Short bowel syndrome (SBS) is a leading cause of intestinal failure (IF) and the need for long term home parenteral nutrition (HPN). Understanding the anatomical features and nutritional requirements of this sub set of patients within any HPN cohort is vital, given the associated risk of HPN related complications. Moreover, with developments in surgical lengthening and potential for emerging pharmacological interventions, appropriate patient selection is key. However, there may be regional and national differences between different SBS-IF patient populations; this study therefore aimed to develop a greater contemporary understanding of the SBS-IF subset managed within a large U. K. HPN cohort.Method
We performed a retrospective observational study from a prospectively maintained database, evaluating patients with type 3 IF managed in a national U. K. centre. Patients’ intestinal anatomical details were reviewed and PN requirements evaluated according to the novel ESPEN classification for type 3 IF. Each individual SBS case was evaluated to assess eligibility for GLP-2 analogue therapy according to recently published inclusion criteriaResults
A total of 273 patients were included in the HPN database as of October 2017. One hundred and fifty two patients (55.7%; mean age of 56.9 years) were identified as having IF as a result of SBS (SBS-IF), with the presence of a jejunostomy (SBS-J; 41.8%) as the most frequent pathophysiological mechanism. Only 7.3% of patients with SBS-IF had colon in continuity. Crohn’s disease was the most common underlying aetiology leading to SBS-IF. The mean duration of HPN was 60.8 months (range: 4–415.8). Univariate analysis for the whole HPN cohort demonstrated SBS-IF and a longer duration of HPN to be associated with higher PN energy requirements, p≤0.0001. Seventy three (48.0%) patients with SBS-IF were deemed suitable for treatment with a GLP-2 analogue, with co-morbidity being the most frequent cause of non-suitability.Conclusion
This is the largest UK HPN cohort individually reported using ESPEN pathophysiological and clinical severity classification. The vast majority of patients with SBS-IF have a jejunostomy and, as compared to other international cohorts, relatively few have colon-in-continuity. The study further demonstrates that existing co-morbidity is a principal contra-indication to therapy with GLP-2 analogue therapy in a majority of patients with SBS-IF; these data will be useful for funding bodies to consider when planning reimbursement costs for novel therapies within limited national healthcare budgets.