Background and Aims

Intestinal failure (IF) is a feared complication of Crohn’s disease (CD). Although cumulative loss of small bowel due to bowel resections is thought to be the dominant cause, the causes and outcomes have not been reported.

Methods

Consecutive adult patients referred to a national intestinal failure unit 2000-2018 with a diagnosis of CD and subsequently treated with parenteral nutrition during at least 12 months were included in this longitudinal cohort study. Data were extracted from a prospective institutional clinical database and patient records.

Results

121 patients were included. 62 (51%) of patients developed IF as a consequence of abdominal sepsis complicating abdominal surgery, while small bowel resection, primary disease activity and proximal stoma were less common causes (31, 12 and 6%, respectively). 32 had perianastomotic sepsis, and 15 of those had documented risk factors for anastomotic dehiscence. On Kaplan-Meier analysis, 40% of all patients regained nutritional autonomy within 10 years and none did subsequently. 14% of patients developed intestinal-failure-associated liver disease. On Kaplan-Meier analysis, projected mean age of death was 74 (2) years.

Conclusions

IF is a severe complication of CD, with 60% permanently dependent on parenteral nutrition. The most frequent event leading directly to IF was a septic complication following abdominal surgery, in many cases following intestinal anastomosis in the presence of significant risk factors for anastomotic dehiscence. A reduced need for abdominal surgery, an increased awareness of perioperative risk factors and structured pre-operative optimisation may reduce the incidence of IF in CD.

中文翻译：

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克罗恩病肠功能衰竭的原因和预后：来自国家中心的 18 年经验

背景和目标

肠功能衰竭 (IF) 是克罗恩病 (CD) 令人担忧的并发症。尽管肠切除术导致的小肠累积丢失被认为是主要原因，但尚未报道其原因和结果。

方法

该纵向队列研究包括连续成年患者转诊至 2000-2018 年被诊断为 CD 并随后接受肠外营养治疗至少 12 个月的国家肠功能衰竭病房。从前瞻性机构临床数据库和患者记录中提取数据。

结果

包括 121 名患者。62 (51%) 名患者因腹部脓毒症并发腹部手术而发展为 IF，而小肠切除、原发疾病活动和近端造口是不太常见的原因（分别为 31、12 和 6%）。32 人患有吻合口周围脓毒症，其中 15 人记录了吻合口裂开的危险因素。在 Kaplan-Meier 分析中，40% 的患者在 10 年内恢复了营养自主，随后没有。14% 的患者出现了肠功能衰竭相关的肝病。在 Kaplan-Meier 分析中，预计的平均死亡年龄为 74 (2) 岁。

结论

IF 是 CD 的严重并发症，其中 60% 永久依赖肠外营养。直接导致 IF 的最常见事件是腹部手术后的脓毒症并发症，在许多情况下，肠吻合术后存在吻合口裂开的重要危险因素。减少对腹部手术的需求、提高对围手术期危险因素的认识以及结构化的术前优化可能会降低 CD 中 IF 的发生率。