2011 - ISBTS 2011 Symposium

Oral Communications 3: Nutrition Outcomes

5.125 - Crohn’s disease-related short bowel syndrome: Outcomes in intestinal rehabilitation and transplantation

Presenter: Lauren, Schwartz, New York, United States
Authors: Lauren Schwartz1, Matthew Suh1, Thomas Schiano1, Christine Chamberlain1, Hiroshi Sogawa1, Kishore Iyer1

Crohn’s disease-related short bowel syndrome: Outcomes in intestinal rehabilitation and transplantation

Lauren Schwartz, Matthew Suh, Thomas Schiano, Christine Chamberlain, Hiroshi Sogawa, Kishore Iyer

Department of Intestinal Transplantation, Mount Sinai Hospital, New York, NY, United States

Background: Crohn’s disease (CD) accounts for 9 to18% of adult short bowel syndrome (SBS) and 8% of intestinal transplants (ITx). We review outcomes of intestinal rehabilitation (IR) and ITx in patients with CD.

Methods: We reviewed records of patients with SBS due to CD focusing on bowel anatomy, inflammatory activity, parenteral nutrition (PN) dependence and weaning, need for surgery or ITx, and outcomes. 

Results: 24 of 238 (10%) intestinal failure patients over a 4-year period had SBS due to CD.  All but 1 had clinically quiescent CD, and 6 were on immunomodulators.  11 patients were considered “stable” IR candidates.  2 of the 11 weaned off PN following enterocutaneous fistula (ECF) repairs. 3 additional patients had PN reductions.  Both patients who achieved full enteral autonomy retained partial colon whereas most patients who remained PN dependent or required ITx (n=19) had an end ostomy.  7 patients underwent surgery to improve bowel function including 4 ECF repairs, 3 reverse segment procedures, and 1 resection of strictured small bowel.  4 of the surgical patients went on to require ITx evaluations. 6 patients were transplanted and 2 await ITx. 2 additional patients opted against ITx, 1 patient was too ill for ITx, and 1 patient died.  Of the 6 ITx patients, 4 patients are alive with functional grafts off PN.  2 patients died post ITx due to infectious complications; 1of the 2 developed recurrent ECF without evidence of recurrent CD.

Conclusions: 45% of stable patients with SBS from CD were partially or fully weaned from PN, suggesting potential for IR.  Surgery to correct ECF helped wean TPN; reverse segments appeared ineffective.  ITx was indicated in over 50% of patients, but was only pursued in 25% due to medical instability or patient preference.  Patient and graft survivals of 67% suggest comparable risk to other causes of SBS.

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