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Wyer N. Dietary management of patients with a high-output stoma. Nurs Stand 2022; 37:71-76. [PMID: 35343172 DOI: 10.7748/ns.2022.e11941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 11/09/2022]
Abstract
A stoma enables faeces and flatus to be passed through a small surgically formed aperture in the abdominal wall, and may be temporary or permanent. However, in some cases, the output of a stoma can exceed normal limits. Without appropriate management, a high-output stoma can lead to dehydration, electrolyte disturbances and malnutrition in patients. Interventions to manage a high-output stoma include the use of oral rehydration solutions, restriction of hypotonic fluids and dietary modifications. This article reviews the causes of high-output stomas, and describes the assessment and management options available to nurses.
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Affiliation(s)
- Nicola Wyer
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, England
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Pironi L, Steiger E, Joly F, Jeppesen PB, Wanten G, Sasdelli AS, Chambrier C, Aimasso U, Mundi MS, Szczepanek K, Jukes A, Theilla M, Kunecki M, Daniels J, Serlie M, Poullenot F, Cooper SC, Rasmussen HH, Compher C, Seguy D, Crivelli A, Santarpia L, Guglielmi FW, Kozjek NR, Schneider SM, Ellegard L, Thibault R, Matras P, Matysiak K, Van Gossum A, Forbes A, Wyer N, Taus M, Virgili NM, O'Callaghan M, Chapman B, Osland E, Cuerda C, Udvarhelyi G, Jones L, Won Lee AD, Masconale L, Orlandoni P, Spaggiari C, Díez MB, Doitchinova-Simeonova M, Serralde-Zúñiga AE, Olveira G, Krznaric Z, Czako L, Kekstas G, Sanz-Paris A, Jáuregui MEP, Murillo AZ, Schafer E, Arends J, Suárez-Llanos JP, Youssef NN, Brillanti G, Nardi E, Lal S. Characteristics of adult patients with chronic intestinal failure due to short bowel syndrome: An international multicenter survey. Clin Nutr ESPEN 2021; 45:433-441. [PMID: 34620351 DOI: 10.1016/j.clnesp.2021.07.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/08/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND AIMS The case-mix of patients with intestinal failure due to short bowel syndrome (SBS-IF) can differ among centres and may also be affected by the timeframe of data collection. Therefore, the ESPEN international multicenter cross-sectional survey was analyzed to compare the characteristics of SBS-IF cohorts collected within the same timeframe in different countries. METHODS The study included 1880 adult SBS-IF patients collected in 2015 by 65 centres from 22 countries. The demographic, nutritional, SBS type (end jejunostomy, SBS-J; jejuno-colic anastomosis, SBS-JC; jejunoileal anastomosis with an intact colon and ileocecal valve, SBS-JIC), underlying disease and intravenous supplementation (IVS) characteristics were analyzed. IVS was classified as fluid and electrolyte alone (FE) or parenteral nutrition admixture (PN). The mean daily IVS volume, calculated on a weekly basis, was categorized as <1, 1-2, 2-3 and >3 L/day. RESULTS In the entire group: 60.7% were females and SBS-J comprised 60% of cases, while mesenteric ischaemia (MI) and Crohn' disease (CD) were the main underlying diseases. IVS dependency was longer than 3 years in around 50% of cases; IVS was infused ≥5 days/week in 75% and FE in 10% of cases. Within the SBS-IF cohort: CD was twice and thrice more frequent in SBS-J than SBS-JC and SBS-JIC, respectively, while MI was more frequent in SBS-JC and SBS-JIC. Within countries: SBS-J represented 75% or more of patients in UK and Denmark and 50-60% in the other countries, except Poland where SBS-JC prevailed. CD was the main underlying disease in UK, USA, Denmark and The Netherlands, while MI prevailed in France, Italy and Poland. CONCLUSIONS SBS-IF type is primarily determined by the underlying disease, with significant variation between countries. These novel data will be useful for planning and managing both clinical activity and research studies on SBS.
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Affiliation(s)
- Loris Pironi
- CHU Rennes, Nutrition Unit, Clinique Saint Yves, Home Parenteral Nutrition Centre, INRAE, INSERM, Univ Rennes, Nutrition Metabolisms and Cancer, NuMeCan, Rennes, France.
| | - Ezra Steiger
- Home Nutrition Support, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Francisca Joly
- Centre for Intestinal Failure, Department of Gastroenterology and Nutritional Support, Hôpital Beaujon, Clichy, France
| | - Palle B Jeppesen
- Rigshospitalet, Department of Gastroenterology, Copenhagen, Denmark
| | - Geert Wanten
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Anna S Sasdelli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Centre for Chronic Intestinal Failure - Clinical Nutrition and Metabolism Unit, Bologna, Italy
| | - Cecile Chambrier
- Unité de Nutrition Clinique Intensive, Hospices Civils de Lyon, Hôpital Lyon Sud, Lyon, France
| | | | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo College of Medicine, Rochester, MN, USA
| | - Kinga Szczepanek
- General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | - Amelia Jukes
- University Hospital of Wales, Cardiff, United Kingdom
| | - Miriam Theilla
- Rabin Medical Center, Petach Tikva, Sackler School of Medicine, Tel Aviv University, Israel
| | | | - Joanne Daniels
- Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
| | - Mireille Serlie
- Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Florian Poullenot
- Service de Gastroentérologie, Hôpital Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Sheldon C Cooper
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Henrik H Rasmussen
- Centre for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Charlene Compher
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - David Seguy
- Service de Nutrition, CHRU de Lille, Lille, France
| | - Adriana Crivelli
- Unidad de Soporte Nutricional, Rehabilitación y Trasplante de Intestino, Hospital Universitario Fundacion Favaloro, Buenos Aires, Argentina
| | | | | | | | - Stéphane M Schneider
- Gastroenterology and Clinical Nutrition, CHU of Nice, Université Côte D'Azur, Nice, France
| | - Lars Ellegard
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Ronan Thibault
- CHU Rennes, Nutrition Unit, Clinique Saint Yves, Home Parenteral Nutrition Centre, INRAE, INSERM, Univ Rennes, Nutrition Metabolisms and Cancer, NuMeCan, Rennes, France
| | - Przemysław Matras
- Department of General and Transplant Surgery and Clinical Nutrition, Medical University of Lublin, Lublin, Poland
| | - Konrad Matysiak
- Centre for Intestinal Failure, Department of General, Endocrinological and Gastroenterological Surgery, Poznań University of Medical Science, Poznań, Poland
| | - Andrè Van Gossum
- Medico-Surgical Department of Gastroenterology, Hôpital Erasme, Free University of Brussels, Belgium
| | - Alastair Forbes
- Institute of Internal Medicine, University of Tartu, Tartu, Estonia, And Previously at Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Nicola Wyer
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Marina Taus
- SOD Dietetica e Nutrizione Clinica, Centro Riferimento Regionale NAD, Ospedali Riuniti di Ancona, Italy
| | - Nuria M Virgili
- Facultatiu Especialista. Servei D'Endocrinologia I Nutrició, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | | | - Emma Osland
- Royal Brisbane and Women's Hospital, Herston, Australia
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | | | - Lynn Jones
- Royal Prince Alfred Hospital, Camperdown, Australia
| | - Andre D Won Lee
- Hospital Das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Paolo Orlandoni
- Nutrizione Clinica-Centro di Riferimento Regionale NAD, IRCCS-INRCA, Ancona, Italy
| | | | - Marta Bueno Díez
- Servei D'Endocrinologia I Nutrició, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | | | | | | | - Zeljko Krznaric
- Centre of Clinical Nutrition, Department of Medicine, University Hospital Centre, Zagreb, Croatia
| | - Laszlo Czako
- First Department of Internal Medicine, Szeged, Hungary
| | | | | | | | | | - Eszter Schafer
- Magyar Honvedseg Egészségügyi Központ (MHEK), Budapest, Hungary
| | - Jann Arends
- Department of Medicine, Oncology and Hematology, University of Freiburg, Germany
| | - José P Suárez-Llanos
- Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Nader N Youssef
- VectivBio AG Basel, Switzerland, Digestive Healthcare Center, NJ, USA
| | - Giorgia Brillanti
- Alma Mater Studiorum, University of Bologna, Department of Medical and Surgical Sciences, Bologna, Italy
| | - Elena Nardi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK
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Allan PJ, Ambrose T, Mountford C, Bond A, Donnellan C, Boyle R, Calvert C, Cernat E, Clarke E, Cooper SC, Donnelly S, Evans B, Glynn M, Hewett R, Holohan AS, Leitch EF, Louis-Auguste J, Mehta S, Naik S, Nightingale J, Rafferty G, Rodrigues A, Sharkey L, Small M, Teubner A, Urs A, Wyer N, Lal S. COVID-19 infection in patients with intestinal failure: UK experience. JPEN J Parenter Enteral Nutr 2021; 45:1369-1375. [PMID: 33586170 PMCID: PMC8013499 DOI: 10.1002/jpen.2087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The direct effect of the coronavirus disease 2019 (COVID-19) pandemic on patients with intestinal failure (IF) has not been described. METHODS We conducted a nationwide study of UK IF centers to evaluate the infection rates, presentations, and outcomes in patients with types 2 and 3 IF. RESULTS A total of 45 patients with IF contracted COVID-19 between March and August 2020; this included 26 of 2191 (1.2%) home parenteral nutrition (HPN)-dependent adults and 19 of 298 (6.4%) adults hospitalized with type 2 IF. The proportion of patients receiving nursing care for HPN administration was higher in those with community-acquired COVID-19 (66.7%) than the proportion in the entire HPN cohort (26.1%; P < .01). Two HPN-dependent and 1 hospitalized patient with type 2 IF died as a direct consequence of the virus (6.7% of 45 patients with types 2 or 3 infected). CONCLUSION This is the first study to describe the outcomes of COVID-19 in a large cohort of patients requiring long-term PN. Methods to reduce hospital and community nosocomial spread would likely be beneficial.
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Affiliation(s)
- P J Allan
- Translational Gastroenterology Unit, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - T Ambrose
- Translational Gastroenterology Unit, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - C Mountford
- Department of Gastroenterology, Freeman Hospital, Newcastle, UK
| | - A Bond
- Department of Gastroenterology, Royal Liverpool and Broadgreen Hospitals, Liverpool, UK
| | - C Donnellan
- St James' and Leeds Gastroenterology Institute, St James' Hospital, Leeds, UK
| | - R Boyle
- Department of Biochemistry, Aberdeen Royal Infirmary, Aberdeen, UK
| | - C Calvert
- Department of Gastroenterology, Royal Devon and Exeter Hospital, Exeter, UK
| | - E Cernat
- Department of Paediatric Gastroenterology, Leeds General Infirmary, Leeds, UK
| | - E Clarke
- Department of Gastroenterology, Southampton University Hospital, Southampton, UK
| | - S C Cooper
- GI Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Donnelly
- Leonard Jones' Intestinal Rehabilitation Unit, St Mark's Hospital, Harrow, UK
| | - B Evans
- Department of Gastroenterology, Bristol Royal Infirmary, Bristol, UK
| | - M Glynn
- Centre for Digestive Diseases, Royal London Hospital, London, UK
| | - R Hewett
- Department of Gastroenterology, University of Wales Hospital, Cardiff, UK
| | - A S Holohan
- Nutrition, Leicester Royal Infirmary, Leicester, UK
| | - E F Leitch
- Intestinal Failure Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | | | - S Mehta
- Intestinal Failure Unit, University College London Hospitals, London, UK
| | - S Naik
- Department of Paediatric Gastroenterology, Royal London Children's Hospital, London, UK
| | | | - G Rafferty
- Department of Gastroenterology, Belfast City Hospital, Belfast, UK
| | - A Rodrigues
- Department of Paediatric Gastroenterology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - L Sharkey
- Intestinal Failure and Transplant, Cambridge University Hospitals, Cambridge, UK
| | - M Small
- Leonard Jones' Intestinal Rehabilitation Unit, St Mark's Hospital, Harrow, UK
| | - A Teubner
- Intestinal Failure Unit, Salford Royal Hospital, Salford, UK
| | - A Urs
- Paediatric Gastroenterology, Sheffield Children's Hospital, Sheffield, UK
| | - N Wyer
- Intestinal Failure and Nutrition Support, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - S Lal
- Intestinal Failure Unit, Salford Royal Hospital, Salford, UK.,Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
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4
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Pironi L, Steiger E, Joly F, Wanten GJA, Chambrier C, Aimasso U, Sasdelli AS, Szczepanek K, Jukes A, Theilla M, Kunecki M, Daniels J, Serlie MJ, Cooper SC, Poullenot F, Rasmussen HH, Compher CW, Crivelli A, Hughes SJ, Santarpia L, Guglielmi FW, Rotovnik Kozjek N, Ellegard L, Schneider SM, Matras P, Forbes A, Wyer N, Zmarzly A, Taus M, O'Callaghan M, Osland E, Thibault R, Cuerda C, Jones L, Chapman B, Sahin P, Virgili NM, Lee ADW, Orlandoni P, Matysiak K, Di Caro S, Doitchinova-Simeonova M, Masconale L, Spaggiari C, Garde C, Serralde-Zúñiga AE, Olveira G, Krznaric Z, Petrina Jáuregui E, Zugasti Murillo A, Suárez-Llanos JP, Nardi E, Van Gossum A, Lal S. Intravenous supplementation type and volume are associated with 1-year outcome and major complications in patients with chronic intestinal failure. Gut 2020; 69:1787-1795. [PMID: 31964752 DOI: 10.1136/gutjnl-2018-318172] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 12/23/2019] [Accepted: 01/07/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM No marker to categorise the severity of chronic intestinal failure (CIF) has been developed. A 1-year international survey was carried out to investigate whether the European Society for Clinical Nutrition and Metabolism clinical classification of CIF, based on the type and volume of the intravenous supplementation (IVS), could be an indicator of CIF severity. METHODS At baseline, participating home parenteral nutrition (HPN) centres enrolled all adults with ongoing CIF due to non-malignant disease; demographic data, body mass index, CIF mechanism, underlying disease, HPN duration and IVS category were recorded for each patient. The type of IVS was classified as fluid and electrolyte alone (FE) or parenteral nutrition admixture (PN). The mean daily IVS volume, calculated on a weekly basis, was categorised as <1, 1-2, 2-3 and >3 L/day. The severity of CIF was determined by patient outcome (still on HPN, weaned from HPN, deceased) and the occurrence of major HPN/CIF-related complications: intestinal failure-associated liver disease (IFALD), catheter-related venous thrombosis and catheter-related bloodstream infection (CRBSI). RESULTS Fifty-one HPN centres included 2194 patients. The analysis showed that both IVS type and volume were independently associated with the odds of weaning from HPN (significantly higher for PN <1 L/day than for FE and all PN >1 L/day), patients' death (lower for FE, p=0.079), presence of IFALD cholestasis/liver failure and occurrence of CRBSI (significantly higher for PN 2-3 and PN >3 L/day). CONCLUSIONS The type and volume of IVS required by patients with CIF could be indicators to categorise the severity of CIF in both clinical practice and research protocols.
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Affiliation(s)
- Loris Pironi
- Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Ezra Steiger
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Francisca Joly
- Service de Gastroentérologie et d'Assistance nutritive, Hôpital Beaujon, Assistance Publique - Hopitaux de Paris, University of Paris, Clichy, France
| | - Geert J A Wanten
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cecile Chambrier
- Centre Hospitalier Universitaire de Lyon, Lyon, Rhône-Alpes, France
| | - Umberto Aimasso
- Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino, Torino, Piemonte, Italy
| | | | | | - Amelia Jukes
- University Hospital of Wales, Cardiff, Cardiff, UK
| | - Miriam Theilla
- Nursing Department, Steyer School of Health Professions, Sackler School of Medicine, Tel Aviv, Israel
| | - Marek Kunecki
- Clinical Nutrition Department, M Pirogow Hospital, Lodz, Poland
| | - Joanne Daniels
- Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Mireille J Serlie
- Endocrinology and Metabolism, Academic Medical Center, Amsterdam, The Netherlands
| | - Sheldon C Cooper
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK
| | - Florian Poullenot
- Hôpital Haut-Lévêque, Service d'hépato-gastroentérologie, CHU Bordeaux, Pessac, France
| | - Henrik Højgaard Rasmussen
- Center for Nutrition and Bowel Disease, Department of Medical Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Charlene W Compher
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Adriana Crivelli
- Fundacion Favaloro Hospital Universitario, Buenos Aires, Federal District, Argentina
| | | | - Lidia Santarpia
- Department of Clinical Medicine and Surgery, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | | | | | | | - Stéphane M Schneider
- Centre Hospitalier Universitaire de Nice, Nice, Provence-Alpes-Côte d'Azur, France
| | | | - Alastair Forbes
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Nicola Wyer
- University Hospital Coventry, Coventry, Coventry, UK
| | | | - Marina Taus
- Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Marche, Italy
| | | | - Emma Osland
- Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia
| | - Ronan Thibault
- Centre de référence Maladies Rares Digestives, Unité de Nutrition, CHU Rennes, INRAE, INSERM, Universite de Rennes, Nutrition Metabolisms and Cancer institute, NuMeCan, Rennes, Bretagne, France
| | - Cristina Cuerda
- Hospital General Universitario Gregorio Maranon, Madrid, Madrid, Spain
| | - Lynn Jones
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Brooke Chapman
- Nutrition and Dietetics, Austin Health, Heidelberg, Victoria, Australia
| | | | - Núria M Virgili
- Unitat de Nutrició i Dietètica, Hospital Universitari Bellvitge, L'Hospitalet Llobregat, Barcelona, Spain
| | - Andre Dong Won Lee
- Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Konrad Matysiak
- Centre for Intestinal Failure, Uniwersytet Medyczny imienia Karola Marcinkowskiego w Poznaniu, Poznan, Poland
| | | | | | - Luisa Masconale
- Unita' Locale Socio-Sanitaria N° 22, Bussolengo, Verona, Italy
| | - Corrado Spaggiari
- Azienda Unita Sanitaria Locale di Parma, Parma, Emilia-Romagna, Italy
| | - Carmen Garde
- Hospital Universitario de Donostia, San Sebastian, País Vasco, Spain
| | | | - Gabriel Olveira
- Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
| | | | | | | | - José P Suárez-Llanos
- Hospital Universitario Nuestra Senora de la Candelaria, Santa Cruz de Tenerife, Canarias, Spain
| | - Elena Nardi
- Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - André Van Gossum
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Simon Lal
- Gastroenterology and Intestinal Failure Unit, Salford Royal Foundation Trust, University of Manchester, Manchester, UK
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5
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Pironi L, Konrad D, Brandt C, Joly F, Wanten G, Agostini F, Chambrier C, Aimasso U, Zeraschi S, Kelly D, Szczepanek K, Jukes A, Di Caro S, Theilla M, Kunecki M, Daniels J, Serlie M, Poullenot F, Wu J, Cooper SC, Rasmussen HH, Compher C, Seguy D, Crivelli A, Pagano MC, Hughes SJ, Guglielmi FW, Kozjek NR, Schneider SM, Gillanders L, Ellegard L, Thibault R, Matras P, Zmarzly A, Matysiak K, Van Gossum A, Forbes A, Wyer N, Taus M, Virgili NM, O'Callaghan M, Chapman B, Osland E, Cuerda C, Sahin P, Jones L, Lee ADW, Bertasi V, Orlandoni P, Izbéki F, Spaggiari C, Díez MB, Doitchinova-Simeonova M, Garde C, Serralde-Zúñiga AE, Olveira G, Krznaric Z, Czako L, Kekstas G, Sanz-Paris A, Jáuregui EP, Murillo AZ, Schafer E, Arends J, Suárez-Llanos JP, Shaffer J, Lal S. Clinical classification of adult patients with chronic intestinal failure due to benign disease: An international multicenter cross-sectional survey. Clin Nutr 2017; 37:728-738. [PMID: 28483328 DOI: 10.1016/j.clnu.2017.04.013] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/19/2017] [Accepted: 04/11/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS The aim of the study was to evaluate the applicability of the ESPEN 16-category clinical classification of chronic intestinal failure, based on patients' intravenous supplementation (IVS) requirements for energy and fluids, and to evaluate factors associated with those requirements. METHODS ESPEN members were invited to participate through ESPEN Council representatives. Participating centers enrolled adult patients requiring home parenteral nutrition for chronic intestinal failure on March 1st 2015. The following patient data were recorded though a structured database: sex, age, body weight and height, intestinal failure mechanism, underlying disease, IVS volume and energy need. RESULTS Sixty-five centers from 22 countries enrolled 2919 patients with benign disease. One half of the patients were distributed in 3 categories of the ESPEN clinical classification. 9% of patients required only fluid and electrolyte supplementation. IVS requirement varied considerably according to the pathophysiological mechanism of intestinal failure. Notably, IVS volume requirement represented loss of intestinal function better than IVS energy requirement. A simplified 8 category classification of chronic intestinal failure was devised, based on two types of IVS (either fluid and electrolyte alone or parenteral nutrition admixture containing energy) and four categories of volume. CONCLUSIONS Patients' IVS requirements varied widely, supporting the need for a tool to homogenize patient categorization. This study has devised a novel, simplified eight category IVS classification for chronic intestinal failure that will prove useful in both the clinical and research setting when applied together with the underlying pathophysiological mechanism of the patient's intestinal failure.
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Affiliation(s)
- Loris Pironi
- Center for Chronic Intestinal Failure, Department of Digestive System, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Denise Konrad
- Home Nutrition Support, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Francisca Joly
- Centre for Intestinal Failure, Department of Gastroenterology and Nutritional Support, Hôpital Beaujon, Clichy, France
| | - Geert Wanten
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Federica Agostini
- Center for Chronic Intestinal Failure, Department of Digestive System, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Cecile Chambrier
- Unité de Nutrition Clinique Intensive, Hospices Civils de Lyon, Hôpital de la Croix Rousse, Lyon, France
| | | | - Sarah Zeraschi
- Nutrition Team Office, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Darlene Kelly
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Kinga Szczepanek
- General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | - Amelia Jukes
- University Hospital of Wales, Cardiff, United Kingdom
| | | | | | | | - Joanne Daniels
- Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
| | | | - Florian Poullenot
- Service de Gastroentérologie, Hôpital Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Jian Wu
- Intestinal Failure Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Sheldon C Cooper
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Henrik H Rasmussen
- Centre for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Charlene Compher
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - David Seguy
- Service de Nutrition, CHRU de Lille, Lille, France
| | - Adriana Crivelli
- Unidad de Soporte Nutricional, Rehabilitación y Trasplante de Intestino, Hospital Universitario Fundacion Favaloro, Buenos Aires, Argentina
| | | | - Sarah-Jane Hughes
- Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | | | | | - Stéphane M Schneider
- Gastroenterology and Clinical Nutrition, CHU of Nice, University of Nice Sophia Antipolis, Nice, France
| | - Lyn Gillanders
- National Intestinal Failure Service, Auckland City Hospital, Auckland, New Zealand
| | - Lars Ellegard
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Ronan Thibault
- Gastrointestinal and Nutritional Rehabilitation Medicine, Clinique Saint Yves, Rennes Cedex, France
| | - Przemysław Matras
- Department of General and Transplant Surgery and Clinical Nutrition, Medical University of Lublin, Lublin, Poland
| | - Anna Zmarzly
- Department of Clinical Nutrition, J. Gromkowski City Hospital, Wroclaw, Poland
| | - Konrad Matysiak
- Centre for Intestinal Failure, Department of General, Endocrinological and Gastroenterological Surgery, Poznan University of Medical Science, Poznań, Poland
| | - Andrè Van Gossum
- Medico-Surgical Department of Gastroenterology, Hôpital Erasme, Free University of Brussels, Belgium
| | - Alastair Forbes
- Norfolk and Norwich University Hospital, University of East Anglia, Norwich, United Kingdom
| | - Nicola Wyer
- University Hospital, Coventry, United Kingdom
| | - Marina Taus
- Centro di Riferimento Regionale NAD Ospedali Riuniti Ancona, Ancona, Italy
| | - Nuria M Virgili
- Unitat Nutrició i Dietética, Servei Endocrinologia i Nutrició, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | | | - Emma Osland
- Royal Brisbane and Women's Hospital, Herston, Australia
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | | | - Lynn Jones
- Royal Prince Alfred Hospital, Camperdown, Australia
| | - Andre D W Lee
- Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Paolo Orlandoni
- Centro di Riferimento Regionale NAD, INRCA -IRCCS, Ancona, Italy
| | - Ferenc Izbéki
- Szent György Teaching Hospital of County Fejér, Székesfehérvár, Hungary
| | | | - Marta Bueno Díez
- Servei d'Endocrinologia i Nutrició, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | | | - Carmen Garde
- Hospital Universitario Donostia, San Sebastian, Spain
| | | | | | - Zeljko Krznaric
- Centre of Clinical Nutrition, Department of Medicine, University Hospital Centre, Zagreb, Croatia
| | - Laszlo Czako
- First Department of Internal Medicine, Szeged, Hungary
| | | | | | | | | | - Eszter Schafer
- Magyar Honvedseg Egészségügyi Központ (MHEK), Budapest, Hungary
| | - Jann Arends
- Department of Medicine, Oncology and Hematology, University of Freiburg, Germany
| | - José P Suárez-Llanos
- Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Jon Shaffer
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK
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