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Guglielmi FW, Diamanti A, Gandullia P, Aimasso U, Arrigo S, Capriati T, Elia D, Guidetti M, Lezo A, Madeo A, Mazzuoli S, Merlo FD, Regano N, Sasdelli AS, Pironi L, De Francesco A. Non-interventional, 5-year retrospective data of home parenteral nutrition in patients with benign chronic intestinal failure: Analysis of an Italian nurse registry (SERECARE II). Nutrition 2024; 120:112257. [PMID: 38335907 DOI: 10.1016/j.nut.2023.112257] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/17/2023] [Accepted: 10/01/2023] [Indexed: 02/12/2024]
Abstract
OBJECTIVE This study is an assessment of home parenteral nutrition service performance and safety and efficacy outcomes in patients with benign chronic intestinal failure. METHODS This is a retrospective, non-interventional, and multicenter study. Data were collected by trained nurses and recorded in a dedicated registry (SERECARE). RESULTS From January 1, 2013 to June 30, 2018, data from a total of 683 patients with benign chronic intestinal failure were entered in the registry. Patients included 208 pediatric (53.8% male; median age = 4.0 y) and 475 adult (47.6% male; median age = 59.0 y) participants. On average, patients were visited 5.4 ± 4.5 times and received 1.4 ± 0.8 training sessions. Retraining was not common and mostly due to change of therapy or change of caregiver. Of 939 complications, 40.9% were related to the central venous catheter and were mostly infectious (n = 182) and mechanical (n = 187). The rate of infectious and mechanical complications per 1000 catheter days decreased over 5 y (0.30-0.15 and 0.33 -0.19, respectively). The rate of complications per 1000 catheter days and the mean complications per patient were higher in pediatric than in adult patients. The hospitalization rate was 1.01 per patient throughout the study period. These data were similar to those registered in a previous study period (2002-2011) (n = 1.53 per patient). Changes over time in the efficacy variables were mostly small and non-significant. CONCLUSIONS This study confirms the importance of setting up and maintaining structured registries to monitor and improve home parenteral nutrition care. Safety outcomes have improved over the years, most likely due to the underlying efficient nursing service.
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Affiliation(s)
| | | | | | - Umberto Aimasso
- A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | | | | | - Antonella Lezo
- Ospedale Infantile Regina Margherita, A.O.U. Città della Salute e della Scienzadi Torino, Turin, Italy
| | | | | | | | - Nunzia Regano
- Ospedale Monsignor Raffaele Dimiccoli, Barletta, Italy
| | | | - Loris Pironi
- Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Mazzuoli S, Regano N, Lamacchia S, Silvestri A, Guglielmi FW. Intestinal iatrogenic hyperadaptation in patients with short bowel syndrome and Crohn's disease: Is this an indication for mandatory lifelong injections of teduglutide? Nutrition 2021; 91-92:111396. [PMID: 34399400 DOI: 10.1016/j.nut.2021.111396] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/20/2021] [Accepted: 06/16/2021] [Indexed: 11/18/2022]
Abstract
Short bowel syndrome with chronic intestinal failure (SBS-CIF) is a rare disease leading to a markedly decreased absorption of fluids and nutrients. Intestinal adaptation in patients with SBS-CIF who are treated with home parenteral nutrition is a natural repair process activated by increased secretions of glucagon-like peptide-2, inducing intestinal trophism, nutrient transport, and lowering gastrointestinal motility. Teduglutide (TED), a glucagon-like peptide-2 analog, offers a new, effective therapeutic alternative to boost intestinal adaptation. There is still no consensus regarding the question of whether intestinal adaptation is permanent or a transient, drug-dependent process requiring lifelong injections of TED. Here we report the clinical cases of two female patients with SBS-CIF secondary to Crohn's disease, who had received TED for 36 and 41 mo. In both patients, TED was discontinued for 5 d but needed to be resumed after an additional 5 d. In patient 1, the discontinuation of TED was accidental (the patient inadvertently injected frozen TED vials); whereas in patient 2, the suspension was at the patient's request. A rapid, significant (P < 0.0001) decline of intestinal function (diarrheal evacuations, fecal volume, food intake) was documented after the suspension of active TED in patient 1. After the resumption of active TED, the symptoms rapidly and significantly (P < 0.0001) improved. The same trend was observed in patient 2. Infective causes of diarrhea were ruled out in both patients. In conclusion, our experience shows that even after long-term treatment, the iatrogenic hyperadaptation process obtained with TED results is a temporary, drug-dependent process and vanishes with the suspension of therapy. These clinical cases suggest that in patients with SBS-CIF receiving TED, this treatment must be administered lifelong.
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Affiliation(s)
- Silvia Mazzuoli
- Gastroenterology Department, Monsignor Raffaele Dimiccoli Hospital, Barletta, Italy
| | - Nunzia Regano
- Gastroenterology Department, Monsignor Raffaele Dimiccoli Hospital, Barletta, Italy
| | - Stefania Lamacchia
- Gastroenterology Department, Monsignor Raffaele Dimiccoli Hospital, Barletta, Italy
| | - Angela Silvestri
- Gastroenterology Department, Monsignor Raffaele Dimiccoli Hospital, Barletta, Italy
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Regano N, Mazzuoli S, Lamacchia S, Guglielmi F. EFFICACY OF TEDUGLUTIDE IN PATIENTS WITH SHORT BOWEL SYNDROME ON HOME PARENTERAL NUTRITION: A REAL LIFE STUDY. Nutrition 2019. [DOI: 10.1016/j.nut.2019.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lamacchia S, Regano N, Mazzuoli S, Amerotti I, Rizzi S, Paolo SD, Guglielmi F. LOW PROTEIN DIET IN THE MANAGEMENT OF CHRONIC KIDNEY DISEASE IMPROVES NUTRITIONAL STATUS AND RENAL FUNCTION. Nutrition 2019. [DOI: 10.1016/j.nut.2019.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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De Francesco A, Diamanti A, Gandullia P, Aimasso U, Arrigo S, Brolatti N, Capriati T, Elia D, Mazzuoli S, Merlo FD, Pazzeschi C, Regano N, Sasdelli AS, Pironi L, Guglielmi FW. Non-interventional, retrospective data of long-term home parenteral nutrition in patients with benign diseases: Analysis of a nurse register (SERECARE). Nutrition 2019; 66:131-141. [PMID: 31276929 DOI: 10.1016/j.nut.2019.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 10/09/2018] [Revised: 01/02/2019] [Accepted: 01/17/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the safety and efficacy of home parenteral nutrition (HPN) service in patients with benign chronic intestinal failure (CIF). METHODS This was a 10-y retrospective, non-interventional, multicenter study conducted with adult and pediatric patients with CIF who received HPN service. We analyzed data prospectively collected from a dedicated register by HPN nurses. RESULTS From January 2002 to December 2011 a total of 794 patients (49.7% male, median age 1 y for children and 57 y for adults) were included in the analysis. Over the 10-y period, 723 central venous catheter (CVC) complications occurred, of which 394 were infectious (54.5%), 297 were mechanical (41.1%), and 32 (3.3%) were defined as CVC-related thrombosis. The complication rate was higher in children (1.11 per patient) than in adults (0.70 per patient). During the observation period, the rates of both infectious and mechanical complications showed a global declining trend and ∼75% of patients had neither infectious nor mechanical CVC complications. HPN efficacy was evaluated in 301 patients with a minimum follow-up of 36 mo. Body mass index and Karnofsky score showed that the median growth significantly increased (P < 0.001) over baseline for adults and pediatric patients in the 0 to 2 age range. CONCLUSIONS The use of a structured register has proved to be a key strategy for monitoring the outcomes of long-term treatment, improving time efficiency, and preventing potential malpractice. To our knowledge, this is the largest survey ever documented; the results were consistent despite the heterogeneity of the centers because of duly applied standard rules and protocols.
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Affiliation(s)
| | | | - Paolo Gandullia
- Istituto di Ricerca e Cura a Carattere Scientifico Istituto G. Gaslini, Genova, Italy
| | - Umberto Aimasso
- Azienda Ospedaliera Città della Salute e della Scienza, Torino, Italy
| | - Serena Arrigo
- Istituto di Ricerca e Cura a Carattere Scientifico Istituto G. Gaslini, Genova, Italy
| | - Noemi Brolatti
- Istituto di Ricerca e Cura a Carattere Scientifico Istituto G. Gaslini, Genova, Italy
| | | | | | | | - Fabio Dario Merlo
- Azienda Ospedaliera Città della Salute e della Scienza, Torino, Italy
| | | | | | | | - Loris Pironi
- Azienda Ospedaliera Universitaria S. Orsola Malpighi, Bologna, Italy
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Rizzi M, Mazzuoli S, Regano N, Inguaggiato R, Bianco M, Leandro G, Bugianesi E, Noè D, Orzes N, Pallini P, Petroni ML, Testino G, Guglielmi FW. Undernutrition, risk of malnutrition and obesity in gastroenterological patients: A multicenter study. World J Gastrointest Oncol 2016; 8:563-572. [PMID: 27559436 PMCID: PMC4942745 DOI: 10.4251/wjgo.v8.i7.563] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/23/2016] [Accepted: 04/22/2016] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate the prevalence of undernutrition, risk of malnutrition and obesity in the Italian gastroenterological population.
METHODS: The Italian Hospital Gastroenterology Association conducted an observational, cross-sectional multicenter study. Weight, weight loss, and body mass index were evaluated. Undernutrition was defined as unintentional weight loss > 10% in the last three-six months. Values of Malnutrition Universal Screening Tool (MUST) > 2, NRS-2002 > 3, and Mini Nutritional Assessment (MNA) from 17 to 25 identified risk of malnutrition in outpatients, inpatients and elderly patients, respectively. A body mass index ≥ 30 indicated obesity. Gastrointestinal pathologies were categorized into acute, chronic and neoplastic diseases.
RESULTS: A total of 513 patients participated in the study. The prevalence of undernutrition was 4.6% in outpatients and 19.6% in inpatients. Moreover, undernutrition was present in 4.3% of the gastrointestinal patients with chronic disease, 11.0% of those with acute disease, and 17.6% of those with cancer. The risk of malnutrition increased progressively and significantly in chronic, acute and neoplastic gastrointestinal diseases in inpatients and the elderly population. Logistical regression analysis confirmed that cancer was a risk factor for undernutrition (OR = 2.7; 95%CI: 1.2-6.44, P = 0.02). Obesity and overweight were more frequent in outpatients.
CONCLUSION: More than 63% of outpatients and 80% of inpatients in gastroenterological centers suffered from significant changes in body composition and required specific nutritional competence and treatment.
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Guglielmi F, Fregnan S, Mazzuoli S, Addante I, Leogrande G, Regano N, Rizzi M, Guglielmi A, Di Molfetta A. PP089 THE ROLE OF A SPECIFIC GASTROENTEROLOGICAL OPERATIVE PROTOCOL TO PREVENT HOME ENTERAL NUTRITION COMPLICATIONS. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s1744-1161(10)70165-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hengstermann S, Valentini L, Schaper L, Buning C, Koernicke T, Maritschnegg M, Buhner S, Tillinger W, Regano N, Guglielmi F, Winklhofer-Roob BM, Lochs H. Altered status of antioxidant vitamins and fatty acids in patients with inactive inflammatory bowel disease. Clin Nutr 2008; 27:571-8. [PMID: 18316141 DOI: 10.1016/j.clnu.2008.01.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Revised: 11/01/2007] [Accepted: 01/11/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Data regarding the nutritional status, antioxidant compounds and plasma fatty acid (FA) composition in inactive IBD are conflicting. We compared plasma levels of antioxidants and FA of patients with inactive IBD with active IBD and controls. METHODS Plasma levels of vitamin C, vitamin E, carotenoids, saturated, monounsaturated and polyunsaturated FA, inflammatory markers and nutritional status were determined after an overnight fast in 132 patients with quiescent IBD (40.6+/-13.2 years, 87F/45M), 35 patients with active disease (37.9+/-12.1 years, 25F/10M) and 45 age- and BMI-matched healthy controls (38.1+/-10.5 years, 39F/6M). Results are expressed as mean+/-SD or median [25th percentile;75th percentile]. RESULTS Body mass index (BMI) was normal in inactive (23.9+/-4.7 kg/m(2)), active IBD (22.7+/-4.2 kg/m(2)) and controls (22.3+/-1.9 kg/m(2)). Compared with controls patients with quiescent IBD showed significantly decreased plasma levels of carotenoids (1.85 [1.37;2.56] vs 1.39 [0.88;1.87] micromol/L) and vitamin C (62.3 [48.7;75.0] vs 51.0 [36.4;77.6] micromol/L), increased levels of saturated FA (3879 [3380;4420] vs 3410 [3142;3989] micromol/L) and monounsaturated FA (2578 [2258;3089] vs 2044 [1836;2434] micromol/L) and similar levels of vitamin E and polyunsaturated FA. Results in active disease were similar to inactive disease. CONCLUSION This study shows that antioxidant status and FA profile in a larger population of IBD patients are disturbed independently from disease activity and despite normal overall nutritional status.
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Affiliation(s)
- Susanne Hengstermann
- Charité-Universitatsmedizin Berlin, Campus Mitte, Department of Gastroenterology, Charitéplatz 1, 10117 Berlin, Germany
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