title: Crohn's disease patients with chronic intestinal failure receiving long-term parenteral nutrition: a cross-national adult study.
abstract: BACKGROUND
  Chronic intestinal failure (CIF) is a very rare Crohn's disease (CD) complication.
  
  
  OBJECTIVE
  To determine incidence of CIF treated with home parenteral nutrition (HPN) in adult CD patients and to isolate factors associated with severe CIF.
  
  
  METHODS
  This retrospective multicentre study included 38 patients with CD-related CIF treated with HPN for at least 12 months in French HPN centres. Severe CIF was defined by a length of remnant small bowel of less than 100 cm or CIF occurrence within the 15 years following CD diagnosis.
  
  
  RESULTS
  Median delay between CD diagnosis and CIF was 15 years. CIF incidence did not decrease over time (1.4/year before 1995 vs. 2.2/year after). Median number of small bowel resections per patient was three (range 1-8). Median small bowel resection, remnant and initial lengths were 160, 80 and 260 cm, respectively. Twenty-four per cent of patients developed stenosis within 1 year after CD diagnosis and 76% developed perforative complications within 2 years. In multivariate analysis, severe CIF, defined as CIF onset <15 years after CD diagnosis, was associated with a more recent CD diagnosis (odds ratio, 0.785; 95% confidence interval, 0.623-0.989). CIF occurred despite frequent use of immunosuppressants. Course of CD remained severe during HPN: immunosuppressants prescription occurred in 11 patients, surgery in six. Six patients died from CD (n = 2), HPN complications (n = 2) or other causes (n = 2).
  
  
  CONCLUSIONS
  Chronic intestinal failure requiring HPN is rare during CD. Incidence remained stable over time. Surgical procedures play a minor role in the occurrence of severe chronic intestinal failure compared to CD severity.
authors.affiliation: Service d'hépatogastroentérologie et de Nutrition, Hôpital Universitaire de Rouen, France.
authors.forename: K
authors.initials: K
authors.lastname: Elriz
authors.forename: V
authors.initials: V
authors.lastname: Palascak-Juif
authors.forename: F
authors.initials: F
authors.lastname: Joly
authors.forename: D
authors.initials: D
authors.lastname: Seguy
authors.forename: P
authors.initials: P
authors.lastname: Beau
authors.forename: C
authors.initials: C
authors.lastname: Chambrier
authors.forename: M
authors.initials: M
authors.lastname: Boncompain
authors.forename: E
authors.initials: E
authors.lastname: Fontaine
authors.forename: D
authors.initials: D
authors.lastname: Laharie
authors.forename: G
authors.initials: G
authors.lastname: Savoye
authors.forename: E
authors.initials: E
authors.lastname: Lerebours
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002908:Chronic Disease; D003424:Crohn Disease / Q000150:complications* / Q000628:therapy; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007421:Intestine, Small / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012778:Short Bowel Syndrome / Q000209:etiology* / Q000628:therapy; D013997:Time Factors; D055815:Young Adult