P0784 INTESTINAL FUNCTION TESTS IN INTESTINAL FAILURE

Abstract

Introduction: Intestinal failure (IF) is a complex condition requiring parenteral nutrition (PN). The outcome of IF is associated with its primary etiology (1) but individual prognostic factors are not available to predict weaning from PN. We tested the hypothesis that non-invasive intestinal function tests could predict weaning from PN in children with IF. Methods: IF was defined as need for total PN for at least 4 weeks or for supportive PN for at least 3 months. In children with IF we retrospectively evaluated the following non-invasive intestinal function tests: fecal steatocrit, d-xylose oral load, fecal alpha1-antitrypsin. At least 3 determinations for fecal steatocrit and 2 for d-xylose oral load were obtained. Results were analysed in relation with the primary etiology of IF. Statistical analysis was performed with non parametric and logistic regression tests, and X2 test. Results: 10 children with short bowel syndrome (SBS) and 5 with various causes of IF (NSBS) were enrolled. Fecal alpha1-antitrypsin was normal in all cases. Mean values of steatocrit were abnormal in both groups, 17 (range 0–55) and 13 (range 0–53) in children with SBS and non SBS, respectively. Xylose absorption test was significantly different in children with SBS (mean 14, range 3–35.5) versus children with NSBS (mean 26, range 16–44) (p<0.01). When we analysed steatocrit and xylose absorption in children that were eventually weaned from PN, and in those who were not, a difference was detected in SBS and NSBS children. In the latter no statistical correlation was observed between functional tests and gaining of intestinal sufficiency. In children with SBS, at enrolment, xylose absorption was statistically associated with intestinal length and weaning from PN (p<0.05), whereas such correlation was not observed for fecal steatocrit. Among functional tests, fecal steatocrit was normal in all patients weaned from PN and in 1/3 patients who could not be weaned (p=0.08). Xylose test was normal in all but 1 weaned children, and abnormal in all children who did not reach intestinal sufficiency (p<0.05). Conclusion: In children with IF and SBS fecal steatocrit and xylose absorption are markedly abnormal, and the latter correlates with residual intestinal length. Functional tests may help predicting weaning from PN. In NSBS children, only fecal steatocrit is impaired but is not associated with intestinal function.