Abstract
Intestinal failure (IF) is the inability of the gut to absorb necessary water, macronutrients (carbohydrate, protein, and fat), micronutrients, and electrolytes sufficient to sustain life and requiring intravenous supplementation or replacement. Acute IF (types 1 and 2) is the initial phase of the illness and may last for weeks to a few months, and chronic IF (type 3) from months to years. The challenge of caring for patients with IF is not merely the management of the underlying condition leading to IF or the correct provision of appropriate nutrition or both but also the prevention of complications, whether thromboembolic phenomenon (for example, venous occlusion), central venous catheter-related bloodstream infection, IF-associated liver disease, or metabolic bone disease. This review looks at recent questions regarding chronic IF (type 3), its diagnosis and management, the role of the multidisciplinary team, and novel therapies, including hormonal treatment for short bowel syndrome but also surgical options for intestinal lengthening and intestinal transplant.
Highlights
Intestinal failure (IF) is the inability of the gut to absorb sufficient macronutrients, micronutrients, or water, resulting in the need for intravenous supplementation to maintain health or facilitate growth[1]
Other complications Intestinal failure-associated liver disease IF-associated liver disease (IFALD) is a common complication in children but is far less common in adults, and severe liver dysfunction is observed in less than 5% of patients[70,71]
Intestinal transplant Intestinal transplant is a critically important salvage operation to replace lost or diseased gut to prevent the progression of IFALD, to prevent further complications associated with long-term home parenteral nutrition (HPN), and to increase longevity in Conclusions IF is an uncommon condition, but the impact on the individual is enormous
Summary
Intestinal failure (IF) is the inability of the gut to absorb sufficient macronutrients (carbohydrates, protein, and fat), micronutrients (vitamins, minerals, and electrolytes), or water, resulting in the need for intravenous supplementation to maintain health or facilitate growth[1]. Against usual microbiological despondency recommending routine CVC removal in all patients, two recent papers—from the UK21 and the US32—report success in the management of suspected CRBSIs in clinically stable patients with high salvage rates (72.5% and 70%, respectively) with antibiotics and, importantly, low mortality. Both the most commonly isolated and successfully treated microbe was coagulase-negative staphylococci (77.8–79.8%). Intestinal transplant Intestinal transplant is a critically important salvage operation to replace lost or diseased gut to prevent the progression of IFALD, to prevent further complications associated with long-term HPN ( loss of venous access), and to increase longevity in
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