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1.
Liver Int ; 38(1): 174-182, 2018 01.
Artículo en Inglés | MEDLINE | ID: mdl-28792647

RESUMEN

BACKGROUND & AIMS: Intestinal failure-associated liver disease is rare in adults and risk factors are unclear. The aim of this study was to determine risk factors of liver fibrosis in adults receiving home parenteral nutrition for intestinal failure and its impact on survival. METHODS: We retrospectively analysed patients with irreversible intestinal failure who underwent a liver biopsy between 2000 and 2013. Significant liver fibrosis was defined as ≥F2 according to NASH-CRN score. RESULTS: Thirty-two patients (46 years [29-60]) underwent liver biopsy 55 months (9-201) after beginning parenteral nutrition. Twenty-six patients (81%) had a short bowel (gut < 200 cm), including 12 (37%) with an ultra-short bowel (gut < 20 cm). Eighteen patients (56%) had liver fibrosis (4 F2, 10 F3, 4 F4), associated with steatohepatitis (72%) and/or cholestasis (17%). Factors associated with occurrence of liver fibrosis included ultra-short bowel (83% vs 13% at 60 months; P < .001), alcohol consumption (73% vs 33% at 60 months; P < .001) and diabetes (80% vs 34% at 60 months; P = .01). Home parenteral nutrition composition, quantity, or duration, episodes of sepsis, abandoned bowel segment were not associated with fibrosis. Ultra-short bowel [risk ratio 12.4, P < .001] and alcohol consumption [risk ratio 7.4, P = .009] independently predicted the development of liver fibrosis on multivariate analysis. After a median follow-up of 118 months (72-155), survival was poorer in patients who developed liver fibrosis than in those without (59% vs 92% at 120 months; P = .02). CONCLUSION: An ultra-short bowel and alcohol consumption are independent risk factors for liver fibrosis in adults requiring HPN.


Asunto(s)
Cirrosis Hepática/etiología , Nutrición Parenteral en el Domicilio , Síndrome del Intestino Corto/terapia , Adulto , Consumo de Bebidas Alcohólicas/efectos adversos , Biopsia , Femenino , Humanos , Cirrosis Hepática/diagnóstico , Masculino , Persona de Mediana Edad , Nutrición Parenteral en el Domicilio/efectos adversos , Estudios Retrospectivos , Factores de Riesgo , Síndrome del Intestino Corto/complicaciones , Síndrome del Intestino Corto/diagnóstico , Síndrome del Intestino Corto/fisiopatología , Resultado del Tratamiento , Adulto Joven
2.
Liver Int ; 34(9): 1314-21, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-24237969

RESUMEN

BACKGROUND & AIMS: The most serious complication of acute mesenteric vein thrombosis (MVT) is acute intestinal ischaemia requiring intestinal resection or causing death. Risk factors for this complication are unknown. To identify risk factors for severe intestinal ischaemia leading to intestinal resection in patients with acute MVT. METHODS: We retrospectively analysed consecutive patients seen between 2002 and 2012 with acute MVT in 2 specialized units. Patients with cirrhosis were excluded. We compared patients who required intestinal resection to patients who did not. RESULTS: Among 57 patients, a local risk factor was identified in 14 (24%) patients, oral contraceptive use in 16 (29%), and at least one or more other systemic prothrombotic condition in 25 (44%). Five (9%) patients had diabetes mellitus (DM), 33 (58%) had overweight or obesity, 9 (18%) had hypertriglyceridemia and 10 (19%) had arterial hypertension. Eleven patients (19%) underwent intestinal resection. DM was significantly associated with intestinal resection (P = 0.02) while local factors or prothrombotic conditions were not. Computed tomography (CT) scans performed at diagnosis found that occlusion of second order radicles of the superior mesenteric vein was more frequently observed in patients who underwent intestinal resection (P = 0.009). CONCLUSIONS: In acute MVT, patients with underlying DM have an increased risk of requiring intestinal resection. Neither local factors nor systemic prothrombotic conditions are associated with intestinal resection. When CT scan shows the preservation of second order radicles of the superior mesenteric vein, the risk of severe resection is low.


Asunto(s)
Diabetes Mellitus Tipo 2/epidemiología , Intestinos/cirugía , Isquemia/patología , Isquemia/cirugía , Isquemia Mesentérica/complicaciones , Anticoagulantes/uso terapéutico , Femenino , Humanos , Intestinos/patología , Isquemia/epidemiología , Isquemia/etiología , Masculino , Isquemia Mesentérica/diagnóstico por imagen , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Estadísticas no Paramétricas , Tomografía Computarizada por Rayos X
4.
Clin Gastroenterol Hepatol ; 11(2): 158-65.e2, 2013 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-23103820

RESUMEN

BACKGROUND & AIMS: Acute mesenteric ischemia (AMI) is an emergency with a high mortality rate; survivors have high rates of intestinal failure. We performed a prospective study to assess a multidisciplinary and multimodal management approach, focused on intestinal viability. METHODS: In an Intestinal Stroke Center, we developed a multimodal management strategy involving gastroenterologists, vascular and abdominal surgeons, radiologists, and intensive care specialists; it was tested in a pilot study on 18 consecutive patients with occlusive AMI, admitted to a tertiary center from July 2009 to November 2011. Patients with left ischemic colitis, nonocclusive AMI, chronic mesenteric ischemia, and other emergencies were excluded. Patients received specific medical management: revascularization of viable small bowel and/or resection of nonviable small bowel; 12 patients received arterial revascularization. We evaluated the percentages of patients who survived for 30 days or 2 years, the number with permanent intestinal failure, and morbidity. Lengths and rates of intestinal resection were compared with or without revascularization, and in patients with early or late-stage disease. RESULTS: Patients were followed up for a mean of 497 days (range, 7-2085 d); 95% survived for 30 days, 89% survived for 2 years, and 28% had morbidities within 30 days. Intestinal resection was necessary for 7 cases (39%), with mean lengths of intestinal resection of 30 cm and 207 cm, with or without revascularization, respectively (P = .03). Among patients with early or late-stage AMI, rates of resection were 18% and 71%, respectively (P = .049). Patients with early stage disease had shorter lengths of intestinal resection than those with late-stage disease (7 vs 94 cm; P = .02), and spent less time in intensive care (2.5 vs 49.8; P = .02). CONCLUSIONS: A multidisciplinary and multimodal management approach might increase survival of patients with AMI and prevent intestinal failure.


Asunto(s)
Isquemia/mortalidad , Isquemia/terapia , Enfermedades Vasculares/mortalidad , Enfermedades Vasculares/terapia , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada , Cuidados Críticos/métodos , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Femenino , Humanos , Masculino , Isquemia Mesentérica , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Análisis de Supervivencia , Resultado del Tratamiento
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