Cholestasis

Rationale: Previous studies showed that chronic cholcstasis (CC) in long-term home parenteral nutrition (HPN) is also related to iv-lipid amount. Our aim was to evaluate the presence of CC m non malignant pts with short bowel syndrome (SBS) currently receiving HPN in our center.

Method: Twenty-five subjects with HPN duration > or = 1 year were selected. Exclusion criteria: non HPN-related liver disease (n=4).

Pts were evaluated for cholestasis at baseline and every 6 months. CC was defined as a value at least 1.5-fold the upper limit of normal on two of three liver function measures: s-gammaglutamyltransferase, s-alkaline phosphatase, s-bilirubin, for at least 6 months.

HPN regimen was performed with a lipid amount

Data collected included age, gender, diagnosis, gastrointestinal characteristics, HPN duration and regimen, nutritional assessment [median (range)].

Results: Diagnosis: ischemic bowel (64%), radiation enteritis (16%), Crohn (8%), other (12%). Patients were divided in three groups: group A, 18 pts without cholestasis at the start and during HPN, age: 62 (26 - 76); 8M/10F; small bowel remnant: 37.5 cm (10-110); percent of colon: 85 (0-100); ileo-coecal valve: 5 yes/13 no; HPN duration, years: 6.97 (1.2-16.2). Group B1, 5 pts with cholestasis at the start of HPN that disappeared during HPN, [10 months (9-56)], age: 66 (26 - 77); 5F; small bowel remnant: 30 cm (12-50); percent of colon: 65 (0-100); ileo-coecal valve: 1 yes/4 no; HPN duration, years: 4.8 (1.1-10.8). Group B2, 2 pts with cholestasis at the start of HPN until last follow-up, age: 58 - 64; 2M; small bowel remnant: 10-15 cm; percent of colon: O; ileo-coecal valve: 2 no; HPN duration, years: 2.4-6.6.

Table shows HPN regimen and nutritional assessment at the beginning of treatment and at the last follow-up Conclusions: The small number of pts does not allow statistical analysis, but some considerations can he drawn:

* CC did not occur during HPN, even with very short bowel remnant and tor long tenu follow-up (16 years), with low energy HPN intakes (group A).

* The pts with cholcstasis at the beginning may experience regression (group Bl) of their CC with relatively high amounts of dextrose and lipid amount

* The length of residual small bowel and particularly the presence of colon seems Io be crucial to allow the regression of CC. In our experience the most severe anatomical conditions might lead to combined liver-intestinal transplantation.

Francesco; P. Massarenti; M. Rinaldi; M. Zanardi; F. Rahimi; A. Palmo; Clinical Nutrition, S. Giovanni Battista Hospital, Turin, Italy.

Copyright American Society for Parenteral and Enteral Nutrition Jan/Feb 2004
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