Effect of bile acid supplementation on endogenous lipid synthesis in patients with short bowel syndrome: A pilot study.

BACKGROUND & AIMS: Short bowel syndrome patients (SBS) receiving parenteral nutrition (PN) often have dyslipidaemia and can develop intestinal failure-associated liver disease (IFALD). These patients demonstrate increased cholesterol synthesis and hepatic lipogenesis. These lipid disturbances may be due to a decreased concentration of the bile acid pool or malabsorption. The aim of this pilot study was to evaluate the effect of bile acid administration on lipid synthesis in patients with SBS. METHODS: The 24 h fractional synthesis rate (FSR) of cholesterol and triglycerides was measured by the isotopic method (deuterated water) before and after 4 months of ursodeoxycholic acid (UDCA) treatment (20 mg/kg/day). Five short bowel patients (age: 53.4 ± 19.2 years) who had normal liver function and lipid plasmatic profiles received 1920 ± 300 ml of PN for 151 ± 74 days (mean PN energy intake was 27.0 ± 6.0 kcal/kg body weight, composed with 3.87 ± 1.38 g/kg of carbohydrate, 0.72 ± 0.25 g/kg of fat and 1.10 ± 0.23 g/kg of amino acids). Plasma metabolites, liver enzymes, 7-α-OH-cholesterol and steatosis levels were also evaluated before and after treatment. Student's t-tests were performed, and the results were expressed in means (±SD). RESULTS: After treatment, decreases in the absolute values of cholesterol synthesis (0.31 ± 0.12 mmol L-1 to 0.24 ± 0.11 mmol L-1; p < 0.05), FSR of cholesterol (31.6 ± 4.7% to 26.4 ± 4.7%; p = 0.06) and FSR of triglycerides (12.8 ± 5.8% to 9.2 ± 5.5%; p < 0.01) were observed. Cholesterol and alanine aminotransferase concentrations also decreased (ALT) (p < 0.05). The absolute values of triglyceride synthesis and triglyceride concentrations remained unchanged. CONCLUSIONS: In SBS patients, UDCA decreases the hepatic synthesis of triglycerides and cholesterol. These results suggest that UDCA could prevent the onset of the IFALD.

Need for Intensive Nutrition Care After Bariatric Surgery.

Severe nutrition complications after bariatric surgery remain poorly described. The aim of this case series was to identify specific factors associated with nutrition complications after bariatric surgery and to characterize their nutrition disorders. We retrospectively reviewed all people referred to the clinical nutrition intensive care unit of our university hospital after bariatric surgery from January 2013 to June 2015. Twelve persons who required artificial nutrition supplies (ie, enteral nutrition or parenteral nutrition) were identified. Seven persons underwent a "one-anastomosis gastric bypass" (OAGB) or "mini gastric bypass," 2 underwent a Roux-en-Y gastric bypass, 2 had a sleeve gastrectomy, and 1 had an adjustable gastric band. This case series suggests that OAGB could overexpose subjects to severe nutrition complications requiring intensive nutrition care and therefore cannot be considered a "mini" bariatric surgery. Even if OAGB is often considered a simplified surgical technique, it obviously requires as the other standard bariatric procedures a close follow-up by experimented teams aware of its specific complications.

Taurolidine lock solution in the secondary prevention of central venous catheter-associated bloodstream infection in home parenteral nutrition patients.

BACKGROUND & AIMS: Central venous catheter-associated bloodstream infection (CBSI) is a serious complication in patients on home parenteral nutrition (HPN). The aim was to analyze the impact of taurolidine-citrate lock solution (TLS) on CBSI rate in HPN patients with a high risk of catheter infection. METHODS: This retrospective study compared CBSI rates 12 months before and 12 months after implementation of TLS. In the first period, only standardized strategies were used to reduce the CBSI rate. In the second period, TLS was injected into the catheter at the end of parenteral nutrition. The CBSI rate with a confident interval was calculated as Poisson event rates, and compared by testing for homogeneity of rates. RESULTS: 15 patients were included. During the 24 months, the CBSI rate was 6.58/1000 catheter-days in the first period and 1.09/1000 catheter-days in the second period (p < 0.001). In patients with TLS once a week (n = 8), the CBSI rate decreased from 4.8/1000 catheter-days to 1.37/1000 catheter-days (p = 0.02) and in patients with TLS after each TPN (n = 7), the CBSI rate decreased from 8.61/1000 catheter-days to 0.78/1000 catheter-days (p = 0.001). CONCLUSION: In HPN patients, TLS associated with standardized precautions significantly reduced the CBSI rate.

3D gastric computed tomography as a new imaging in patients with failure or complication after bariatric surgery.

The number of bariatric operations performed each year is increasing. As a result, a rising number of patients in possible need for revisional surgery are referred to bariatric surgeons. But the standard methods of evaluation are often insufficient, and the best strategy remains difficult to choose. In our centre, we have developed 3D gastric computed tomography with air (3D-GCT). The aim of this pilot study was to assess the usefulness of this new image modality as an aid in the decision-making process in patients with failure or complications after bariatric surgery. Twenty patients referred for failure or complications after various bariatric procedures were included in the study. 3D-GCT was performed on a multidetector CT scanner after absorption of effervescent salt diluted in 10 ml of water and IV injection of butylscopolamine. Thin-slice data were transferred to a dedicated 3D workstation creating three-dimensional volume-rendering images of the oesophagus, gastric cavities and anastomoses. The volume of the gastric pouches and the diameter of stoma or anastomoses were measured. No failure or complications were observed. In all patients, 3D-GCT resulted in very impressive precise 3D images of post-surgical anatomy of the stomach. Imaging findings allowed us to identify or to eliminate the common complications of each procedure with a good accuracy, resulting in an aid to choose the best strategy in each patient. In conclusion, our pilot study suggests that 3D-GCT is useful as a decision-making aid in patients with failure or complications after bariatric surgery.