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Observational Study
. 2021 Jul;45(5):1100-1107.
doi: 10.1002/jpen.1988. Epub 2020 Sep 10.

Clinical Characteristics of Inflammatory Bowel Disease Patients Requiring Long-Term Parenteral Support in the Present Era of Highly Effective Biologic Therapy

Michael Kurin  1 , Alyce Anderson  2 , Claudia Ramos Rivers  3 , Filippos Koutroumpakis  3 , Patricia Centa  3 , Juliette Bender-Heine  3 , Gina Kozak  3 , Elisabeth Kramer  3 , Stephen J O'Keefe  3 , David C Whitcomb  3 , David J Levinthal  3 , Ioannis E Koutroubakis  3 , Michael A Dunn  3 , Jana G Hashash  3 , David G Binion  3
Affiliations
Observational Study

Clinical Characteristics of Inflammatory Bowel Disease Patients Requiring Long-Term Parenteral Support in the Present Era of Highly Effective Biologic Therapy

Michael Kurin et al. JPEN J Parenter Enteral Nutr. 2021 Jul.

Abstract

Background: Despite advances in the medical management of inflammatory bowel disease (IBD), a subset of patients may require extensive surgery, leading to short-bowel syndrome/intestinal failure requiring long-term home parenteral nutrition (PN) or customized intravenous fluid (IVF) support. Our aim was to further define the characteristics of IBD patients requiring home PN/IVF.

Methods: This is an observational study from a prospective IBD research registry. Patients receiving long-term home PN/IVF support during 2009-2015 were identified and compared with remaining IBD patients. Demographics, surgical history, smoking, narcotic use, IBD treatment, healthcare charges, and presence of biomarkers were reviewed. The IBD-PN group was stratified into 3 groups based on median healthcare charges.

Results: Of 2359 IBD patients, there were 25 (1%, 24 with Crohn's disease) who required home PN/IVF, and 250 randomly selected IBD patients matched for disease type formed the control population. Median duration of PN use was 27 months (interquartile range, 11-66). PN use was significantly associated with smoking, narcotic use, IBD-related operations, and lower quality-of-life scores. Among IBD-PN patients, 7 of 25 (28%, 3 after use of teduglutide) were able to successfully discontinue this modality. Median healthcare charges in the IBD-PN group were $51,456 annually. Median charges in the controls were $3427. Period prevalence mortality was 11.5% in IBD-PN and 3.8% in controls.

Conclusions: IBD patients requiring long-term home PN/IVF support are a small minority in the present era of immunomodulator/biologic therapy. These refractory patients have a 15-fold increase in annual median healthcare charges compared with control IBD patients.

Keywords: Crohn's disease; biologics; health care charges; parenteral nutrition; short bowel syndrome; teduglutide.

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