Ursodeoxycholic acid for treatment of cholestasis in children on long-term total parenteral nutrition: a pilot study

Area of Science:

• Pediatric Gastroenterology
• Hepatology
• Clinical Nutrition

Background:

• Cholestatic liver disease (CLD) is a serious complication of long-term total parenteral nutrition (TPN).
• CLD can necessitate TPN withdrawal, impacting patient management.
• Identifying effective treatments for TPN-associated CLD is crucial.

Purpose of the Study:

• To evaluate the efficacy of ursodeoxycholic acid (UDCA) in treating TPN-associated CLD in pediatric patients.
• To assess the impact of UDCA on clinical and biochemical markers of cholestasis.

Main Methods:

• A pilot study involving seven children with TPN-associated CLD treated with UDCA.
• Monitoring of liver function tests including GGT, ALP, conjugated bilirubin, and ALT.
• Observation of treatment response during UDCA therapy and upon temporary discontinuation.

Main Results:

• UDCA treatment led to the resolution of CLD signs and normalization of liver markers within 4-8 weeks in all children.
• Temporary UDCA discontinuation while on TPN caused a transient increase in liver enzymes, which normalized upon reintroduction.
• No relapse of cholestasis was observed after UDCA withdrawal upon achieving full oral feeding.

Conclusions:

• Ursodeoxycholic acid (UDCA) demonstrates significant effectiveness in treating TPN-related cholestasis in children.
• UDCA offers a viable therapeutic option for managing this complication.
• The study highlights the importance of sustained UDCA treatment during TPN.