Home parenteral Nutrition (HPN) in adult patients: Indications and outcome.

BACKGROUND & AIMS: Home parenteral nutrition (HPN) is used in patients with chronic intestinal failure (IF) who cannot meet their nutritional requirements by oral and/or enteral intake and who can be safely managed outside of the hospital. The objective of this educational paper is to inform readers about the indications for HPN in adult patients as well as about the outcomes of patients on HPN for both benign and malignant diseases.

METHODS

The review presented in this paper was conducted through a comprehensive evaluation of relevant published literature, including original research articles, review papers, and clinical guidelines.

RESULTS

The most common underlying diseases for benign chronic IF are inflammatory bowel disease, complications following surgery, mesenteric vascular disease, radiation enteritis, chronic small bowel disease with severe malabsorption and dysmotility syndromes. Short bowel syndrome is the indication in 64.4% of the patients with chronic benign IF. The prevalence of HPN varies worldwide reflecting different organizational structures and treatment strategies. The gastrointestinal anatomy as well as its function is important in determining the likelihood of subsequent weaning. The overall 5-year survival for patients with benign disease on HPN can vary between 58% and 83%, depending on the age of the patient at HPN initiation, underlying disease and mechanism leading to IF and gastrointestinal anatomy. Patients with advanced cancer may enter a HPN program but this is not recommended for those with a short life-expectancy; each patient with cancer should be selected on an individual basis by a multidisciplinary team. The survival of cancer patients on HPN depends on the severity of the malignant disease, its staging and type in addition to performance capacity and patient nutritional status.

CONCLUSIONS

This educational paper summarises our understanding of this complex condition and reviews indications and outcomes in the benign and malignant patient cohorts.