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Intestinal failure-associated liver disease in adult patients

Morgan, Jamesa,b; Dibb, Martynb; Lal, Simona

Current Opinion in Clinical Nutrition & Metabolic Care: September 2019 - Volume 22 - Issue 5 - p 383–388
doi: 10.1097/MCO.0000000000000594
NUTRITION AND THE GASTROINTESTINAL TRACT: Edited by M. Isabel T.D. Correia and André Van Gossum
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Purpose of review The aim of this review is to give up-to-date information on intestinal failure-associated liver disease (IFALD) and how its investigation and management has evolved. Despite advances in treatment for patients with intestinal failure, IFALD remains a significant cause of mortality.

Recent findings Liver biopsy remains as the gold standard for the diagnosis of IFALD, but its invasive nature has prompted assessment of noninvasive techniques. Risk factors for IFALD are both nonnutritional (e.g. sepsis) and nutritional. Strict protocols for the prevention of central venous catheter infections in patients with intestinal failure are well established, as is the optimization of the constituents of parenteral nutrition. Further research comparing the available lipid emulsions has become available. Novel approaches at maximizing intestinal absorption are discussed including glucagon-like peptide-2 analogues, as well as surgical approaches.

Summary Although there are data on the novel investigative and therapeutic strategies for managing IFALD, further study is required to identify a suitable noninvasive technique for earlier diagnosis and then monitoring of IFALD. Further data are also required on the impact of novel therapies aimed at improving absorption and reducing parenteral nutrition load on IFALD occurrence and progression.

aIntestinal Failure Unit, Salford Royal NHS Foundation Trust, Stott Ln, Salford M6 8HD

bGastroenterology Department, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK

Correspondence to James Morgan, Gastroenterology Department, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK. E-mail: James.Morgan@rlbuht.nhs.uk

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