Clinical nutrition ESPEN · 2026
Metabolic complications of home parenteral nutrition and chronic intestinal failure and indications for intestinal transplantation.
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Pironi Loris, Joly Francisca, Lal Simon, Van Gossum Andre, Wanten Geert
Аннотация
BACKGROUND & AIMS: Patients on home parenteral nutrition (HPN) for chronic intestinal failure (CIF) may develop several metabolic complications whose pathogenesis is multifactorial, due to factors "CIF-related" and "HPN-related" factors. In a few cases, a life-saving or a rehabilitative intestinal transplantation (ITx) may be required. The learning objectives of this educational paper is to inform readers on the pathogenesis, diagnosis, prevention and treatment of HPN/CIF-related metabolic complications as well as on the indications for ITx.
METHODS: The present review is based on the guidelines on HPN and on CIF of the European Society for Clinical Nutrition and Metabolism (ESPEN) and on relevant original research articles and review papers.
RESULTS: The following metabolic complications are discussed: fluid, electrolyte and acid-base balance abnormalities, hyper and hypo-glycaemia, essential fatty acid deficiency, vitamin and trace element deficiency or excess, intestinal failure associated liver disease, gallbladder sludge and stones, renal function impairment and renal stones, and metabolic bone disease. Indication criteria for life-saving ITx are described.
CONCLUSIONS: Patients on HPN for CIF may develop several metabolic complications that can be prevented and treated through appropriate monitoring and management by an expert multidisciplinary team. Early referral to expert intestinal rehabilitative-centres is recommended for patients with CIF, in order to devise the most appropriate treatment strategy.
METHODS: The present review is based on the guidelines on HPN and on CIF of the European Society for Clinical Nutrition and Metabolism (ESPEN) and on relevant original research articles and review papers.
RESULTS: The following metabolic complications are discussed: fluid, electrolyte and acid-base balance abnormalities, hyper and hypo-glycaemia, essential fatty acid deficiency, vitamin and trace element deficiency or excess, intestinal failure associated liver disease, gallbladder sludge and stones, renal function impairment and renal stones, and metabolic bone disease. Indication criteria for life-saving ITx are described.
CONCLUSIONS: Patients on HPN for CIF may develop several metabolic complications that can be prevented and treated through appropriate monitoring and management by an expert multidisciplinary team. Early referral to expert intestinal rehabilitative-centres is recommended for patients with CIF, in order to devise the most appropriate treatment strategy.