Viola Knop1, Sophie-Charlott Neuberger2, Sabine Marienfeld2, Jörg Bojunga2, Eva Herrmann3, Thierry Poynard4, Stefan Zeuzem2, Irina Blumenstein2, Mireen Friedrich-Rust2. 1. Medizinische Klinik 1, Universitätsklinikum, Frankfurt, Germany. Electronic address: viola.knop@kgu.de. 2. Medizinische Klinik 1, Universitätsklinikum, Frankfurt, Germany. 3. Institut für Biostatistik und Mathematische Modellierung, Fachbereich Medizin, J.W.Goethe-Universität, Frankfurt, Germany. 4. Department of Hepatology, Assistance publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpétrière, Paris, France.
Abstract
OBJECTIVE: Patients with short bowel syndrome (SBS) receiving long-term parenteral nutrition (PN) are at risk for intestinal failure-associated liver disease (IFALD). The aim of the present study was to evaluate dynamic changes of liver fibrosis and steatosis within 12 mo by transient elastography (TE), including controlled attenuation parameter (CAP) in a cohort of patients with SBS receiving long-term PN. METHODS: Twenty-five adult patients with SBS and PN requirement for ≥3 mo consecutively were included and prospectively followed. Liver stiffness by FibroScan (Echosens, Paris, France) and CAP measurement were done at study entry and after 12 mo. Clinical parameters, as well as data on underlying bowel disease and nutrition composition, were collected. Bioelectrical impedance analysis was performed in all patients. RESULTS: FibroScan and CAP did not show any significant differences after 12 mo (5.2 kPa [2.8-16.2 kPa]; 223dB/m [101-366 dB/m]) compared with study entry (5.3 kPa [2.7-12.3 kPa]; 237dB/m [100-344 dB/m]). There was no significant correlation between FibroScan and CAP and elevated transaminase levels. CAP significantly correlated with triacylglyceride levels (r = 0.411; P = 0.042) and body mass index (r = 0.468; P = 0.016). Patients with a remnant small bowel <100cm showed a significantly higher stiffness value by FibroScan than those having a remnant length ≥100cm (6.1 versus 4.7 kPa; P = 0.028). CONCLUSION: In the present study cohort, prevalence of advanced fibrosis or cirrhosis was low (<10%) without significant dynamic within the 12-mo follow-up. Short intestinal remnant length <100cm appeared to be a risk factor for development of fibrosis.
OBJECTIVE:Patients with short bowel syndrome (SBS) receiving long-term parenteral nutrition (PN) are at risk for intestinal failure-associated liver disease (IFALD). The aim of the present study was to evaluate dynamic changes of liver fibrosis and steatosis within 12 mo by transient elastography (TE), including controlled attenuation parameter (CAP) in a cohort of patients with SBS receiving long-term PN. METHODS: Twenty-five adult patients with SBS and PN requirement for ≥3 mo consecutively were included and prospectively followed. Liver stiffness by FibroScan (Echosens, Paris, France) and CAP measurement were done at study entry and after 12 mo. Clinical parameters, as well as data on underlying bowel disease and nutrition composition, were collected. Bioelectrical impedance analysis was performed in all patients. RESULTS: FibroScan and CAP did not show any significant differences after 12 mo (5.2 kPa [2.8-16.2 kPa]; 223dB/m [101-366 dB/m]) compared with study entry (5.3 kPa [2.7-12.3 kPa]; 237dB/m [100-344 dB/m]). There was no significant correlation between FibroScan and CAP and elevated transaminase levels. CAP significantly correlated with triacylglyceride levels (r = 0.411; P = 0.042) and body mass index (r = 0.468; P = 0.016). Patients with a remnant small bowel <100cm showed a significantly higher stiffness value by FibroScan than those having a remnant length ≥100cm (6.1 versus 4.7 kPa; P = 0.028). CONCLUSION: In the present study cohort, prevalence of advanced fibrosis or cirrhosis was low (<10%) without significant dynamic within the 12-mo follow-up. Short intestinal remnant length <100cm appeared to be a risk factor for development of fibrosis.
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