Chyme reinfusion therapy in adults with severe acute intestinal failure: A descriptive cohort study.

Abstract

Chyme reinfusion therapy treats patients with high-output fistulas or stomas by returning chyme to the distal gut. The role of this treatment in severe acute intestinal failure is currently unclear. The primary outcome of this study was a successful establishment of chyme reinfusion therapy, defined by the ability to replace parenteral nutrition for nutrition support. A descriptive cohort study of adult patients with severe acute intestinal failure due to a high-output stoma and distal mucus fistula or a high-output small intestinal fistula receiving chyme reinfusion therapy was undertaken. The effect of chyme reinfusion therapy on parenteral nutrition requirements, medication, nutrition status, liver function, and treatment cost were studied. Twenty-four patients commenced treatment for a median of 44 (range, 3-571; total, 2263) days. Fifteen (62.5%) were successfully established for 1208 days, and nine continued treatment at home. Parenteral requirements, including volume, energy and nitrogen content, and frequency, were significantly reduced (P = 0.002), whereas anthropometric measurements remained stable. However, chyme therapy was not tolerated in nine patients (37.5%), and only two (8.3%) weaned fully from parenteral nutrition. Chyme reinfusion therapy was associated with a 47.6% reduction in parenteral energy requirements, 42.8% reduction in nitrogen, and 33.3% reduction in volume of parenteral nutrition requirements. Treatment was associated with a net cost of £30.05 ($40.27) per patient per day. Chyme reinfusion therapy was associated with reductions in the need for parenteral therapy and medication but did not replace parenteral nutrition or result in a significant cost saving.