Chronic intestinal failure and short bowel syndrome in Crohn's disease.

Chronic intestinal failure (CIF) is a rare but feared complication of Crohn's disease. Depending on the remaining length of the small intestine, the affected intestinal segment, and the residual bowel function, CIF can result in a wide spectrum of symptoms, from single micronutrient malabsorption to complete intestinal failure. Management of CIF has improved significantly in recent years. Advances in home-based parenteral nutrition, in particular, have translated into increased survival and improved quality of life. Nevertheless, 60% of patients are permanently reliant on parenteral nutrition. Encouraging results with new drugs such as teduglutide have added a new dimension to CIF therapy. The outcomes of patients with CIF could be greatly improved by more effective prevention, understanding, and treatment. In complex cases, the care of patients with CIF requires a multidisciplinary approach involving not only physicians but also dietitians and nurses to provide optimal intestinal rehabilitation, nutritional support, and an improved quality of life. Here, we summarize current literature on CIF and short bowel syndrome, encompassing epidemiology, pathophysiology, and advances in surgical and medical management, and elucidate advances in the understanding and therapy of CIF-related complications such as catheter-related bloodstream infections and intestinal failure-associated liver disease.
Competing Interests: Conflict-of-interest statement: Aksan A reports congress expenses, consultancy fees and research funding from Vifor Pharma and Immundiagnostik AG. Farrag K reports speakers’ honoraria and congress expenses from Immundiagnostik AG, Janssen Cilag GmbH; consultancy honoraria from Vifor Pharma. Blumenstein I reports consultancy honoraria from AbbVie Deutschland, Amgen GmbH, Bristol Myers Squibb, Janssen Cilag GmbH, Fresenius Kabi Deutschland, Pharmacosmos GmbH, Pfizer GmbH, Shire Deutschland GmbH, Takeda Pharma GmbH; honoraria from AbbVie Deutschland, Biogen GmbH, DGVS, Dr. Falk Pharma GmbH, Endoakademie, Ferring Arzneimittel, Fraunhofer, Fresenius Kabi Deutschland, Kompetenznetz Darmerkrankungen, MSD Sharp Dome, Mylan GmbH, Pfizer GmbH, Janssen Cilag GmbH, Shire Deutschland GmbH, Takeda Pharma GmbH. Schroeder O reports congress expenses from Abbvie, Falk, Janssen, Takeda; speakers’ honoraria from Abbvie, Falk, Janssen, Takeda, Norgine, Pfizer. Dignass A reports consultancy honoraria from Abbott, Pharmacosmos, MSD, Ferring, Janssen, Pfizer, Otsuka, Roche/Genentech, Takeda, Falk; grants from Institut für Gemeinwohl & Stiftung Leben mit Krebs; Lecturing: Falk, Ferring, MSD, Abbott, Janssen, Pfizer, Otsuka, Vifor, Stiftung Leben mit Krebs, Kompetenznetz CED, Takeda, Pharmacosmos; Manuscript preparation: Falk. Education presentations: Abbott, Pharmacosmos, Falk, Ferring. Stein J reports personal fees from Abbvie, personal fees from Dr Schär, personal fees from Falk, personal fees from Ferring, personal fees from Fresenius Kabi, personal fees from Immundiagnostik AG, personal fees from Janssen, personal fees from Medice, personal fees from MSD, personal fees from Pfizer, personal fees from Pharmacosmos, personal fees from Shire, personal fees from Shield, personal fees from Takeda, personal fees from ThermoFisher, personal fees from Vifor Pharma, from NPS, outside the submitted work.
(©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.)