Format

Send to

Choose Destination
Clin Nutr. 2018 Apr;37(2):728-738. doi: 10.1016/j.clnu.2017.04.013. Epub 2017 Apr 19.

Clinical classification of adult patients with chronic intestinal failure due to benign disease: An international multicenter cross-sectional survey.

Author information

1
Center for Chronic Intestinal Failure, Department of Digestive System, St. Orsola-Malpighi University Hospital, Bologna, Italy.
2
Home Nutrition Support, Cleveland Clinic Foundation, Cleveland, OH, USA.
3
Rigshospitalet, Department of Gastroenterology, Copenhagen, Denmark.
4
Centre for Intestinal Failure, Department of Gastroenterology and Nutritional Support, Hôpital Beaujon, Clichy, France.
5
Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
6
Unité de Nutrition Clinique Intensive, Hospices Civils de Lyon, Hôpital de la Croix Rousse, Lyon, France.
7
Città della Salute e della Scienza, Turin, Italy.
8
Nutrition Team Office, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
9
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA.
10
General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland.
11
University Hospital of Wales, Cardiff, United Kingdom.
12
University College Hospital, London, United Kingdom.
13
Rabin Medical Center, Petach Tikva, Israel.
14
M. Pirogow Hospital, Lodz, Poland.
15
Nottingham University Hospital NHS Trust, Nottingham, United Kingdom.
16
Academic Medical Center, Amsterdam, The Netherlands.
17
Service de Gastroentérologie, Hôpital Haut-Lévêque, CHU de Bordeaux, Pessac, France.
18
Intestinal Failure Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
19
University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
20
Centre for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark.
21
Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
22
Service de Nutrition, CHRU de Lille, Lille, France.
23
Unidad de Soporte Nutricional, Rehabilitación y Trasplante de Intestino, Hospital Universitario Fundacion Favaloro, Buenos Aires, Argentina.
24
Federico II University, Naples, Italy.
25
Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom.
26
Gastroenterology Unit, San Nicola Pellegrino Hospital, Trani, Italy.
27
Institute of Oncology, Ljubljana, Slovenia.
28
Gastroenterology and Clinical Nutrition, CHU of Nice, University of Nice Sophia Antipolis, Nice, France.
29
National Intestinal Failure Service, Auckland City Hospital, Auckland, New Zealand.
30
Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
31
Gastrointestinal and Nutritional Rehabilitation Medicine, Clinique Saint Yves, Rennes Cedex, France.
32
Department of General and Transplant Surgery and Clinical Nutrition, Medical University of Lublin, Lublin, Poland.
33
Department of Clinical Nutrition, J. Gromkowski City Hospital, Wroclaw, Poland.
34
Centre for Intestinal Failure, Department of General, Endocrinological and Gastroenterological Surgery, Poznan University of Medical Science, Poznań, Poland.
35
Medico-Surgical Department of Gastroenterology, Hôpital Erasme, Free University of Brussels, Belgium.
36
Norfolk and Norwich University Hospital, University of East Anglia, Norwich, United Kingdom.
37
University Hospital, Coventry, United Kingdom.
38
Centro di Riferimento Regionale NAD Ospedali Riuniti Ancona, Ancona, Italy.
39
Unitat Nutrició i Dietética, Servei Endocrinologia i Nutrició, Hospital Universitari de Bellvitge, Barcelona, Spain.
40
Flinders Medical Centre, Adelaide, Australia.
41
Austin Health, Melbourne, Australia.
42
Royal Brisbane and Women's Hospital, Herston, Australia.
43
Nutrition Unit, Hospital General Universitario Gregorio Marañon, Madrid, Spain.
44
St. Imre Hospital, Budapest, Hungary.
45
Royal Prince Alfred Hospital, Camperdown, Australia.
46
Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
47
Ospedale Orlandi, Bussolengo, VR, Italy.
48
Centro di Riferimento Regionale NAD, INRCA -IRCCS, Ancona, Italy.
49
Szent György Teaching Hospital of County Fejér, Székesfehérvár, Hungary.
50
AUSL Parma, Parma, Italy.
51
Servei d'Endocrinologia i Nutrició, Hospital Universitari Arnau de Vilanova, Lleida, Spain.
52
Bulgarian Executive Agency of Transplantation, Sofia, Bulgaria.
53
Hospital Universitario Donostia, San Sebastian, Spain.
54
Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, México, Mexico.
55
Hospital Regional Universitario de Málaga, Málaga, Spain.
56
Centre of Clinical Nutrition, Department of Medicine, University Hospital Centre, Zagreb, Croatia.
57
First Department of Internal Medicine, Szeged, Hungary.
58
Vilnius University Hospital Santariskiu Clinics, Vilnius, Lithuania.
59
Miguel Servet Hospital, Zaragoza, Spain.
60
Complejo Hospitalario de Navarra, Pamplona, Spain.
61
Hospital Virgen del Camino, Pamplona, Spain.
62
Magyar Honvedseg Egészségügyi Központ (MHEK), Budapest, Hungary.
63
Department of Medicine, Oncology and Hematology, University of Freiburg, Germany.
64
Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain.
65
Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK.

Abstract

BACKGROUND & AIMS:

The aim of the study was to evaluate the applicability of the ESPEN 16-category clinical classification of chronic intestinal failure, based on patients' intravenous supplementation (IVS) requirements for energy and fluids, and to evaluate factors associated with those requirements.

METHODS:

ESPEN members were invited to participate through ESPEN Council representatives. Participating centers enrolled adult patients requiring home parenteral nutrition for chronic intestinal failure on March 1st 2015. The following patient data were recorded though a structured database: sex, age, body weight and height, intestinal failure mechanism, underlying disease, IVS volume and energy need.

RESULTS:

Sixty-five centers from 22 countries enrolled 2919 patients with benign disease. One half of the patients were distributed in 3 categories of the ESPEN clinical classification. 9% of patients required only fluid and electrolyte supplementation. IVS requirement varied considerably according to the pathophysiological mechanism of intestinal failure. Notably, IVS volume requirement represented loss of intestinal function better than IVS energy requirement. A simplified 8 category classification of chronic intestinal failure was devised, based on two types of IVS (either fluid and electrolyte alone or parenteral nutrition admixture containing energy) and four categories of volume.

CONCLUSIONS:

Patients' IVS requirements varied widely, supporting the need for a tool to homogenize patient categorization. This study has devised a novel, simplified eight category IVS classification for chronic intestinal failure that will prove useful in both the clinical and research setting when applied together with the underlying pathophysiological mechanism of the patient's intestinal failure.

KEYWORDS:

Chronic intestinal pseudo-obstruction; Home parenteral nutrition; Intestinal failure; Intravenous supplementation; Short bowel syndrome

PMID:
28483328
DOI:
10.1016/j.clnu.2017.04.013

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center