Home parenteral nutrition study from a national UK IF reference centre
Abstract:
Background and aims: Intestinal failure (IF) is a recognised complication of Crohn’s disease (CD). The aim of this study was to identify factors predicting the development and recurrence of CD in patients with IF (CD-IF), and their long-term outcomes.
Methods: This was a cohort study of adults with CD-IF admitted to a national UK IF reference centre between 2000-2021. Patients were followed from discharge with home parenteral nutrition (HPN) until death or 28.2.2021.
Results: 124 patients were included; 47 (37.9%) changed disease location and 55 (44.4%) changed disease behaviour between CD and CD-IF diagnosis, with increased upper gastrointestinal involvement (4.0% vs 22.6% patients), p<0.001. Following IF diagnosis 29/124 (23.4%) patients commenced CD prophylactic medical therapy; 18 (62.1%) had a history of stricturing or penetrating small bowel disease and 9 (31.0%) had ileocolonic phenotype brought back into continuity. The cumulative incidence of disease recurrence was 2.4% at 1 year, 16.3% at 5 years and 27.2% at 10 years; colon-in-continuity and prophylactic treatment were associated with an increased likelihood of disease recurrence. Catheter-related bloodstream infection (CRBSI) rate was 0.32 episodes/1000 catheter days, with no association between medical therapy and CRBSI rate.
Conclusions: This is the largest series reporting disease behaviour and long-term outcomes in CD-IF and the first describing prophylactic therapy use. The incidence of disease recurrence was low. Immunosuppressive therapy appears to be safe in HPN-dependent patients with no increased risk of CRBSI. The management of CD-IF needs to be tailored to the patient’s surgical disease history alongside disease phenotype.
Reference:
Kopczynska M, Crooks B, Deutsch L, Conley T, Stansfield C, Bond A, Soop M, Carlson G, Lal S. Disease recurrence and long-term outcomes following the development of intestinal failure in Crohn’s disease: over 20 years of experience from a national reference centre. J Crohns Colitis. 2023 Jun 21:jjad105. doi: 10.1093/ecco-jcc/jjad105. Epub ahead of print. PMID: 37343184.