ESPEN guideline on chronic intestinal failure in adults - Update 2023
Loris Pironi1, Cristina Cuerda2, Palle Bekker Jeppesen3
1Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Center for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy.
Clinical Nutrition (Edinburgh, Scotland)
|August 28, 2023
Summary
Updated ESPEN guidelines for Chronic Intestinal Failure (CIF) in adults incorporate new evidence. Management of CIF requires complex, expert multidisciplinary care and advanced technologies for home parenteral nutrition (HPN).
Area of Science:
- Gastroenterology
- Clinical Nutrition
- Evidence-Based Medicine
Background:
- The European Society for Parenteral and Enteral Nutrition (ESPEN) published guidelines for Chronic Intestinal Failure (CIF) in adults in 2016.
- An updated guideline was developed to incorporate new evidence and refine recommendations for managing CIF due to benign diseases.
Purpose of the Study:
- To provide updated, evidence-based recommendations for the management of Chronic Intestinal Failure (CIF) in adults.
- To address new areas including IF centers, chronic enterocutaneous fistulas, and patient care during pregnancy and transition from pediatric to adult care.
Main Methods:
- Literature grading used the Scottish Intercollegiate Guidelines Network (SIGN) system.
- Recommendations were graded using A (strong), B (conditional), 0 (weak), and Good Practice Points (GPP).
- New recommendations and chapters were developed, and existing ones were reviewed, reworded, and re-graded.
Main Results:
- The updated guideline includes 149 recommendations and 16 statements, with strong consensus achieved for most.
- The majority of recommendations were graded as Good Practice Points (GPP) (64.4%), with a significant portion also graded as weak (19.5%) or conditional (12.7%).
- Only 3.4% of recommendations received a strong grade (A).
Conclusions:
- Chronic Intestinal Failure (CIF) management is complex, demanding specialized technologies, and multidisciplinary expertise.
- Home parenteral nutrition (HPN) is a key component of CIF management.
- Despite most recommendations being GPP, strong consensus indicates high agreement on the necessity of expert-led, integrated care approaches.
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