Irreversible intestinal failure: prevalence and prognostic factors.
OBJECTIVE
Parenteral nutrition (PN) is the primary treatment for intestinal failure, which is considered irreversible in patients who remain partially or fully dependent on PN. Causes of irreversible intestinal failure are short bowel syndrome (SBS), motility disorders (MD), and severe protracted diarrhea (SPD). The aim of this study was to report the clinical outcome in these patients in relation to the underlying disease.


METHODS
From January 1, 1989 to December 31, 2006, 218 intestinal failure patients were observed in our center, but only 96 (48 SBS, 39 SPD, and 9 MD) were included because they required at least 50% of their total calories as PN for not less than 3 months. In these patients, survival and complication rates were evaluated.


RESULTS
The survival rate was significantly higher in SBS patients than in the other groups (P < 0.01). SBS patients showed a higher rate of major complications, although only intestinal failure-associated liver disease was significantly higher (P < 0.001). In our series, MD was the main cause of irreversible intestinal failure.


CONCLUSIONS
The potential for bowel adaptation is higher in surgical than in medical causes of intestinal failure and does not seem to be influenced by complications of intestinal failure. SBS, although worsened by the major number of complications, was not the main category contributing to intestinal failure.
Diamanti
Antonella
A
Gastroenterology and Nutrition Unit, Bambino Gesù Children's Hospital, Rome, Italy.
Basso
Maria Sole
MS
Castro
Massimo
M
Di Ciommo
Vincenzo
V
Bracci
Fiammetta
F
Ferretti
Francesca
F
Pietrobattista
Andrea
A
Gambarara
Manuela
M
D000222:Adaptation, Physiological / Q000502:physiology*; D000293:Adolescent; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D005260:Female; D005769:Gastrointestinal Motility / Q000502:physiology; D006801:Humans; D007223:Infant; D007410:Intestinal Diseases / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D008297:Male; D010288:Parenteral Nutrition / Q000009:adverse effects / Q000379:methods*; D015995:Prevalence; D011379:Prognosis; D012778:Short Bowel Syndrome / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D016019:Survival Analysis; D013997:Time Factors