Characterization of Splanchnic Blood Flow in Patients with Chronic Intestinal Failure

Intestinal failure-associated liver disease (IFALD) is a severe complication of chronic intestinal failure (CIF). Splanchnic circulation plays a central role in linking intestinal and hepatic physiology. However, splanchnic hemodynamics in patients with CIF remain poorly characterized. The primary aim was to characterize splanchnic blood flow in patients with CIF compared with healthy controls. The secondary aim was to explore associations between splanchnic blood flow and IFALD-related parameters.

In this cross-sectional study, patients with CIF receiving home parenteral support (HPS) and age- and sex-matched healthy controls underwent phase-contrast magnetic resonance imaging (MRI) for assessment of blood flow in the coeliac artery (CA), superior mesenteric artery (SMA) and portal vein (PV). Exploratory analyses evaluated associations between blood flow and the following liver parameters: liver stiffness measured by transient elastography, liver fat fraction measured by MRI-proton density fat fraction, and biochemical liver tests. Sensitivity analyses were performed according to oral intake status.

Thirty-three patients with CIF and 14 controls were included. CA flow was higher in patients than in controls (825 [579-1042] vs 404 [349-671] mL/min, p = 0.0025), whereas SMA flow was lower (285 [168-449] vs 426 [372-503] mL/min, p = 0.019). The differences between patients and controls in CA (p <0.001) and SMA (p = 0.015) blood flow remained significant in sensitivity analyses restricted to patients with no oral intake for >2 hours. PV flow was higher in patients than in controls (984 [790-1087] vs 785 [696-872] mL/min, p = 0.044), but this difference was attenuated and no longer statistically significant in the oral intake sensitivity analysis. Compared with controls, CA flow was higher in both patients with SBS and patients with dysmotility without bowel resection, whereas lower SMA blood flow was primarily observed in patients with SBS. No associations between splanchnic blood flow and IFALD-related parameters remained significant after correction for multiple testing.

Patients with CIF appear to have altered splanchnic blood flow characterized by higher CA flow, lower SMA flow, and higher PV flow compared with controls. The difference in PV flow, however, was sensitive to oral intake status. Splanchnic blood flow was not associated with IFALD-related parameters in this cohort.