Denis Picot1, Sabrina Layec2, Laurence Dussaulx2, Florence Trivin2, Ronan Thibault3. 1. Department of Nutritional and Digestive Rehabilitation, Clinique Saint Yves, Rennes F-35044, France. Electronic address: picot@clinique-styves.fr. 2. Department of Nutritional and Digestive Rehabilitation, Clinique Saint Yves, Rennes F-35044, France. 3. Nutrition Unit, Department of Endocrinology, Diabetology and Nutrition, Home Parenteral Nutrition Centre, CHU Rennes, Université de Rennes 1, INSERM U991, Rennes F-35000, France. Electronic address: ronan.thibault@chu-rennes.fr.
Abstract
BACKGROUND & AIMS: Patients with double temporary enterostomy may suffer from intestinal failure (IF). Parenteral nutrition (PN) is the gold standard treatment until surgical reestablishment of intestinal continuity. Chyme reinfusion (CR) is a technique consisting in an extracorporeal circulation of the chyme. The aims were to determine: i) whether CR could restore intestinal absorption, decrease PN needs, improve nutritional status and plasma liver tests; ii) the feasibility of home CR. METHODS: From the 232 patients IF consecutively referred for CR from 2000 to 2014, the 212 patients with IF, technical feasibility of CR, and effectively treated by CR, were included. Were collected prospectively before and during CR: daily stomal and fecal outputs, coefficients of nitrogen (CNDA) and fat (CFDA) digestive absorption, weight loss, body mass index (BMI), Nutritional Risk Index (NRI), plasma albumin, citrulline, and liver tests. RESULTS: 183 patients had temporary double enterostomy and 29 exposed enterocutaneous fistulas. CR reduced the intestinal output (2444 ± 933 vs 370 ± 457 ml/day, P < 0.001), improved CNDA (46 ± 16 vs 80 ± 14%, P < 0.001) and CFDA (48 ± 25 vs 86 ± 11%, P < 0.001), and normalized plasma citrulline concentration (17.6 ± 8.4 vs 30.3 ± 11.8 μmol/l, P < 0.001). PN was stopped in 126/139 (91%) patients within 2 ± 8 d. Nutritional status improved (P < 0.001): weight (+4.6 ± 8.6%), BMI (+3.8 ± 7.7%), plasma albumin (+6.2 ± 6.1 g/l), and NRI (+10.9 ± 9.5). The proportion of patients with plasma liver tests abnormalities decreased (88 vs 51%, P < 0.01). Home CR was feasible without any serious complications in selected patients. CONCLUSIONS: CR corrected the intestinal failure by restoring intestinal absorption, allowing PN weaning in 91% of patients. CR contributes to improve nutritional status and to reduce plasma liver tests abnormalities, and is feasible at home.
BACKGROUND & AIMS:Patients with double temporary enterostomy may suffer from intestinal failure (IF). Parenteral nutrition (PN) is the gold standard treatment until surgical reestablishment of intestinal continuity. Chyme reinfusion (CR) is a technique consisting in an extracorporeal circulation of the chyme. The aims were to determine: i) whether CR could restore intestinal absorption, decrease PN needs, improve nutritional status and plasma liver tests; ii) the feasibility of home CR. METHODS: From the 232 patients IF consecutively referred for CR from 2000 to 2014, the 212 patients with IF, technical feasibility of CR, and effectively treated by CR, were included. Were collected prospectively before and during CR: daily stomal and fecal outputs, coefficients of nitrogen (CNDA) and fat (CFDA) digestive absorption, weight loss, body mass index (BMI), Nutritional Risk Index (NRI), plasma albumin, citrulline, and liver tests. RESULTS: 183 patients had temporary double enterostomy and 29 exposed enterocutaneous fistulas. CR reduced the intestinal output (2444 ± 933 vs 370 ± 457 ml/day, P < 0.001), improved CNDA (46 ± 16 vs 80 ± 14%, P < 0.001) and CFDA (48 ± 25 vs 86 ± 11%, P < 0.001), and normalized plasma citrulline concentration (17.6 ± 8.4 vs 30.3 ± 11.8 μmol/l, P < 0.001). PN was stopped in 126/139 (91%) patients within 2 ± 8 d. Nutritional status improved (P < 0.001): weight (+4.6 ± 8.6%), BMI (+3.8 ± 7.7%), plasma albumin (+6.2 ± 6.1 g/l), and NRI (+10.9 ± 9.5). The proportion of patients with plasma liver tests abnormalities decreased (88 vs 51%, P < 0.01). Home CR was feasible without any serious complications in selected patients. CONCLUSIONS:CR corrected the intestinal failure by restoring intestinal absorption, allowing PN weaning in 91% of patients. CR contributes to improve nutritional status and to reduce plasma liver tests abnormalities, and is feasible at home.
Authors: Stella Maye Dilke; Laura Gould; Mark Yao; Maria Souvatzi; Adam Stearns; Ana Ignjatovic-Wilson; Phil Tozer; Carolynne J Vaizey Journal: Frontline Gastroenterol Date: 2020-08-18
Authors: Kiran V K Koelfat; Ruben G J Visschers; Caroline M J M Hodin; D Rudi de Waart; Wim G van Gemert; Jack P M Cleutjens; Marion J Gijbels; Ronit Shiri-Sverdlov; Rajeshwar P Mookerjee; Kaatje Lenaerts; Frank G Schaap; Olde Damink Steven W M Journal: J Clin Transl Res Date: 2017-10-15
Authors: Elisabeth Blüthner; Ulrich-Frank Pape; Martin Stockmann; Mirjam Karber; Sebastian Maasberg; Sophie Pevny; Undine Gerlach-Runge; Andreas Pascher; Johann Pratschke; Frank Tacke; Jan Bednarsch Journal: Nutrients Date: 2020-04-26 Impact factor: 5.717
Authors: Kiran V K Koelfat; Denis Picot; Xinwei Chang; Ronan Thibault; Frank G Schaap; Steven W M Olde Damink; Mireille Desille-Dugast; Hans M van Eijk; Sander M J van Kuijk; Martin Lenicek; Sabrina Layec; Marie Carsin; Laurence Dussaulx; Eloi Seynhaeve; Florence Trivin; Laurence Lacaze Journal: Hepatology Date: 2021-08-26 Impact factor: 17.425