[Therapeutic alternatives in intestinal failure].
BACKGROUND
Long-term parenteral nutrition is effective in the treatment of intestinal failure. Equally, the results of intestinal transplantation (IT) are promising. The choice of one or other form of treatment depends on the balance between the advantages and disadvantages of each. Based on these premises, we analyzed the outcome of home parenteral nutrition (HPN) for intestinal failure in our patients.


METHODS
Intestinal failure was considered when parenteral nutrition was required for more than 5 months. In the 14 patients included in the HPN program since 1993, we reviewed the indication of HPN as well as their suitability for IT.


RESULTS
Five of the 14 patients received HPN for causes other than intestinal failure. Of the remaining nine patients, four had severe motility disorder, three had short bowel syndrome, and two had protracted diarrhea of infancy. All these patients would be potential candidates for IT. Five patients were weaned off HPN because of intestinal adaptation between 2.5 and 13 months after starting HPN. One patient died because of lack of venous access. Three patients currently continue on HPN.


CONCLUSIONS
Intestinal rehabilitation constitutes the best option for patients with intestinal failure. HPN offers the best interim treatment while waiting for adaptation. IT should be reserved for those patients with severe complications due to HPN. Nevertheless, it may become a real option for those with indefinite HPN. HPN and IT should be considered as complementary treatments.
Moreno Villares
J M
JM
Unidad de Nutrición Clínica, Hospital Universitario 12 de Octubre, Ctra. de Andalucía, km. 5,400, 28041 Madrid, Spain. jmoreno.hdoc@salud.madrid.org
Galiano Segovia
M J
MJ
Urruzuno Tellería
P
P
Gomis Muñoz
P
P
León Sanz
M
M
D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007422:Intestines / Q000637:transplantation*; D008137:Longitudinal Studies; D016331:Parenteral Nutrition, Home; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000628:therapy*; D016896:Treatment Outcome