Clinical approach to the management of Intestinal Failure Associated Liver Disease (IFALD) in adults: A position paper from the Home Artificial Nutrition and Chronic Intestinal Failure Special Interest Group of ESPEN
Clinical approach to the management of Intestinal Failure Associated Liver Disease (IFALD) in adults: A position paper from the Home Artificial Nutrition and Chronic Intestinal Failure Special Interest Group of ESPEN
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DOI：
10.1016/j.clnu.2018.07.006
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发表时间：
2018-12-01
影响因子：
6.3
通讯作者：
Schneider, Stephane Michel
中科院分区：
文献类型：
--
作者：
Lal, Simon;Pironi, Loris;Schneider, Stephane Michel
我们建议，在没有其他原发性实质肝脏病理（如病毒性或自身免疫性肝炎）、其他肝毒性因素（如酒精/药物）或胆道梗阻的情况下，应通过肝功能检查异常和/或影像学和/或组织学肝脏异常的证据来诊断肠衰竭相关性肝病（IFALD）。应注意是否存在败血症，以及PN给药的持续时间。对于IFALD的诊断，肝脏组织学异常并不是强制性的，进行肝活检的决定应根据具体情况而定，但对于那些在放射成像上没有肝内或肝外胆汁淤积的持续异常的结合胆红素和/或持续或恶化的高胆红素血症，尽管任何潜在的败血症和/或任何慢性肝病的临床或放射特征得到解决，应特别考虑。应制定旨在减少PN过度喂养和优化口服/肠内营养的营养方法，以预防和/或管理IFALD。我们进一步建议给药的脂质限制在1克/千克/天以内，并尽可能减少规定的omega-6/omega-3 PUFA比例。对于有进展性肝纤维化或明显肝功能衰竭证据的患者，应考虑肠和肝联合移植。(C) 2018爱思唯尔有限公司和欧洲临床营养与代谢学会。版权所有。
We recommend that intestinal failure associated liver disease (IFALD) should be diagnosed by the presence of abnormal liver function tests and/or evidence of radiological and/or histological liver abnormalities occurring in an individual with IF, in the absence of another primary parenchymal liver pathology (e.g. viral or autoimmune hepatitis), other hepatotoxic factors (e.g. alcohol/medication) or biliary obstruction. The presence or absence of sepsis should be noted, along with the duration of PN administration. Abnormal liver histology is not mandatory for a diagnosis of IFALD and the decision to perform a liver biopsy should be made on a case-by-case basis, but should be particularly considered in those with a persistent abnormal conjugated bilirubin in the absence of intra or extra-hepatic cholestasis on radiological imaging and/or persistent or worsening hyperbilirubinaemia despite resolution of any underlying sepsis and/or any clinical or radiological features of chronic liver disease. Nutritional approaches aimed at minimising PN overfeeding and optimising oral/enteral nutrition should be instituted to prevent and/or manage IFALD. We further recommend that the lipid administered is limited to less than 1 g/kg/day, and the prescribed omega-6/omega-3 PUFA ratio is reduced wherever possible. For patients with any evidence of progressive hepatic fibrosis or overt liver failure, combined intestinal and liver transplantation should be considered. (C) 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.