Elimination of Soybean Lipid Emulsion in Parenteral Nutrition and Supplementation With Enteral Fish Oil Improve Cholestasis in Infants With Short Bowel Syndrome

OBJECTIVE: To describe the authors’ experience with the implementation of a multidisciplinary approach and use of fish oil emulsion (FOE) in the management of infants with short bowel syndrome (SBS) and parenteral nutrition-associated liver disease (PNALD).METHODS: Between August 2006 and June 2009, four cases of SBS and severe PNALD were managed by the team using specifically developed protocols. The FOE was initiated if serum direct bilirubin levels were ≥100 μmol/L. To quantify the degree of exposure to high serum direct bilirubin levels over time, the area under the curve (AUC) for each patient was calculated before and after initiation of FOE. Linear regression analyses were performed to evaluate correlations between the AUC, duration of cholestasis and initiation of FOE.RESULTS: All patients survived and no complications were observed during the study period. After the first patient, FOE was initiated progressively earlier, but poor correlation between the AUC before and after its introduction was observed (r2=0.41924). However, there was strong correlation between the duration of PNALD before FOE initiation and time to resolution (r2=0.72133): the earlier the FOE was initiated, the shorter the time to resolution.CONCLUSION: The authors report a positive experience with the implementation of a multidisciplinary approach and the use of FOE in infants with SBS and severe PNALD. The earlier the FOE was initiated during the cholestatic process, the shorter the time to resolution. The present study is a hypothesis generator, raising the question of whether an earlier introduction of this particular therapy can effectively shorten the cholestasis process in these patients.

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Reversal of Parenteral Nutrition-Associated Liver Disease in Two Infants With Short Bowel Syndrome Using Parenteral Fish Oil: Implications for Future Management

PEDIATRICS ◽

10.1542/peds.2005-2662 ◽

2006 ◽

Vol 118 (1) ◽

pp. e197-e201 ◽

Cited By ~ 249

Author(s):

K. M. Gura ◽

C. P. Duggan ◽

S. B. Collier ◽

R. W. Jennings ◽

J. Folkman ◽

...

Keyword(s):

Liver Disease ◽

Parenteral Nutrition ◽

Fish Oil ◽

Short Bowel Syndrome ◽

Short Bowel ◽

Future Management

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What is the optimal lipid emulsion for preventing intestinal failure-associated liver disease following parenteral feeding in a rat model of short-bowel syndrome?

Pediatric Surgery International ◽

10.1007/s00383-020-04802-0 ◽

2021 ◽

Author(s):

Seiro Machigashira ◽

Tatsuru Kaji ◽

Shun Onishi ◽

Keisuke Yano ◽

Toshio Harumatsu ◽

...

Keyword(s):

Liver Disease ◽

Fish Oil ◽

Hepatic Steatosis ◽

Short Bowel Syndrome ◽

Rat Model ◽

Lipid Emulsion ◽

Intestinal Failure ◽

Small Bowel Resection ◽

Sprague Dawley ◽

Short Bowel

Abstract Purpose Composite lipid emulsion (CLE) has been used for intestinal failure-associated liver disease (IFALD) to compensate for the disadvantages of soybean oil lipid emulsion (SOLE) or fish oil lipid emulsion (FOLE). However, the influence of its administration is unclear. We evaluated the effects of these emulsions on IFALD using a rat model of the short-bowel syndrome. Methods We performed jugular vein catheterization and 90% small bowel resection in Sprague–Dawley rats and divided them into four groups: control (C group), regular chow with intravenous administration of saline; and total parenteral nutrition co-infused with SOLE (SOLE group), CLE (CLE group) or FOLE (FOLE group). Results Histologically, obvious hepatic steatosis was observed in the SOLE and CLE groups but not the FOLE group. The liver injury grade of the steatosis and ballooning in the FOLE group was significantly better than in the SOLE group (p < 0.05). The TNF-α levels in the liver in the FOLE group were significantly lower than in the SOLE group (p < 0.05). Essential fatty acid deficiency (EFAD) was not observed in any group. Conclusion Fish oil lipid emulsion attenuated hepatic steatosis without EFAD, while CLE induced moderate hepatic steatosis. The administration of CLE requires careful observation to prevent PN-induced hepatic steatosis.

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Reversal of severe parenteral nutrition-associated liver disease in an infant with short bowel syndrome using parenteral fish oil (Omega-3 fatty acids)

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2008.01.005 ◽

2008 ◽

Vol 43 (6) ◽

pp. 1191-1195 ◽

Cited By ~ 53

Author(s):

George Ekema ◽

Diego Falchetti ◽

Giovanni Boroni ◽

Anna Rita Tanca ◽

Cristian Altana ◽

...

Keyword(s):

Fatty Acids ◽

Liver Disease ◽

Parenteral Nutrition ◽

Fish Oil ◽

Short Bowel Syndrome ◽

Omega 3 Fatty Acids ◽

Omega 3 ◽

Short Bowel

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Growth Hormone, Glutamine, and an Optimal Diet Reduces Parenteral Nutrition in Patients With Short Bowel Syndrome: A Prospective, Randomized, Placebo-Controlled, Double-Blind Clinical Trial

Yearbook of Gastroenterology ◽

10.1016/s0739-5930(08)70386-6 ◽

2006 ◽

Vol 2006 ◽

pp. 198-199

Author(s):

J.L. Rombeau

Keyword(s):

Clinical Trial ◽

Growth Hormone ◽

Parenteral Nutrition ◽

Short Bowel Syndrome ◽

Optimal Diet ◽

Double Blind ◽

Short Bowel ◽

Double Blind Clinical Trial

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PARENTERAL NUTRITION WITH OMEGA-3 FATTY ACIDS RESULTS IN HIGH ENDOGENOUS EPA/DHA LEVELS IN SHORT BOWEL SYNDROME PATIENTS

10.1055/s-0037-1603256 ◽

2017 ◽

Author(s):

M Karber ◽

S Pevny ◽

D Thurmann ◽

WH Schunck ◽

KH Weylandt ◽

...

Keyword(s):

Fatty Acids ◽

Parenteral Nutrition ◽

Short Bowel Syndrome ◽

Omega 3 Fatty Acids ◽

Omega 3 ◽

Short Bowel

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Incidence and Outcomes of Home Parenteral Nutrition in Patients With Crohn Disease in Olmsted County, Minnesota

Crohn's & Colitis 360 ◽

10.1093/crocol/otaa083 ◽

2020 ◽

Vol 2 (4) ◽

Author(s):

Zeinab Bakhshi ◽

Siddhant Yadav ◽

Bradley R Salonen ◽

Sara L Bonnes ◽

Jithinraj Edakkanambeth Varayil ◽

...

Keyword(s):

Weight Loss ◽

Parenteral Nutrition ◽

Short Bowel Syndrome ◽

Crohn Disease ◽

Severe Disease ◽

Bloodstream Infections ◽

Home Parenteral Nutrition ◽

Average Weight ◽

Olmsted County ◽

Short Bowel

Abstract Background We sought to estimate the incidence of home parenteral nutrition (HPN) use in a population-based cohort of patients with Crohn disease (CD), and to assess clinical outcomes and complications associated with HPN. Methods We used the Rochester Epidemiology Project (REP) to identify residents of Olmsted County, who were diagnosed with CD between 1970 and 2011, and required HPN. Results Fourteen out of 429 patients (3.3%) with CD received HPN (86% female). Eleven patients (79%) had moderate–severe CD and 12 patients (86%) had fistulizing disease. Thirteen patients (93%) underwent surgery, primarily due to obstruction. Among CD incidence cases, the cumulative incidence of HPN from the date of CD diagnosis was 0% at 1 year, 0.5% at 5 years, 0.8% at 10 years, and 2.4% at 20 years. Indications for HPN included short bowel syndrome in 64%, malnutrition in 29%, and bowel rest in 21%. The median duration of HPN was 2.5 years. There was an average weight gain of 1.2 kg at 6 months, an average weight loss of 1.4 kg at 1 year, and a further weight loss of 2.2 kg at 2 years from the start of HPN. Patients were hospitalized a mean of 5 times after the start of HPN, mainly due to catheter-related bloodstream infections and thrombosis. Conclusions Less than 4% of patients with CD need HPN. Most have moderate to severe disease with short bowel syndrome or malnutrition. Possible reasons for the patients’ weight loss could be noncompliance, and increased metabolic needs because of active disease.

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