Intestinal failure-associated liver disease: causes, manifestations and therapies

Purpose of review The goal of this review is to provide updates on the causes, manifestations and therapies IFALD in adults with an emphasis on recent discoveries on pathways of pathogenesis and interventions to reduce the incidence of IFALD. Recent findings IFALD is a multifactorial complication of long-term home parenteral therapy. Although exact pathways are unknown, altered bile acid metabolism, microbiome dysbiosis impact on the gut–liver axis and soybean-based lipid formulations are major drivers of IFALD development. Summary IFALD contributes to morbidity and mortality in patients on parenteral nutrition. Proactive management by a multidisciplinary team has led to improved outcomes in at-risk patients. Attention to early treatment and prevention of sepsis, introduction of nonsoybean based lipid formulations, surgical procedures such as step enteroplasties and, potentially, microbiome dysbiosis are considerations in IFLAD management.
Source: Current Opinion in Gastroenterology - Category: Gastroenterology Tags: NUTRITION: Edited by Eamonn M.M. Quigley Source Type: research

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Source: Clinical Nutrition - Category: Nutrition Authors: Tags: Liver and gastrointestinal tract II Source Type: research
Purpose of review The aim of this review is to give up-to-date information on intestinal failure-associated liver disease (IFALD) and how its investigation and management has evolved. Despite advances in treatment for patients with intestinal failure, IFALD remains a significant cause of mortality. Recent findings Liver biopsy remains as the gold standard for the diagnosis of IFALD, but its invasive nature has prompted assessment of noninvasive techniques. Risk factors for IFALD are both nonnutritional (e.g. sepsis) and nutritional. Strict protocols for the prevention of central venous catheter infections in patients ...
Source: Current Opinion in Clinical Nutrition and Metabolic Care - Category: Nutrition Tags: NUTRITION AND THE GASTROINTESTINAL TRACT: Edited by M. Isabel T.D. Correia and André Van Gossum Source Type: research
In the past decades, considerable progress has been made in intensive care and survival rate of premature infants. Administration of parenteral nutrition (PN) has improved the nutritional status of premature infants in their early life, especially for infants with extremely low birth weight. Lipid emulsions (LEs) are recognized as essential components of non-protein energy supplement of PN. In addition to their high caloric value and low osmolality, the use of LE prevents the complications of using glucose as sole non-protein energy source; these complications include fatty acid deficiency, hyperglycemia, and hepatic steatosis.
Source: Pediatrics and Neonatology - Category: Perinatology & Neonatology Authors: Tags: Editorial Source Type: research
Abstract BACKGROUND: Routine monitoring of gastric residuals in preterm infants on gavage feeds is a common practice in many neonatal intensive care units and is used to guide the initiation and advancement of feeds. No guidelines or consensus is available on whether to re-feed or discard the aspirated gastric residuals. Although re-feeding gastric residuals may replace partially digested milk, gastrointestinal enzymes, hormones, and trophic substances that aid in digestion and promote gastrointestinal motility and maturation, re-feeding abnormal residuals may result in emesis, necrotising enterocolitis, or sepsis...
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
CONCLUSION: Children with IFALD are at risk for vitamin K deficiency during cholestasis reversal. Close monitoring and quantified supplementation of vitamin K may be warranted during this period. However, this should not be guided by INR alone, as it is a poor indicator of vitamin K status. PMID: 31282035 [PubMed - as supplied by publisher]
Source: JPEN Journal Of Parenteral And Enteral Nutrition - Category: Nutrition Authors: Tags: JPEN J Parenter Enteral Nutr Source Type: research
The recently published guidelines on nutrition in chronic liver disease, proposed by the European Association for the Study of the Liver (EASL), offer a wide panorama of the most important recommendations on malnutrition in cirrhotic patients [1]. Nevertheless, as stated by the authors, it is still controversial whether malnutrition in decompensated liver disease can be reversed by the proposed nutritional strategies (late evening oral nutritional supplementation and breakfast in a dietary regimen, branched chain amino acid supplements, leucine-enriched amino acid supplements, improvement of diet palatability and enteral o...
Source: Digestive and Liver Disease - Category: Gastroenterology Authors: Tags: Correspondence Source Type: research
CONCLUSIONS: Based on the current review, there is insufficient data from randomised studies to determine with any certainty, the potential benefit of any LE including fish oil-containing LEs over another LE, for prevention or resolution of PNALD/cholestasis or any other outcomes in term and late preterm infants with underlying surgical conditions or cholestasis. There were no studies in infants without surgical conditions or cholestasis.Further research is required to establish role of fish oil or lipids from other sources in LEs to improve PNALD/cholestasis, and other clinical outcomes in parenterally fed term and late p...
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
CONCLUSIONS: In the current review, we did not find any particular LE with or without fish oil to be better than another LE in preterm infants for prevention of PNALD/cholestasis, growth, mortality, ROP, BPD and other neonatal outcomes.In preterm infants with surgical conditions or cholestasis, there is currently insufficient evidence from randomised studies to determine with any certainty if fish oil LEs offer advantage in prevention or resolution of cholestasis or in any other clinical outcome.Further research, with larger well-designed trials, is warranted to evaluate the ideal composition of LE in preterm infants and t...
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
Objectives: In parenteral nutrition-dependent infants and children, intestinal failure (IF)-associated liver disease (IFALD) remains an important problem. A comparative study was undertaken of parenteral mixed lipid (ML), ω-3 predominant fish oil (FO), and ω-6 predominant soybean oil (SO) emulsions in regards to hepatic phytosterol, neutral lipid, fatty acid (FA) content, and the relationship to cholestasis in piglets. Methods: Neonatal piglets received parenteral nutrition, varying in lipid dose (5 or 10 g· kg−1 · day−1) and formulation: SO5 (n = 5), SO10 (n = 5),...
Source: Journal of Pediatric Gastroenterology and Nutrition - Category: Gastroenterology Tags: Original Articles: Nutrition Source Type: research
The objective of the present study was to investigate the immediate and delayed effects of moderate, clinically-relevant HB on cardiorespiratory control in preterm lambs. Two groups of five preterm lambs, namely control and HB, were studied. At day five of life, moderate HB (150–250 μmol/L) was induced and maintained during 17 h in the HB group while control lambs received a placebo solution. Six hours after HB onset, 7-h polysomnographic recordings with electrocardiogram (ECG) and respiratory (RESP) signals were performed to assess the immediate effects of HB on heart rate variability (HRV), respiratory rate vari...
Source: Frontiers in Physiology - Category: Physiology Source Type: research
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