically ill, Tube feeding

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