Reversal of parenteral nutrition-associated liver disease with a fish oil-based lipid emulsion (Omegaven) in an adult dependent on home parenteral nutrition.
Patients with intestinal failure and short bowel syndrome usually require chronic parenteral nutrition (PN). PN is associated with risks, including infections, vascular thrombosis, and liver disease. PN-associated liver disease (PNALD) can progress from steatosis to chronic hepatitis and ultimately to cirrhosis. The etiology of PNALD is not completely understood. Therapies for PNALD include carbohydrate or lipid calorie reduction, antibiotics, or the use of ursodeoxycholic acid. When these efforts fail, therapeutic options are limited and liver transplantation may be required. The transition from a soybean- to a fish oil-based lipid formulation, such as the ω-3 parenteral lipid formulation (Omegaven), has shown a dramatic reversal of PNALD within the pediatric population. This is the first report of a PN-dependent adult in the United States complicated by PNALD and hepatic failure who had improvement of liver disease with an ω-3 fish oil-based parenteral formulation.
Department of Gastroenterology, Lahey Clinic Medical Center, Burlington, Massachusetts, USA. David.L.Burns@lahey.org
David L
DL
Burns
Brian M
BM
Gill
D004041:Dietary Fats / Q000627:therapeutic use*; D005217:Fat Emulsions, Intravenous / Q000627:therapeutic use*; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use; D005260:Female; D005395:Fish Oils / Q000627:therapeutic use*; D006801:Humans; D008107:Liver Diseases / Q000209:etiology / Q000628:therapy*; D008875:Middle Aged; D016331:Parenteral Nutrition, Home / Q000009:adverse effects / Q000379:methods*; D010289:Parenteral Nutrition, Total / Q000009:adverse effects / Q000379:methods*; D012778:Short Bowel Syndrome / Q000628:therapy*; D013024:Soybean Oil; D014481:United States
D004041:Dietary Fats; D005217:Fat Emulsions, Intravenous; D015525:Fatty Acids, Omega-3; D005395:Fish Oils; D013024:Soybean Oil