BACKGROUND AND AIMS: Intestinal failure (IF) is a feared complication of Crohn's disease (CD). Although cumulative loss of small bowel due to bowel resections is thought to be the dominant cause, the causes and outcomes have not been reported. METHODS: Consecutive adult patients referred to a national intestinal failure unit 2000-2018 with a diagnosis of CD and subsequently treated with parenteral nutrition during at least 12 months were included in this longitudinal cohort study. Data were extracted from a prospective institutional clinical database and patient records. RESULTS: 121 patients were included. 62 (51%) of patients developed IF as a consequence of abdominal sepsis complicating abdominal surgery, while small bowel resection, primary disease activity and proximal stoma were less common causes (31, 12 and 6%, respectively). 32 had perianastomotic sepsis, and 15 of those had documented risk factors for anastomotic dehiscence. On Kaplan-Meier analysis, 40% of all patients regained nutritional autonomy within 10 years and none did subsequently. 14% of patients developed intestinal-failure-associated liver disease. On Kaplan-Meier analysis, projected mean age of death was 74 (2) years. CONCLUSIONS: IF is a severe complication of CD, with 60% permanently dependent on parenteral nutrition. The most frequent event leading directly to IF was a septic complication following abdominal surgery, in many cases following intestinal anastomosis in the presence of significant risk factors for anastomotic dehiscence. A reduced need for abdominal surgery, an increased awareness of perioperative risk factors and structured pre-operative optimisation may reduce the incidence of IF in CD.
BACKGROUND AND AIMS: Intestinal failure (IF) is a feared complication of Crohn's disease (CD). Although cumulative loss of small bowel due to bowel resections is thought to be the dominant cause, the causes and outcomes have not been reported. METHODS: Consecutive adult patients referred to a national intestinal failure unit 2000-2018 with a diagnosis of CD and subsequently treated with parenteral nutrition during at least 12 months were included in this longitudinal cohort study. Data were extracted from a prospective institutional clinical database and patient records. RESULTS: 121 patients were included. 62 (51%) of patients developed IF as a consequence of abdominal sepsis complicating abdominal surgery, while small bowel resection, primary disease activity and proximal stoma were less common causes (31, 12 and 6%, respectively). 32 had perianastomotic sepsis, and 15 of those had documented risk factors for anastomotic dehiscence. On Kaplan-Meier analysis, 40% of all patients regained nutritional autonomy within 10 years and none did subsequently. 14% of patients developed intestinal-failure-associated liver disease. On Kaplan-Meier analysis, projected mean age of death was 74 (2) years. CONCLUSIONS:IF is a severe complication of CD, with 60% permanently dependent on parenteral nutrition. The most frequent event leading directly to IF was a septic complication following abdominal surgery, in many cases following intestinal anastomosis in the presence of significant risk factors for anastomotic dehiscence. A reduced need for abdominal surgery, an increased awareness of perioperative risk factors and structured pre-operative optimisation may reduce the incidence of IF in CD.
Authors: Aysegül Aksan; Karima Farrag; Irina Blumenstein; Oliver Schröder; Axel U Dignass; Jürgen Stein Journal: World J Gastroenterol Date: 2021-06-28 Impact factor: 5.742