Chronic cholestasis in patients on parenteral nutrition: the influence of restoring bowel continuity after mesenteric infarction.
OBJECTIVE
Patients with a short bowel and receiving parenteral nutrition (PN) have an increased risk of chronic cholestasis (CC). Restoration of bowel continuity after a mesenteric infarction results in PN requirements being reduced or stopped. This study aimed to determine the prevalence of CC and whether restoring bowel continuity reduced the risk of CC.


METHODS
A retrospective review of patients with a short bowel owing to mesenteric infarction from 2000 to 2012. CC was defined as two of bilirubin, alkaline phosphatase and gamma-glutamyl transferase being 1.5 times the upper limit of normal for >6 months.


RESULTS
We identified 104 (55 females, median age 54 years) patients. Seventy-three (70%) patients had restoration of bowel continuity; of these, 25 (34%) had abnormal liver biochemistry (liver function test (LFT)), with 15 (21%) having CC. Following restoration of bowel continuity, 8 (53%) of 15 patients with CC and 10 (100%) of 10 patients with abnormal LFT but not CC had a return of liver function within normal range within a year. Univariate analysis showed restoring bowel continuity (P=0.002) and cessation of PN (P=0.006) were associated with a reduction in prevalence of CC. Multivariate analysis showed that cessation of PN was a significant factor in reducing CC (P=0.02).


CONCLUSIONS
The prevalence of CC is 29% for patients with a short bowel receiving PN following a mesenteric infarction. CC resolves in 53% after continuity is restored, and this is most likely due to stopping or reducing the PN.
Intestinal Failure Unit, St Mark's Hospital, Harrow, UK.
F
F
Adaba
Intestinal Failure Unit, St Mark's Hospital, Harrow, UK.
M
M
Uppara
Intestinal Failure Unit, St Mark's Hospital, Harrow, UK.
F
F
Iqbal
Intestinal Failure Unit, St Mark's Hospital, Harrow, UK.
S
S
Mallappa
Intestinal Failure Unit, St Mark's Hospital, Harrow, UK.
C J
CJ
Vaizey
Intestinal Failure Unit, St Mark's Hospital, Harrow, UK.
S M
SM
Gabe
Intestinal Failure Unit, St Mark's Hospital, Harrow, UK.
J
J
Warusavitarne
Intestinal Failure Unit, St Mark's Hospital, Harrow, UK.
J M D
JM
Nightingale
D000469:Alkaline Phosphatase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D002779:Cholestasis / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D007238:Infarction / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D007422:Intestines / Q000503:physiopathology / Q000601:surgery; D007582:Jejunostomy; D008099:Liver / Q000503:physiopathology; D008111:Liver Function Tests; D008297:Male; D065666:Mesenteric Ischemia / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000009:adverse effects*; D010537:Peritoneum / Q000098:blood supply*; D015995:Prevalence; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000209:etiology / Q000628:therapy; D005723:gamma-Glutamyltransferase / Q000097:blood
D005723:gamma-Glutamyltransferase; D000469:Alkaline Phosphatase; D001663:Bilirubin