HOME PARENTERAL-NUTRITION FOR THE MANAGEMENT OF CHRONIC INTESTINAL FAILURE - A 34 PATIENT-YEAR EXPERIENCE

Home parenteral nutrition (HPN) was used for the treatment of 18 patie nts with chronic intestinal failure (CIF): short bowel syndrome (9), e xtensive intestinal disease (4), motility disorder (4), entero-enteric fistulas (1). The underlying diseases were: chronic inflammatory (7), mesenteric vascular (4), scleroderma (2), pseudo-obstruction (2), mal ignancy (2), radiation enteritis (1). HPN was more effective on protei n-calorie nutritional status than on fluid and electrolyte balances. A bout two-thirds of the patients achieved full or partial social rehabi litation. During the 6 months before HPN, there were 20 hospitalizatio ns (mean stay: 55 days). During HPN (mean length of treatment: 22 mont hs/patient) there were 16 hospitalizations (mean stay: 22 days), 8 of which were caused by HPN complications (sepsis and deep vein thrombosi s; overall incidence of catheter-related complications: 0.411 per pati ent-year). Bone demineralization, liver abnormalities and biliary ston es developed, respectively, in 57%, 28% and 11% of the cases. The unde rlying intestinal condition played a role in their pathogenesis. The a nnual cost of HPN ranged from 40 (Hospital Pharmacy Service) to 80 (co mmercial firm) million lire per patient. To sum up, HPN improves the n utritional status and the quality of life of patients with CIF, and th e risk of complications is acceptable. The medical and social advantag es are considered to offset the cost of the technique.