title: Lessons from a 20 year experience of Home Parenteral Nutrition in adult patients.
abstract: BACKGROUND
  Home Parenteral Nutrition (HPN) is a method commonly used in patients with Chronic Intestinal Failure (CII) related to benign or malignant diseases. We report the experience from a 20 year programme of HPN in a single academic centre.
  
  
  METHODS
  In this study, we have reviewed characteristics and outcome of a group of patients enrolled in a HPN program between 1987 and 2007. Focus was given to the prevalence and severity of cholestasis in these patients as well as on their oral food behaviour.
  
  
  RESULTS
  In 20 years, 125 patients were included in a HPN programme; 65 patients had benign diseases (BD) and 60 advanced cancer (AC). Short bowel was the most common indications in patients with BD. Almost 40% of patients with BD were weaned off HPN. Median survival was excellent in BD patients and extremely short in AC. Death related to HPN was very rare. Cholestasis has been observed in 84% of patients but it was mild to moderate in the majority of cases. Hyperphagia was observed in 50% of the patients with BD on long-term HPN.
  
  
  CONCLUSIONS
  This study confirms that HPN is the first line therapy in CII due to BD. Patients with AC should be carefully selected. Cholestasis is frequent but mostly without clinical impact. Half of the patients with CII due to BD become hyperphagic allowing to reduction of parenteral intake. The role of a multidisciplinary nutrition support team is essential for optimizing HPN.
authors.affiliation: Department of Gastroenterology, Nutrition Support Team, Hopital Erasme, Université Libre de Bruxelles (ULB), Belgium.
authors.forename: H
authors.initials: H
authors.lastname: Vafa
authors.forename: A
authors.initials: A
authors.lastname: Ballarin
authors.forename: M
authors.initials: M
authors.lastname: Arvanitakis
authors.forename: S
authors.initials: S
authors.lastname: Vereecken
authors.forename: F
authors.initials: F
authors.lastname: Dutat
authors.forename: C
authors.initials: C
authors.lastname: Lagasse
authors.forename: V
authors.initials: V
authors.lastname: Lievin
authors.forename: A
authors.initials: A
authors.lastname: Van Gossum
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy; D016331:Parenteral Nutrition, Home / Q000009:adverse effects