[The practice of home artificial nutrition in Europe]

Artificial nutrition outside hospital settings is a widespread practice but with great variability. The prevalence of home parenteral nutrition (HPN) ranges from 120 patients per million inhabitants in the United States to 2-4 in Europe or 1.5 in Spain. The most frequent indication is the short intestine syndrome and active cancer. The largest group of patients is aged between 40 and 60, with only 10%-20% of children. Almost 2/3 of patients apply parenteral nutrition through a tunnelled catheter. In Spain, the incidence of complications is higher than that registered in Europe or North America. The most frequent are infection-related complication. At the present time, prognosis and survival in the medium and long term are higher with HPN than with intestinal transplant. This must be reserved for those patients presenting severe complications with HPN. The standardization of care and the development of good education programmes may contribute to an improvement in the results. Although home enteral nutrition was developed after HPN, it has grown much faster. It is difficult to determine the real incidence, which varies from 460 (United States) and 40 (Spain) patients per million inhabitants and year. Neurological diseases and cancer are the most frequent indications. Whereas in other countries of Europe, the main access route is gastrostomy, this only occurs in 25% of cases in Spain. The rate of complications is around 0.16 complications per patient and year. The prognosis basically depends on the underlying disease. Its increasing use in patients with progressive neurological deterioration raises ethical questions. The legislation and the organizational system varies from one country to another. In Spain, only home enteral nutrition is regulated by law.