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Crohn’s disease patients with chronic intestinal failure receiving long‐term parenteral nutrition: a cross‐national adult study
Author(s) -
Elriz K.,
PalascakJuif V.,
Joly F.,
Seguy D.,
Beau P.,
Chambrier C.,
Boncompain M.,
Fontaine E.,
Laharie D.,
Savoye G.,
Lerebours E.
Publication year - 2011
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2011.04806.x
Subject(s) - medicine , parenteral nutrition , incidence (geometry) , odds ratio , short bowel syndrome , complication , gastroenterology , confidence interval , retrospective cohort study , surgery , physics , optics
Aliment Pharmacol Ther 2011; 34: 931–940 Summary Background Chronic intestinal failure (CIF) is a very rare Crohn’s disease (CD) complication. Aim To determine incidence of CIF treated with home parenteral nutrition (HPN) in adult CD patients and to isolate factors associated with severe CIF. Methods This retrospective multicentre study included 38 patients with CD‐related CIF treated with HPN for at least 12 months in French HPN centres. Severe CIF was defined by a length of remnant small bowel of less than 100 cm or CIF occurrence within the 15 years following CD diagnosis. Results Median delay between CD diagnosis and CIF was 15 years. CIF incidence did not decrease over time (1.4/year before 1995 vs. 2.2/year after). Median number of small bowel resections per patient was three (range 1–8). Median small bowel resection, remnant and initial lengths were 160, 80 and 260 cm, respectively. Twenty‐four per cent of patients developed stenosis within 1 year after CD diagnosis and 76% developed perforative complications within 2 years. In multivariate analysis, severe CIF, defined as CIF onset <15 years after CD diagnosis, was associated with a more recent CD diagnosis (odds ratio, 0.785; 95% confidence interval, 0.623–0.989). CIF occurred despite frequent use of immunosuppressants. Course of CD remained severe during HPN: immunosuppressants prescription occurred in 11 patients, surgery in six. Six patients died from CD ( n = 2), HPN complications ( n = 2) or other causes ( n = 2). Conclusions Chronic intestinal failure requiring HPN is rare during CD. Incidence remained stable over time. Surgical procedures play a minor role in the occurrence of severe chronic intestinal failure compared to CD severity.