Home parenteral nutrition support in adults: experience of a medical center in Asia.
BACKGROUND
Parenteral nutrition (PN) support is mandatory in patients with gut failure. Short bowel syndrome is a term used for symptoms and pathophysiological disorders brought about by the removal or malfunction of a large portion of the small bowel. Inflammatory bowel disease, vascular disease, and malignancy are the most common causes of short bowel syndrome in adults. There are many complications associated with chronic use of PN. Cholestasis, nutrient deficiency, small bowel bacterial overgrowth, and catheter-related infections were noted in these patients. Due to the various etiologies, we tried to find the optimal method to manage these patients.


METHODS
We reviewed all patients over 16 years old, from 1989 to 2002, who required home PN support for at least 30 days. Charts were reviewed to obtain information regarding demographics, nutrition management, outcome, and complications related to PN. Survival was estimated by using the Kaplan-Meier method. The association of survival with primary disease, length of small bowel, age, and gender was assessed by proportional hazard regression analysis.


RESULTS
There were 31 patients who needed home PN support during this period, 14 male and 17 female. The average age was 55 (median age, 53; range, 28-88); the average period of PN administration was 19 months (median, 7; range, 1-115 months). The most common indications for home PN were alimentary tract obstruction and short bowel syndrome. Most deaths were related to their original diseases and catheter-related sepsis. Malignant diseases were a major indication for home PN (HPN). However, 20% of these patients with incurable diseases lived longer than 1 year. The disease patterns were different from those in western societies. Most patients had malignancies and vascular insults in our series. There was much less inflammatory bowel disease in our patients than in western countries; catheter-related infections were frequent and caused 25% of mortality.


CONCLUSIONS
HPN is very important to patients with intestinal failure or who are waiting for recovery from temporal intestine insufficiency. Even in malignant diseases, a significant number of patients survived for >1 year with treatment of HPN. Most complications related to their underlying diseases and associated infections. Improving patient education and treatment might improve the prognosis of these patients and expand the application of this technique to help more patients with small intestine failure.
Wang
Ming-Yang
MY
Department of Surgery, National Taiwan University Hospital Taipei, Taiwan, ROC.
Wu
Ming-Hsun
MH
Hsieh
Der-Yirng
DY
Lin
Lie-Jane
LJ
Lee
Po-Huang
PH
Chen
Wei-Jao
WJ
Lin
Ming-Tsan
MT
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000401:mortality / Q000628:therapy; D007415:Intestinal Obstruction / Q000401:mortality / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016331:Parenteral Nutrition, Home / Q000009:adverse effects / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000401:mortality / Q000628:therapy*