Chronic intestinal failure and short bowel syndrome in Crohn’s disease

Abstract

Chronic intestinal failure (CIF) is a rare but feared complication of Crohn’s disease. Depending on the remaining length of the small intestine, the affected intestinal segment, and the residual bowel function, CIF can result in a wide spectrum of symptoms, from single micronutrient malabsorption to complete intestinal failure. Management of CIF has improved significantly in recent years. Advances in home-based parenteral nutrition, in particular, have translated into increased survival and improved quality of life. Nevertheless, 60% of patients are permanently reliant on parenteral nutrition. Encouraging results with new drugs such as teduglutide have added a new dimension to CIF therapy. The outcomes of patients with CIF could be greatly improved by more effective prevention, understanding, and treatment. In complex cases, the care of patients with CIF requires a multidisciplinary approach involving not only physicians but also dietitians and nurses to provide optimal intestinal rehabilitation, nutritional support, and an improved quality of life. Here, we summarize current literature on CIF and short bowel syndrome, encompassing epidemiology, pathophysiology, and advances in surgical and medical management, and elucidate advances in the understanding and therapy of CIF-related complications such as catheter-related bloodstream infections and intestinal failure-associated liver disease.

Keywords: Chronic intestinal failure; Short bowel syndrome; Crohn's disease; Inflammatory bowel disease; Parenteral nutrition; Intestinal failure-associated liver disease

Core Tip: Chronic intestinal failure (CIF) is a rare but feared severe complication of Crohn’s disease, with 60% of patients permanently dependent on parenteral nutrition. This review aims to summarize the knowledge available in the current literature describing recent advances in the management and treatment of adult patients with CIF, with emphasis on patients with Crohn’s disease. Moreover, it aims to further understanding of modern approaches to CIF complications such as catheter-related bloodstream infections and intestinal failure-associated liver disease.