Metabolic bone diseases in intestinal failure.

Metabolic bone diseases are a group of conditions that are common complications in patients with intestinal failure. These may occur as a result of the underlying condition, leading to intestinal failure, particularly inflammatory conditions such as Crohn's disease and their associated treatments including corticosteroids. Malabsorption, as a result of a loss of enterocyte mass or gut function, of many nutrients, including vitamin D, may further compound metabolic bone problems, and there has been historical contamination of parenteral nutrition with aluminium that has prevented normal bone metabolism contributing to osteoporosis. This review looks at the diagnosis and current management of bone health in patients with intestinal failure.

COVID-19 infection in patients with intestinal failure: UK experience.

BACKGROUND: The direct effect of the coronavirus disease 2019 (COVID-19) pandemic on patients with intestinal failure (IF) has not been described. METHODS: We conducted a nationwide study of UK IF centers to evaluate the infection rates, presentations, and outcomes in patients with types 2 and 3 IF. RESULTS: A total of 45 patients with IF contracted COVID-19 between March and August 2020; this included 26 of 2191 (1.2%) home parenteral nutrition (HPN)-dependent adults and 19 of 298 (6.4%) adults hospitalized with type 2 IF. The proportion of patients receiving nursing care for HPN administration was higher in those with community-acquired COVID-19 (66.7%) than the proportion in the entire HPN cohort (26.1%; P < .01). Two HPN-dependent and 1 hospitalized patient with type 2 IF died as a direct consequence of the virus (6.7% of 45 patients with types 2 or 3 infected). CONCLUSION: This is the first study to describe the outcomes of COVID-19 in a large cohort of patients requiring long-term PN. Methods to reduce hospital and community nosocomial spread would likely be beneficial.

Medical complications of anorexia nervosa.

Anorexia nervosa is a psychiatric disorder with potential life-threatening medical sequelae. This article reviews the principal medical complications associated with anorexia nervosa, highlights associated diagnostic pitfalls and emphasizes the importance of a multidisciplinary approach to management.

Outcome of intestinal failure after bariatric surgery: experience from a national UK referral centre.

BACKGROUND/OBJECTIVES: Bariatric surgery for morbid obesity provides sustained weight loss. Complications of bariatric surgery include severe nutritional decline, but minimal data describing occurrence and outcome of intestinal failure (IF) exist. SUBJECTS/METHODS: All patients referred to one of the UK's National IF units (IFU) are prospectively entered onto a database; case notes were assessed for bariatric surgery details, IF onset, outcomes, resulting intestinal anatomy, mortality and catheter-related bloodstream infections (CRBSIs). RESULTS: A total of six patients (mean referral age 54.0 years; 95% confidence interval (CI): 44.6-63.4; 5 female) were identified with IF after bariatric surgery from 457 patients (total cohort) managed on home parenteral nutrition (HPN) at the IFU between 2008 and 2014. In all, 6/6 had Roux-en-Y gastric bypass bariatric surgery. Median (range) time from index bariatric surgery to IF development was 28.7 months (1.7-106). IF aetiology was internal herniation (4/6), ischaemia (1/6) and anastomotic leak (1/6); all patients required HPN for a median of 26.4 months (15.3-34.7). CRBSI occurred on 7 occasions in 3 patients, equivalent to 1.5/1000 catheter days in these 6 compared with 0.32/1000 in the 451 IFU HPN patients during this time period. In all, 0/6 patients died, 6/6 had continuity restored in a median of 16.5 months (6.5-32.5) after IF diagnosis and 3/6 (50%) were weaned from PN by a median of 2.2 months (0.6-12.8). CONCLUSIONS: Bariatric surgery, an increasingly common operation, can be associated with IF necessitating long-term HPN. The cohort presented had a higher CRBSI compared with other HPN patients; more stringent approaches to catheter care may be required in this patient group, although more collective data are required.

Reduced need for replacement of long term parenteral nutrition catheters following endoluminal brushing.

BACKGROUND & AIMS: Patients with Intestinal failure (IF) on long-term nutritional support (IF Type 3) through parenteral nutrition (PN) require invasive venous access to provide nutritional compounds. Central venous catheters (CVC) are at risk of complications including microbial infections and occlusion. Occlusions can be resolved by administering parenteral solutions to achieve patency. However, we report an alternative methodology for salvaging occluded CVCs and achieving patency using endoluminal brushing. METHODS: Patients admitted with a CVC occlusion to one of the two national IF centres in the UK, were entered into a prospectively managed database and the data were then analysed retrospectively. The study used data from patients who had CVC occlusions from December 2003 to March 2006 (Cohort 1) and from April 2006 to September 2010 (Cohort 2). Cohort 1 included occluded CVCs managed using endoluminal brushing and the split of cohorts was determined by the availability of endoluminal brushes. Cohort 2 included occluded CVCs managed using a 'standard' technique of urokinase with or without adjuncts such as Ethanol, Hydrochloric acid or Sodium hydroxide. If therapy failed, the CVC was removed. Data were recorded on success of achieving patency and occurrence of re-occlusion. RESULTS: 66 episodes of CVC occlusion from 44 patients occurred in Cohort 1, compared to 68 episodes in 45 patients in Cohort 2. There was no difference in gender, age, median time on TPN prior to occlusive episode or disease aetiology. The number of CVCs where patency was achieved was 57 (86%) in Cohort 1 compared to 34 (50%) in Cohort 2 (p < 0.0001). Consequently, the number of CVCs replaced were 9 (14%) in Cohort 1 compared to 34 (50%) in Cohort 2 (p < 0.0001). There were no complications associated with endoluminal brushing or 'standard' therapy. CONCLUSION: This is the first report of the safe and effective use of endoluminal brushing to manage occluded CVCs in patients requiring long-term parenteral nutrition.

Studies on the effects of infectious bovine rhinotracheitis virus on reproduction in heifers.

Natural venereal infection of heifers with IBR virus resulted in vulvovaginal lesions in 9 of 12 heifers at 3 weeks after introducttion to bulls, and virus was isolated from 5 of the 9 affected animals. The infection was not associated with any effect on conception. Experimental nasal and conjunctival infection of 18 heifers pregnant for 3, 5 or 7 months with a genital strain of IBR virus caused mild rhinitis or conjunctivitis in all inoculated animals and virus was recovered from 14 animals at 8 days after inoculation. No effects on pregnancy were recorded.