PTH-196 Chronic cholestasis and parenteral nutrition: prevalence and effect of bowel restoration surgery

Abstract

<h3>Introduction</h3> Patients with mesenteric infarction can have intestinal failure due to a short bowel thereby needing parenteral nutrition. A short bowel and parenteral nutrition can increase the risk of chronic cholestasis. Restoring bowel continuity after a mesenteric infarction results in reduction or stopping parenteral nutrition requirements. The aims of this study are to determine the prevalence and the effect of restoring bowel continuity on chronic cholestasis. <h3>Method</h3> A retrospective review of patients with a short bowel due to mesenteric infarction from 2000–2012. We defined chronic cholestasis as two of bilirubin, alkaline phosphatase and gamma-glutamyl transferase being 1.5 times the upper limit of normal for more than 6 months. <h3>Results</h3> One hundred and four (55 females, median age 54 years) patients were identified. Seventy three (70%) patients had bowel continuity restored while 31 (30%) patients did not have bowel continuity restored. The prevalence of chronic cholestasis was 29%. Fifteen (21%) of 73 patients had chronic cholestasis. Following restoration of bowel continuity, 8 (53%) of 15 patients had a return of liver biochemistry to normal range within a year. Univariate analysis showed restoring bowel continuity (p = 0.002) was associated with a reduced risk of chronic cholestasis. Multivariate analysis showed cessation of PN was a significant factor in reducing chronic cholestasis (p = 0.02). <h3>Conclusion</h3> The prevalence of chronic cholestasis is 29% for patients with a short bowel receiving parenteral nutrition. Chronic cholestasis resolves in over half patients after continuity is restored. <h3>Disclosure of interest</h3> None Declared. <h3>References</h3> Cavicchi M, Beau P, Crenn P, <i>et al</i>. Prevalence of liver disease and contributing factors in patients receiving home parenteral nutrition for permanent intestinal failure. <i>Ann Intern Med</i>. 2000;132(7):525–32 Lloyd DAJ, Zabron AA, Gabe SM. Chronic biochemical cholestasis in patients receiving home parenteral nutrition: prevalence and predisposing factors. <i>Aliment Pharmacol Ther</i>. 2008;27(7):552–60 Nightingale JM. Management of patients with a short bowel. <i>World J Gastroenterol</i>. 2001;7(6):741–51 Salvino R, Ghanta R, Seidner DL, <i>et al</i>. Liver failure is uncommon in adults receiving long-term parenteral nutrition. <i>J Parenter Enter Nutr</i>. 2006;30(3):202–8