The chronic liver disease in patients with short bowel syndrome: etiology and treatment.
Short bowel syndrome is a life threatening disease with a high mortality and morbidity. Since home parenteral nutrition (PN) has been established, there is an increasing number of patients surviving the acute loss of bowel function. But on the long-time these patients suffer from different complications of PN, with loss of central venous access, recurrent sepsis and finally the syndrome of progressive cholestatic liver disease. Both loss of central venous access and especially the progressive cholestatic liver disease are the limiting factor for the long-term survival of patients suffering from intestinal failure. Interestingly, the pathophysiologic mechanisms of PN induced intrahepatic cholestasis have not been dissolved yet and seem to be of multifactorial genesis. Cholestasis has shown to be associated with prematurity, recurrent sepsis, enteral and PN, especially with lipid emulsions. Enteral feeding and a well-controlled regime of PN lower the incidence of end-stage liver disease and, therefore, has to be optimized in the therapy of these patients.
Reinshagen
K
K
Department of Pediatric Surgery, Mannheim, Germany. konrad.reinshagen@kch.ma.uni-heidelberg.de
Adam
R
R
Trunk
M
M
Wessel
L M
LM
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D002779:Cholestasis / Q000628:therapy; D004359:Drug Therapy, Combination; D004750:Enteral Nutrition / Q000379:methods; D019317:Evidence-Based Medicine; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007421:Intestine, Small / Q000637:transplantation; D008107:Liver Diseases / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D010288:Parenteral Nutrition / Q000009:adverse effects; D016331:Parenteral Nutrition, Home / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012307:Risk Factors; D018805:Sepsis / Q000150:complications; D012778:Short Bowel Syndrome / Q000150:complications* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D002756:Cholagogues and Choleretics; D014580:Ursodeoxycholic Acid