Reversal of intestinal failure-associated liver disease (IFALD): emphasis on its multifactorial nature.
Patients with intestinal failure (IF) and home parenteral nutrition commonly develop abnormal liver function tests. The presentations of IF-associated liver disease (IFALD) range from mild cholestasis or steatosis to cirrhosis and decompensated liver disease. We describe the reversal of IFALD in an adult patient with IF secondary to severe Crohn's disease and multiple small bowel resections. The patient developed liver dysfunction and pathology consistent with IFALD. Multiple causal factors were implicated, including nutrition-related factors, catheter sepsis and the use of hepatotoxic medications. Multidisciplinary treatment in a tertiary IF referral centre included aggressive sepsis management, discontinuation of hepatotoxic medications and a reduction of parenteral nutrition dependency through optimisation of enteral nutrition via distal enteral tube feeding. Upon this, liver function tests normalised.
Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus C, Denmark; Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, UK.
Christian
C
Hvas
Intestinal Failure Unit , Salford Royal NHS Foundation Trust , Salford , UK.
Kamelia
K
Kodjabashia
Intestinal Failure Unit , Salford Royal NHS Foundation Trust , Salford , UK.
Emma
E
Nixon
Intestinal Failure Unit , Salford Royal NHS Foundation Trust , Salford , UK.
Stephen
S
Hayes
Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, UK; Department of Dietetics, Salford Royal, Salford, UK.
Kirstine
K
Farrer
Intestinal Failure Unit , Salford Royal NHS Foundation Trust , Salford , UK.
Arun
A
Abraham
Intestinal Failure Unit , Salford Royal NHS Foundation Trust , Salford , UK.
Simon
S
Lal
CROHN'S DISEASE; DRUG INDUCED HEPATOTOXICITY; ENTERAL NUTRITION; INTESTINAL FAILURE; PARENTERAL NUTRITION