Results of home parenteral nutrition in patients with severe inflammatory bowel disease - an alternative for surgery of malnourished patients

Abstract

Introduction: In the world, the inflammatory bowel disease affects an increasing number of younger and younger patients, and in some of them parenteral nutrition is an alternative to high-risk surgical intervention due to advancement of the disease and malnutrition.

Aim: The aim of the study was to assess the results of home parenteral nutrition in patients with severe bowel inflammatory disease, in whom surgical treatment is associated with high risk of complications.

Materials and methods: A retrospective analysis was conducted on 46 patients, who received home parenteral nutrition instead of another surgical intervention. The inclusion criteria included home parenteral nutrition and diagnosis of Crohn's disease or ulcerative colitis.

Results: Mean number of complications requiring hospital admission per patient was 1.76, the BMI increased by 4.3 on average [kg/m2]. During parenteral nutrition, the percentage of patients, in whom anti-inflammatory or immunosuppressant drugs were completely discontinued, was 17.4%. In the whole group, at least one immunosuppressive drug was discontinued in onefifth of patients. Mean albumin level increased by 2.4 g/L, lymphocyte count dropped by 474 lymphocytes/mm3, and leukocyte count increased by 747.6/mm3. The patients described their condition as good in 87%, and 7.4% of patients were able to work.

Conclusions: Home parenteral nutrition positively affects patient's general condition by increasing BMI and normalizing biochemical test results. The results indicate the need to consider this method as an alternative to surgical intervention in severe bowel inflammatory disease with high perioperative risk, which could reduce the complication rate.

Keywords: Crohn’s disease; colitis ulcerosa; home parenteral nutrition; inflammatory bowel disease; nutrition.