INTESTINAL FAILURE ASSOCIATED LIVER DISEASE IN ADULT PATIENTS: A ONE-YEAR PROSPECTIVE STUDY

Abstract

Intestinal Failure Associated Liver Disease (IFALD) results from liver injury due to factors related to intestinal failure (IF) and/or to home parenteral nutrition (HPN), and no other evident cause. The epidemiology of IFALD depends on the criteria used for the diagnosis. The aim of the study was to assess the prevalence and the incidence of IFALD in the first 12 months of HPN in adult patients. 18 adult patients (13 Females; age 46±16 years; short bowel syndrome, 72%) who started HPN between Jan 2016 and December 2017 (T0) were enrolled in the study: 13 completed the 12-month follow-up (T12), 5 are ongoing. Biochemical liver function tests were collected at T0, 6-months (T6) and T12; liver ultrasound (US) was performed at T0 and T12. IFALD-criteria diagnosis: IFALD-Cholestasis: two of ɣglutamyltransferase, alkaline phosphatase and conjugated bilirubin ≥1.5 upper normal level for ≥ 6 months; IFALD-Steatosis: echogenicity at US; IFALD-Fibrosis: FIB-4 index. Statistic: descriptive analysis. Prevalence at T0, T6, T12, respectively: Cholestasis, 50%, 22%, 15%; Steatosis, 69%, 71%, 71%; Fibrosis, 16%, 27%, 0%. Incidence between T0 at T12: Cholestasis, 0%; Steatosis, 50%; Fibrosis, 0%. Our results indicate that IFALD can be present at the beginning of HPN, IFALD-cholestasis and IFALD-fibrosis may disappear during the first period of HPN, whereas IFALD-steatosis remains. This would suggest that at starting HPN, liver may be affected by the metabolic alterations of the acute IF, that subside when turning in chronic IF.