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World J Gastroenterol. Mar 28, 2014; 20(12): 3153-3163
Published online Mar 28, 2014. doi: 10.3748/wjg.v20.i12.3153
Management of intestinal failure in inflammatory bowel disease: Small intestinal transplantation or home parenteral nutrition?
Elizabeth Harrison, Philip Allan, Amrutha Ramu, Anil Vaidya, Simon Travis, Simon Lal
Elizabeth Harrison, Philip Allan, Amrutha Ramu, Simon Lal, Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Greater Manchester M6 8HD, United Kingdom
Philip Allan, Amrutha Ramu, Simon Travis, Translational Gastroenterology Unit, Oxford University Hospitals NHS Trust, Oxford OX3 6RP, United Kingdom
Anil Vaidya, Transplant Centre, Oxford University Hospitals NHS Trust, Oxford OX3 7LE, United Kingdom
Author contributions: Lal S devised, reviewed and edited the article; Harrison E and Allan P wrote and edited the article; Ramu A, Vaidya A and Travis S reviewed and edited the article.
Correspondence to: Dr. Elizabeth Harrison, Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Greater Manchester M6 8HD, United Kingdom. elizabeth.harrison-3@manchester.ac.uk
Telephone: +44-161-2061442 Fax: +44-161-2061442
Received: September 28, 2013
Revised: November 21, 2013
Accepted: January 14, 2014
Published online: March 28, 2014
Processing time: 180 Days and 10.3 Hours
Abstract

Inflammatory bowel disease and Crohn’s disease in particular, is a common cause of intestinal failure. Current therapeutic options include home parenteral nutrition and intestinal transplantation. For most patients, home intravenous therapy including parenteral nutrition, with a good probability of long-term survival, is the favoured choice. However, in selected patients, with specific features that may shorten survival or complicate home parenteral nutrition, intestinal transplantation presents a viable alternative. We present survival, complications, quality of life and economic considerations that currently influence individualised decision-making between home parenteral nutrition and intestinal transplantation.

Keywords: Inflammatory bowel disease; Crohn’s disease; Intestinal failure; Intestinal transplantation; Home parenteral nutrition; Survival; Complications; Quality of life

Core tip: In this review we describe and compare the principal options for the management of intestinal failure in patients with inflammatory bowel disease: home parenteral nutrition and intestinal transplantation. We describe patient survival, complications and quality of life considerations that influence individualised decision-making between approaches. As survival from transplantation improves, decision-making is likely to change.