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Home parenteral nutrition in the United Kingdom and Ireland
Insights
Home parenteral nutrition (HPN) in the UK and Ireland supported 200 patients, primarily for Crohn's disease. Outcomes varied, with some resuming enteral nutrition and others facing complications or death.
Area of Science:
- Gastroenterology
- Clinical Nutrition
- Surgical Outcomes
Background:
- Home parenteral nutrition (HPN) is a critical intervention for patients with intestinal failure.
- Data on HPN utilization and outcomes in the UK and Republic of Ireland were previously limited.
Purpose of the Study:
- To analyze the indications, patient demographics, treatment duration, quality of life, and outcomes of HPN in a UK and Republic of Ireland cohort.
- To identify factors influencing patient outcomes and complications associated with HPN.
Main Methods:
- Retrospective analysis of 200 patients receiving HPN between January 1977 and March 1986.
- Data collected from 28 contributing centers, with 75% of cases from 7 centers.
- Indications, treatment duration, quality of life, and mortality causes were documented.
Main Results:
- Crohn's disease was the primary indication (90 patients), followed by mesenteric vascular disease (27) and extensive small-bowel resection (14).
- Most patients started HPN between ages 10-40.
- 56 out of 108 patients who completed treatment resumed enteral nutrition; 34 patients died, with causes including underlying disease and treatment complications.
- Catheter-related sepsis incidence ranged from 0.2-0.9 episodes/year, influenced by center experience.
Conclusions:
- HPN serves a significant role in managing intestinal failure, particularly for Crohn's disease.
- Outcomes are influenced by the underlying cause of intestinal failure and center expertise.
- Successful transition to enteral nutrition is achievable for a subset of patients, but risks of complications and mortality persist.
Abstract:
Between January, 1977, and March, 1986, 200 patients were registered as receiving home parenteral nutrition (HPN) in the UK and the Republic of Ireland. Although 28 centres contributed case-reports, 75% of the cases were registered by 7 centres. Most patients started treatment between the ages of 10 and 40 years, a reflection of the high incidence of Crohn's disease during these decades. The three main indications for HPN were Crohn's disease (90 patients), mesenteric vascular disease (27), and extensive small-bowel resection for volvulus or other benign enteric disease (14). 85 patients required treatment for less than 1 year and 17 have been on treatment for more than 2 years. Patients whose indication for HPN was a primary intestinal disease had a better quality of life than did those in whom the intestinal failure was secondary to a systemic disorder. Of the 108 patients who have completed treatment 56 have been able to resume enteral nutrition through adaptation of the remaining bowel, or closure of a fistula. 34 have died, 19 as a consequence of the underlying disease and 10 of complications of treatment. The incidence of catheter-related sepsis varied between 0.2 and 0.9 episodes per year of treatment (overall 0.35) depending on the length of experience of the supervising centre.