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Liver Disease in Patients Receiving Home Intravenous Feeding
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What is the problem and what is known about it so far?
Some people with diseases of the digestive tract (particularly those with diseases that require surgery to remove a large part of the intestine) require permanent feeding through a small tube inserted into a vein (intravenous feeding). Liver damage can be a side effect of intravenous feeding. That complication is not uncommon, but its exact frequency is not known. The liver damage may involve only a mild backup of bile (known as chronic cholestasis), which does not keep the liver from functioning. In other instances, the damage is more severe and the liver stops working properly, which sometimes requires liver transplantation or causes death.
Why did the researchers do this particular study?
To determine the frequency of liver disease in patients getting permanent intravenous feeding, and to explore factors associated with this complication.
Who was studied?
The study included 90 patients enrolled in two home intravenous feeding programs in France between 1985 and 1996. None of the patients had liver problems before starting intravenous feeding.
How was the study done?
In addition to gathering information about patients' general and health characteristics, the researchers did blood tests of patients' liver function both before they began the intravenous feeding and again 3, 6, and 12 months later. After 12 months, they did blood tests and ultrasound studies (πctures taken by using sound waves) of the liver yearly or if complications occurred. If the results suggested liver problems, the patients had a liver biopsy. A liver biopsy involves taking a small sample of liver tissue through a needle inserted into the abdomen. Experts then examine the tissue under a microscope. The researchers also collected information on the nutritional content of each patient's intravenous feeding.
What did the researchers find?
Of the 90 patients, chronic cholestasis developed in 58 (65%) and complicated liver disease occurred in 37 (41.5%). Six patients died of liver disease. Cholestasis was more common in people who had been receiving intravenous feeding for more years, had pre-existing risk for liver disease (for example, alcohol use or viral hepatitis), had the smallest amount of intestine left after surgery, and received more fat in their intravenous feeding. Chronic cholestasis and the amount of fat in the feedings were associated with the development of more severe liver complications.
What were the limitations of the study?
This study included relatively few patients in two programs in Europe; the results might be different in other patient groups. The researchers included 15 patients who had pre-existing risks for liver disease, which makes it harder to know how much of the liver damage was caused by the intravenous feeding itself.
What are the implications of the study?
Liver complications are common in patients who require permanent intravenous feeding. Pre-existing risk factors for liver disease increase the risk for cholestasis, which, in turn, appears to increase the risk of more severe liver disease. Changing the fat content of the feeding might help to limit liver complications.
Article and Author Information
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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.
- Copyright ©2004 by the American College of Physicians
