Inflammatory bowel disease (IBD) is increasing in prevalence around the world.1 It can be divided into Crohn’s disease (CD), an inflammatory condition of the entire gastrointestinal tract, or ulcerative colitis, which predominantly affects the large bowel. Advances in therapy, such as anti-integrins, anti IL12/23 and particularly anti-tumour necrosis alpha biologics, have contributed to a decrease in surgical intervention.2 Unfortunately, there is a cohort of patients with a severe phenotype, who are refractory to available therapy and ultimately develop intestinal failure (IF). Risk factors which have been identified for this phenotype include a younger age at diagnosis or at first surgery, ileocolonic and perianal disease, family history, smoking and initial need for corticosteroids.3 4 In fact, a recent study has shown surgical complications (abdominal sepsis) as being the most common cause of IF in patients with CD.4 This may explain why, in combination with the development of targeted biological therapies, a study from a national IF unit found a decrease in the number of patients with IF due to CD directly and an increase in those whose aetiology was from surgical complications.5 A 40-year study from a Danish IF unit showed the number of home parenteral nutrition (HPN) patients due to IBD increased by around 30 patients a decade but reduced as percentage of total cases.6 The accepted definition of IF is “the reduction of gut function below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous supplementation is required to maintain health and/or growth”.7 IF still remains rare, with a prevalence of patients on parenteral nutrition (PN) of between 5 and 20 patients per million7 and around one-third of these patients have CD.3 IF has been defined into three types (table 1).7–9 Many …

中文翻译：

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管理炎症性肠病的肠道衰竭——“当药物不起作用时”

炎症性肠病 (IBD) 在世界范围内的患病率正在增加。1 它可分为克罗恩病 (CD)，一种整个胃肠道的炎症性疾病，或主要影响大肠的溃疡性结肠炎。治疗的进步，例如抗整合素、抗 IL12/23，尤其是抗肿瘤坏死 α 生物制剂，导致手术干预减少。 2 不幸的是，有一组患者具有严重表型，对可用的治疗并最终发展为肠衰竭（IF）。已确定该表型的风险因素包括诊断时或首次手术时年龄较小、回结肠和肛周疾病、家族史、吸烟和对皮质类固醇的初始需求。 3 4 事实上，