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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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  1. An international study of the quality of life of adult patients treated with home parenteral nutrition

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Compensatory mechanisms activated with intermittent energy restriction: A randomized control trial

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Five-year survival and causes of death in patients on home parenteral nutrition for severe chronic and benign intestinal failure

    Research output: Contribution to journalJournal articleResearchpeer-review

  • Home Artificial Nutrition & Chronic Intestinal Failure Special Interest Group of the European Society for Clinical Nutrition and Metabolism (ESPEN)
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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.

Original languageEnglish
JournalClinical nutrition (Edinburgh, Scotland)
Volume37
Issue number6 Pt A
Pages (from-to)1794-1797
Number of pages4
ISSN0261-5614
DOIs
Publication statusPublished - Dec 2018

ID: 56503744