INTESTINAL FAILURE IN SYSTEMIC SCLEROSIS: A STRATEGY ATTEMPT FOR INTESTINAL REHABILITATION

Abstract

Objective Aim of our group was to define etiopathogenesis of severe malnutrition in an highly compromised severely underweight patient, and to define the most high-benefit/low-risk nutritional intervention. Research Methods & Procedures A 62-years-old women affected by systemic sclerosis (SS) was admitted because of asthenia, dyspnea and weight loss: -38% of her usual body weight (BW) in 6 years, -23% BW in the last 6 months; current BW was 31kg (Body Mass Index 12.1kg/m2). Nutritional assessment at admission excluded the hypothesis of both anorexia nervosa and dysphagia. After prompt thiamin and multivitaminic/multimineral supplementation, we started night-time enteral nutrition support (EN) through naso-gastric tube (SNG) with semi-elemental mixture. Neither BW nor prealbumin improved despite rich oral intakes, as documented by the dietitian's monitoring, plus EN support. Risks from parenteral nutrition (PN), mainly infective ones, were too high with respect to the patient. We then decided to stop oral nutrition and to give the patient total enteral nutrition (TEN) with semi-elemental mixture in slow, continuous administration. Results Fourteen days after the beginning of TEN, prealbumin increased from 10 to 21 mg/dL. Refeeding Syndrome was adequately prevented. The patient well tolerated slow, continuous TEN and felt subjective clinical improvement. Conclusions SS can provoke motility disorders associated with inflammation, leading to intestinal failure and, consequently, to severe malnutrition. Nutritional assessment and follow-up after SS diagnosis could positively influence this evolution. Anyway, when intestinal failure is already present, an attempt to intestinal rehabilitation is demanded, especially when risks from PN are too high for the patient.