Patients With Severe Gastrointestinal Dysmotility Disorders Receiving Home Parenteral Nutrition Have Similar Survival As Those With Short-Bowel Syndrome: A Prospective Cohort Study
- 1 March 2021
- journal article
- research article
- Published by Wiley in Journal of Parenteral and Enteral Nutrition
- Vol. 45 (3), 530-537
- https://doi.org/10.1002/jpen.1866
Abstract
Introduction Severe gastrointestinal dysmotility disorder (GID) constitute approximately 20% of patients requiring home parenteral nutrition (HPN), whereas short-bowel syndrome (SBS) remains the most frequent indication for HPN. This study's aim was to characterize GID patients and compare clinical parameters and survival to SBS patients. Similarly, clinical comparisons between sclerodermaand nonscleroderma patients were made. Methods Demographic and clinical data for all patients was extracted from the Canadian HPN Registry from January 1, 2003, to November 1, 2018. Kaplan-Meier method was used to estimate the unadjusted survival probability, and log-rank test was used to compare the survival probability between groups. Result 270 patients (52 GID and 218 SBS) were included in the analysis. For all patients, higher mortality was associated with age (hazard ratio [HR], 1.02 [1.00-1.04]; P = .05), PN dependence (HR, 1.01 [1.00-1.02]; P = .04), hospitalizations (HR, 1.21 [1.10-1.33]; P < .001), and use of immunosuppressant (HR, 1.97 [1.02-3.82]; P = .04). The 5- and 10-year actuarial survival probabilities between GID and SBS were not significantly different (5-year: 70.0% vs 59.2%; 10-year: 79.6% vs 66.2% [P = .5], respectively). There was no difference in survival between scleroderma and nonscleroderma patients (P = .67). Conclusion T5- and 10- year survival probabilities were similar between GID and SBS patients. The diagnosis of scleroderma had no effect on survival. Use of immunosuppressant, older age, PN dependence, and number of hospitalizations per PN duration are risk factors for mortality in both the GID and SBS groups.This publication has 25 references indexed in Scilit:
- Nutrition Management in Patients With Chronic Gastrointestinal Motility Disorders: A Systematic Literature ReviewNutrition in Clinical Practice, 2019
- Five-year survival and causes of death in patients on home parenteral nutrition for severe chronic and benign intestinal failureClinical Nutrition, 2018
- Definitions of intestinal failure and the short bowel syndromeBest Practice & Research Clinical Gastroenterology, 2016
- Long-term outcome of patients with systemic sclerosis requiring home parenteral nutritionClinical Nutrition, 2015
- Review article: the assessment and management of chronic severe gastrointestinal dysmotility in adultsAlimentary Pharmacology & Therapeutics, 2013
- Determinants of home parenteral nutrition dependence and survival of 268 patients with non-malignant short bowel syndromeClinical Nutrition, 2012
- Long-Term Outcome of Chronic Intestinal Pseudo-Obstruction Adult Patients Requiring Home Parenteral NutritionThe American Journal of Gastroenterology, 2009
- Advances in our understanding of the pathology of chronic intestinal pseudo-obstructionGut, 2004
- Long-term survival and parenteral nutrition dependence in adult patients with the short bowel syndromeGastroenterology, 1999
- Survival of Home Parenteral Nutrition-Treated Patients: 20 Years of Experience at the Mayo ClinicMayo Clinic Proceedings, 1999