Improvement in Intestinal-Failure-Associated Liver Disease by Using Parenteral Fish Oil as Monotherapy: Case-Based Review of the Literature

Abstract

Intestinal-failure-associated liver disease (IFALD) is a common complication of prolonged parenteral nutrition (PN). Risk factors for IFALD include clinical features, as well as medical interventions, and its management was initially based on the decrease or interruption of parenteral nutrition while increasing enteral nutrition. However, the tolerance of full enteral nutrition in children with intestinal failure may require prolonged intestinal rehabilitation over a period of years. As a consequence, infants unable to wean from PN are prone to develop end-stage liver disease. We describe the case of an infant receiving long-term PN who was diagnosed with IFALD wherein we were able to reverse IFALD by switching lipid emulsions to fish oil monotherapy. A systemic review of case reports and case series on reversing IFALD using fish oil lipid emulsion follows the case description.

Keywords: fish oil; intestinal-failure-associated liver disease; intravenous lipid emulsion; parenteral nutrition.

Figure 1

Bilirubin levels. The red arrows (1st) indicates the sepsis episode and the introduction of FOLE (2nd).

Figure 2

Transaminases evolution. The red arrows (1st) indicates the sepsis episode and the introduction of FOLE (2nd).

Figure 3

Patient’s growth chart. The green line represents the 50th percentile for weight according to age. The orange lines represent the 15th percentile and the red lines the 97th percentile.