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Nutrients 2017, 9(5), 466; doi:10.3390/nu9050466

Parenteral Nutrition and Intestinal Failure

1
Department of Public Health Sciences, Queen’s University, Kingston, ON K7L 3N6, Canada
2
Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON M5G 2C4, Canada
3
Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
*
Author to whom correspondence should be addressed.
Received: 22 February 2017 / Revised: 11 April 2017 / Accepted: 19 April 2017 / Published: 6 May 2017
(This article belongs to the Special Issue Parenteral Nutrition 2016)
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Abstract

Severe short bowel syndrome (SBS) is a major cause of chronic (Type 3) intestinal failure (IF) where structural and functional changes contribute to malabsorption and risk of micronutrient deficiencies. Chronic IF may be reversible, depending on anatomy and intestinal adaptation, but most patients require long-term nutritional support, generally in the form of parenteral nutrition (PN). SBS management begins with dietary changes and pharmacologic therapies taking into account individual anatomy and physiology, but these are rarely sufficient to avoid PN. New hormonal therapies targeting intestinal adaptation hold promise. Surgical options for SBS including intestinal transplant are available, but have significant limitations. Home PN (HPN) is therefore the mainstay of treatment for severe SBS. HPN involves chronic administration of macronutrients, micronutrients, fluid, and electrolytes via central venous access in the patient’s home. HPN requires careful clinical and biochemical monitoring. Main complications of HPN are related to venous access (infection, thrombosis) and metabolic complications including intestinal failure associated liver disease (IFALD). Although HPN significantly impacts quality of life, outcomes are generally good and survival is mostly determined by the underlying disease. As chronic intestinal failure is a rare disease, registries are a promising strategy for studying HPN patients to improve outcomes. View Full-Text
Keywords: parenteral nutrition; intestinal failure; home parenteral nutrition; short bowel syndrome parenteral nutrition; intestinal failure; home parenteral nutrition; short bowel syndrome
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Bielawska, B.; Allard, J.P. Parenteral Nutrition and Intestinal Failure. Nutrients 2017, 9, 466.

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