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Intestinal failure-associated liver disease

causes, manifestations and therapies

Rochling, Fedja A.a; Catron, Hilary A.b

Current Opinion in Gastroenterology: March 2019 - Volume 35 - Issue 2 - p 126–133
doi: 10.1097/MOG.0000000000000503
NUTRITION: Edited by Eamonn M.M. Quigley

Purpose of review The goal of this review is to provide updates on the causes, manifestations and therapies IFALD in adults with an emphasis on recent discoveries on pathways of pathogenesis and interventions to reduce the incidence of IFALD.

Recent findings IFALD is a multifactorial complication of long-term home parenteral therapy. Although exact pathways are unknown, altered bile acid metabolism, microbiome dysbiosis impact on the gut–liver axis and soybean-based lipid formulations are major drivers of IFALD development.

Summary IFALD contributes to morbidity and mortality in patients on parenteral nutrition. Proactive management by a multidisciplinary team has led to improved outcomes in at-risk patients. Attention to early treatment and prevention of sepsis, introduction of nonsoybean based lipid formulations, surgical procedures such as step enteroplasties and, potentially, microbiome dysbiosis are considerations in IFLAD management.

aDivision of Gastroenterology and Hepatology, MSB 5533, 982000 The Nebraska Medical Center

bDepartment of Clinical Nutrition, 981200 Nebraska Medicine, Omaha, Nebraska, USA

Correspondence to Fedja A. Rochling, MB, BCh (NUI), MBA, Associate Professor of Medicine, Division of Gastroenterology and Hepatology, MSB 5533, 982000 The Nebraska Medical Center, Omaha, NE 68198-2000, USA. E-mail:

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