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|Survival and PN Dependence in SBS Patients|
Following is a review of a French study on “Long-term Survival and Parenteral Nutrition Dependence in Adult Patients with the Short Bowel Syndrome” by Messing, et. al., reported in Gastroenterology 1999;117:1043-1050. In France all TPN patients are treated at a few government-established centers. This is advantageous in that the data is thorough (it represents all of the French long-term TPN patients) and patient management is consistent (quality of care is more consistent and therefore plays a less significant role in varying patient outcomes).
The normal length of adult small bowel ranges from 3 to 8 meters (approximately 10 to 25 feet) depending on how it is measured. A patient is described as having SBS if he or she has roughly 150 cm or less of his/her bowel (about 4 to 6 feet).
Characteristics ...............Percentage of Patients
Factors affecting TPN dependency are detailed in the figures below. Figure A shows, as one would expect, how a shorter bowel length increases the probability that the patient will be dependent on TPN. What may surprise some readers, is the importance of the ileocecal valve and in-continuity colon; these factors play a very important role in determining whether a patient will be able to wean from TPN, as shown in Figures B and C.
Messing, et. al, found that most SBS patients able to wean off TPN, do so within 3 to 6 months of initiating the therapy; and 95 percent of the SBS patients who come off TPN, wean within two years. Conversely, 94 percent of the SBS patients who are on TPN for two years, are on indefinitely. Therefore, if you have SBS, and have been on TPN for two years or more, there is only a slim chance you will get off TPN.
Factors that lower an SBS patient’s chance of survival include having an end-enterostomy (usually an end-jejunostomy) and less than 50 cm of remaining bowel. An arterial infarction as the cause of SBS, was also associated with lower survival rates.
The authors found no significant correlation between dependency on TPN and mortality; they concluded TPN is not likely to kill the patient. (It is typically the patient’s underlying diagnosis or lack of bowel that leads to death.) Likewise, age did not significantly affect an SBS patient’s chance of survival.
The authors conclude that a two-year TPN limit may serve as a useful predictor, distinguishing adult SBS patients with a short-term need for TPN from those who are most likely to be permanently dependent on the therapy.