Abstract
(1) Background: Intestinal failure-associated liver disease (IFALD) in adults is characterized by steatosis with variable progression to fibrosis/cirrhosis. Reference standard liver biopsy is not feasible for all patients, but non-invasive serological and quantitative MRI markers for diagnosis/monitoring have not been previously validated. Here, we examine the potential of serum scores and feasibility of quantitative MRI used in non-IFALD liver diseases for the diagnosis of IFALD steatosis; (2) Methods: Clinical and biochemical parameters were used to calculate serum scores in patients on home parenteral nutrition (HPN) with/without IFALD steatosis. A sub-group underwent multiparameter quantitative MRI measurements of liver fat fraction, iron content, tissue T1, liver blood flow and small bowel motility; (3) Results: Compared to non-IFALD (n = 12), patients with IFALD steatosis (n = 8) demonstrated serum score elevations in Enhanced Liver Fibrosis (p = 0.032), Aspartate transaminase-to-Platelet Ratio Index (p < 0.001), Fibrosis-4 Index (p = 0.010), Forns Index (p = 0.001), Gamma-glutamyl transferase-to-Platelet Ratio Index (p = 0.002) and Fibrosis Index (p = 0.001). Quantitative MRI scanning was feasible in all 10 sub-group patients. Median liver fat fraction was higher in IFALD steatosis patients (10.9% vs 2.1%, p = 0.032); other parameter differences were non-significant; (4) Conclusion: Serum scores used for non-IFALD liver diseases may be useful in IFALD steatosis. Multiparameter MRI is feasible in patients on HPN.
Highlights
Intestinal failure associated liver disease (IFALD) refers to a clinical state of hepatic injury arising as a result of intestinal failure (IF) and / or its treatment [1,2,3]
Results in Intestinal failure-associated liver disease (IFALD) patients are mixed—the detection of steatosis matches the results in the general population [2,67], but imaging-based quantitative measures have been unsuccessful in staging fibrosis [68,69]
This was due to both an inability to attend on agreed dates and a late nursing home parenteral nutrition (HPN) disconnection resulting in hospital transport being missed
Summary
Intestinal failure associated liver disease (IFALD) refers to a clinical state of hepatic injury arising as a result of intestinal failure (IF) and / or its treatment [1,2,3]. The aetiology is multifactorial where both parenteral nutrition (PN)- [5,6,7,8,9,10,11,12,13,14] and non-PN-related factors [10,15,16,17,18,19,20,21,22,23,24]. ESPEN defined IFALD as a complication occurring as a result of one or more factors relating to IF including PN and arising in the absence of another primary parenchymal liver pathology such as hepatotoxicity or biliary obstruction [3]. Isolated intestinal transplantation may reverse hepatic fibrosis [27] and UK experience indicates survival with isolated small bowel grafts is longer than that for liver-containing grafts [28,29]. The pathophysiology of IFALD in adults differs from the paediatric population, where steatosis with variable progression to fibrosis dominate, as opposed to predominantly cholestasis in children [25,30]
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