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Prevalence of Liver Disease and Contributing Factors in Patients Receiving Home Parenteral Nutrition for Permanent Intestinal Failure

Maryan Cavicchi, MD; Philippe Beau, MD; Pascal Crenn, MD; Claude Degott, MD; and Bernard Messing, MD
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From Hôpital Lariboisière-St. Lazare, Paris; Centre Hospitalier Universitaire La Milétrie, Poitiers; and Hôpital Beaujon, Clichy, France.


Acknowledgments: The authors thank Ms. M. Beliah for her helpful assistance and Mr. Jeffrey Arsham for critical reading of the manuscript.

Requests for Single Reprints: Bernard Messing, MD, Service de Gastroentérologie et d'Assistance Nutritive, Hôpital Lariboisière-St. Lazare, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France; e-mail, bernard.messing@lrb.ap-hop-paris.fr.

Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

Current Author Addresses: Dr. Cavicchi: Service d'Hépato-Gastroentérologie, Hôpital Henri Mondor, 51 avenue du Mal de Lattre de Tassigny, 94010 Créteil, France.

Dr. Beau: Service d'Hépato-Gastroentérologie et de Nutrition, Centre Hospitalier Universitaire La Milétrie, 89000 Poitiers, France.

Dr. Crenn: Service d'Hépato-Gastroentérologie et de Nutrition, Hôpital Bichat-C. Bernard, 46 rue Henri Huchard, 75877 Paris Cedex 18, France.

Dr. Degott: Service d'Anatomo-Pathologie, Hôpital Beaujon, 100 boulevard du Général Leclerc, 92110 Clichy, France.

Dr. Messing: Service de Gastroentérologie et d'Assistance Nutritive, Hôpital Lariboisière-St. Lazare, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France.

Author Contributions: Conception and design: M. Cavicchi, P. Beau, B. Messing.

Analysis and interpretation of the data: M. Cavicchi, P. Crenn, C. Degott, B. Messing.

Drafting of the article: M. Cavicchi, B. Messing.

Critical revision of the article for important intellectual content: M. Cavicchi, P. Beau, C. Degott, B. Messing.

Final approval of the article: M. Cavicchi, P. Beau, P. Crenn, C. Degott, B. Messing.

Provision of study materials or patients: P. Beau, B. Messing.

Statistical expertise: M. Cavicchi, P. Crenn, B. Messing.

Administrative, technical, or logistic support: M. Cavicchi, B. Messing.

Collection and assembly of data: M. Cavicchi, P. Beau.


Ann Intern Med. 2000;132(7):525-532. doi:10.7326/0003-4819-132-7-200004040-00003
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During use of home parenteral nutrition, chronic abnormalities on liver function tests are reported to occur in both children and adults at a rate ranging from 15% to 85% (16). The pathogenesis of home parenteral nutrition-related liver disease, which presents mainly as chronic intrahepatic cholestasis with or without jaundice, is multifactorial and involves patient-dependent factors, especially the short-bowel syndrome (2, 57), and nutrition-dependent factors, such as intravenous hyperalimentation (1, 8). Other factors involved are intestinal bacterial overgrowth and translocation (910) and disruption of the enterohepatic bile acid pool with the occurrence of deconjugated toxic bile acids (1, 8). During the early months of home parenteral nutrition-related liver disease, histologic abnormalities consist of canalicular cholestasis and portal inflammation with or without fatty infiltration. Later, severe histologic changes—namely, extensive portal fibrosis or cirrhosis—have been anecdotally reported; over months and years, these conditions lead to liver failure and death (2, 56, 1113).

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Figure 1.
Probability of being free of clinical or biological complicated home parenteral nutrition-related liver disease (solid line) in 90 patients with permanent intestinal failure and probability of being free of histologic complicated home parenteral nutrition-related liver disease (dashed line) in a subgroup of 57 patients who underwent liver biopsy.

The probability of developing complicated clinical or biological home parenteral nutrition-related liver disease was 26% (CI, 17% to 35%) at 2 years, 39% (CI, 28% to 50%) at 4 years, 50% (CI, 37% to 63%) at 6 years, and 53% (CI, 39% to 67%) at 8 years. The probability of developing a severe histologic lesion (extensive fibrosis or cirrhosis) was 20% (CI, 9% to 31%) at 2 years, 35% (CI, 21% to 49%) at 4 years, 45% (CI, 29% to 61%) at 6 years, and 56% (CI, 37% to 75%) at 8 years.

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Figure 2.
Probability of being free of complicated home parenteral nutrition-related liver disease in 90 patients with permanent intestinal failure, according to parenteral lipid intake.dashed linesolid lineP

In univariate analysis, parenteral lipid intake of 1 g/kg per day or more ( ) significantly increased the risk for complicated home parenteral nutrition-related liver disease compared with intake of less than 1 g/kg per day ( ) ( < 0.001). In multivariate analysis, a parenteral lipid intake of 1 g/kg per day or more yielded a relative risk of 3.4 (CI, 1.6 to 6.8) for complicated home parenteral nutrition-related liver disease.

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Summary for Patients

Liver Disease in Patients Receiving Home Intravenous Feeding

The summary below is from the full report titled “Prevalence of Liver Disease and Contributing Factors in Patients Receiving Home Parenteral Nutrition for Permanent Intestinal Failure.”. It is in the 4 April 2000 issue of Annals of Internal Medicine (volume 132, pages 525-532). The authors are M. Cavicchi, P. Beau, P. Crenn, C. Degott, and B. Messing.

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