Explore the vast range of titles available.

Background Immunonutrition is assumed to enhance immune system function. In surgical patients, it is supposed to reduce postoperative complications. However, results of recent clinical trials have been puzzling and have not supported this theory. Aim The aim of our study was to evaluate the value of enteral and parenteral postoperative immunonutrition. Methods After initial evaluation of 969 patients, the intent-to-treat analysis included 776 patients (female 407, male 466, mean age 61.1 years) undergoing gastric or pancreatic resections between 2001 and 2009. All patients were randomly assigned after surgery to one of the following groups: standard enteral nutrition (SEN), immunomodulating enteral nutrition (IMEN), standard parenteral nutrition (SPN), or immunomodulating parenteral nutrition (IMPN). All malnourished patients received preoperative parenteral nutrition. Number and type of postoperative complications, length of hospitalization (length of stay [LOS]), and vital organ function were assessed. Results No statistically significant differences were observed in well-nourished patients, during either enteral or parenteral intervention, independent of the type of intervention (standard or immunomodulating). However, analysis of the malnourished group revealed the positive impact of enteral immunonutrition on reduction of postoperative complications (28.3 vs. 39.2 %, respectively; p  = 0.043) and LOS (17.1 and 13.1 days, respectively; p  < 0.05) compared with a standard enteral diet. The cross-analysis of SEN, IMEN, SPN, and IMPN was insignificant. Conclusions The type of postoperative nutrition was of no importance in well-nourished patients. However, in malnourished patients, enteral immunonutrition helped to improve treatment outcome. These findings suggest its use as a method of choice during the postoperative period.

Background Home parenteral nutrition (HPN) is a life-preserving therapy for patients with chronic intestinal failure (CIF) indicated for patients who cannot achieve their nutritional requirements by enteral intake. Intravenously administered lipid emulsions (ILEs) are an essential component of HPN, providing energy and essential fatty acids, but can become a risk factor for intestinal-failure-associated liver disease (IFALD). In HPN patients, major effort is taken in the prevention of IFALD. Novel ILEs containing a proportion of omega-3 polyunsaturated fatty acids (n-3 PUFA) could be of benefit, but the data on the use of n-3 PUFA in HPN patients are still limited. Methods/design The HOME study is a prospective, randomized, controlled, double-blind, multicenter, international clinical trial conducted in European hospitals that treat HPN patients. A total of 160 patients (80 per group) will be randomly assigned to receive the n-3 PUFA-enriched medium/long-chain triglyceride (MCT/LCT) ILE (Lipidem/Lipoplus® 200 mg/ml, B. Braun Melsungen AG) or the MCT/LCT ILE (Lipofundin® MCT/LCT/Medialipide® 20%, B. Braun Melsungen AG) for a projected period of 8 weeks. The primary endpoint is the combined change of liver function parameters (total bilirubin, aspartate transaminase and alanine transaminase) from baseline to final visit. Secondary objectives are the further evaluation of the safety and tolerability as well as the efficacy of the ILEs. Discussion Currently, there are only very few randomized controlled trials (RCTs) investigating the use of ILEs in HPN, and there are very few data at all on the use of n-3 PUFAs. The working hypothesis is that n-3 PUFA-enriched ILE is safe and well-tolerated especially with regard to liver function in patients requiring HPN. The expected outcome is to provide reliable data to support this thesis thanks to a considerable number of CIF patients, consequently to broaden the present evidence on the use of ILEs in HPN. Trial registration ClinicalTrials.gov, ID: NCT03282955 . Registered on 14 September 2017.

Intravenous lipid emulsions (ILE) are an essential component of parenteral nutrition (PN); however, pure soybean oil emulsion is considered a risk factor for intestinal failure–associated liver disease (IFALD). Limited data are available on the effect of different ILEs on the liver during long-term PN, and to our knowledge, no study has evaluated outcomes beyond 12 mo. Therefore, the aim of the present study was to assess the influence of mixed ILEs on liver function during long-term PN. A randomized, open-label clinical trial was performed at the Intestinal Failure Center in Skawina, Poland. Sixty-seven patients (35 F, 32 M; mean age, 53.2 years) receiving home parenteral nutrition (HPN) due to stable chronic intestinal failure (CIF) were randomized to receive one of the following three ILEs: medium/long-chain triacylglycerides (MCT/LCT), olive oil/soybean oil (OO/SO), or a combination of SO/MCT/OO/fish oil (FO) (SMOFlipid). Patients were followed for 5 y. Liver function was assessed clinically and with biochemical parameters (total bilirubin, serum glutamyl oxalate transaminase, serum glutamyl pyruvate transaminase, γ-glutamyl transpeptidase, and alkaline phosphatase) at baseline and after 24 and 60 mo. The most common etiology for CIF was vascular, followed by Crohn's disease, surgical complications, and radiation enteritis. HPN was effective in improving nutritional status and was associated with low rates of catheter infections and clinical complications. No significant differences were observed between groups in median concentrations serum glutamyl oxalate transaminase, serum glutamyl pyruvate transaminase, γ-glutamyl transpeptidase, or alkaline phosphatase at 24 or 60 mo. A significant reduction in median bilirubin concentration was observed in the SMOFlipid group at 60 mo compared with baseline (6.8 umol/L; interquartile range, 5.2–8.5 versus 7.7 umol/L; interquartile range, 4.9–12.4; P = 0.0138). Mixed ILEs are safe and effective for use in patients on long-term HPN. A multicomponent ILE with FO can provide additional benefits in terms of liver function during long-term HPN. •Patients with chronic intestinal failure who require long-term parenteral nutrition are particularly prone to the development of intestinal failure–associated liver disease (IFALD).•The type of intravenous lipid emulsion plays an important role in decreasing or increasing the risk for IFALD.•Mixed intravenous lipid emulsions are safe and effective for use in patients on long-term home parenteral nutrition.•Lipid emulsion with fish oil can provide additional benefits in terms of liver function during long-term home parenteral nutrition due to chronic intestinal failure.

Aim: Patients on parenteral nutrition (PN) are prone to inflammation. This may aggravate an existing proinflammatory state and become a critical factor in the development of liver dysfunction (LD). Intravenous fish oil may attenuate this inflammatory state, but data on its use in adults are scarce. The aim of this study was to investigate the effects of adding a pure fish oil intravenous lipid emulsion (ILE) into short- and long-term PN in patients either at risk of, or with existing, inflammation. Methods: A retrospective analysis of 61 patients (32 female, 29 male, mean age 51.5 ± 12.6 years) who received all-in-one PN, including amino acids, glucose, and lipids supplemented with pure fish oil ILE, was performed. Pure fish oil ILE (Omegaven®, Fresenius Kabi, Bad Homburg, Germany) was used along with the standard ILE to reach a fish oil dose of 0.4–0.5 g fish oil/kg/d. Diagnoses were chronic intestinal failure (CIF, n = 20), Crohn’s disease (CD, n = 22), and ulcerative colitis (UC, n = 19). The observation period was 12 months for CIF and 21 days for UC and CD. Results: A reduction in inflammation was noticeable in all patients and became statistically significant in CD (hsCRP p < 0.0001, ESR p = 0.0034, procalcitonin p = 0.0014, Il-6 p = 0.001) and UC groups (hsCRP and ESR p < 0.0001, Il-6 p = 0.0001, TNF-α p = 0.0113). In the CIF group, the total bilirubin concentration (p = 0.2157) and aspartate transaminase SGOT (p = 0.1785) did not vary over time. Conclusions: PN with pure fish oil ILE reduces some inflammatory parameters in IBD and maintains liver function parameters in CIF patients. Fish oil might become a valuable ingredient in both short- and long-term PN in patients at risk of liver dysfunction.

•First long-term study on the use of intravenous lipids in parenteral nutrition (PN).•If designed properly, PN is a safe therapy even in patients with chronic intestinal failure.•All intravenous lipids are safe and effective during long-term PN; however, olive oil-based intravenous lipid emulsion showed a trend to decrease bilirubin to an even higher extend than other lipids. Intravenous lipid emulsion (ILE) can become a risk factor for intestinal failure associated liver disease (IFALD). Many ILEs are commercially available, however, a direct comparison of their impact on liver has, to our knowledge, never been performed. The aim of the study was to analyse that clinical problem during long term parenteral nutrition (PN). A randomized, controlled clinical trial was performed at the Intestinal Failure Center in Skawina, Poland. Sixty-seven patients (37 F, 30 M, mean age 53.9 years) enrolled in home parenteral nutrition (HPN) due to stable chronic intestinal failure (CIF) were randomized to receive one the following for 12 months: long-chain triglycerides (LCT), medium/long-chain triglycerides, olive oil/LCT (OO/LCT) and a mix of LCT/MCT/OO/fish oil. Clinical evaluation and biochemical tests (total bilirubin, SGOT, SGTP, GGPT, alkaline phosphatase) were performed at enrolment and after 6 and 12 months. the most common reason for intestinal failure (IF) was short bowel due to mesenteric ischaemia, followed by Crohn's disease, surgical complications and radiation enteritis. PN stabilized liver parameters in all patients. No essential fatty acids deficiency was diagnosed. All four ILEs demonstrated comparable influence on liver in all study periods. The only exception was the decrease in total bilirubin concentration after 12 months (28.1 ± 25.3 vs 11.1 ± 4.5, p = 0.0023) and GGTP (222.5 ± 205.8 vs 146.6 ± 197.7, p = 0.0079) when OO/LCT was in use. All four ILEs tested may be safe even during long-term parenteral nutrition. OO/LCT may be more effective than the others, but more studies in the field are needed.

Background and Aims: An enterocutaneous fistula (ECF) poses a major surgical problem. The definitive surgical repair of persistent fistulas remains a surgical challenge with a high rate of re-fistulation and mortality, and the reasons for that is not the surgical technique alone. Enhanced Recovery after Surgery (ERAS®) is an evidence-based multimodal perioperative protocol proven to reduce postoperative complications. The aim of the study was to assess the clinical value of the ERAS protocol in surgical patients with ECF. Methods: ERAS protocol was used in all patients scheduled for surgery for ECF at the Stanley Dudrick’s Memorial Hospital in Skawina between 2011 and 2020. A multidisciplinary team (MDT) was in charge of the program and performed annual audits. A consecutive series of 100 ECF patients (44 females, 56 males, mean age 54.1 years) were evaluated. Postoperative complications rate, readmission rate, length of hospital stay, prevalence of postoperative nausea and vomiting were assessed. Registered under ClinicalTrials.gov Identifier no. NCT04771832. Results: ERAS protocol was successfully introduced for ECF surgeries; however, eight modifications to the ERAS program was performed in 2015. They led to improvement of surgical outcomes: reduction of postoperative nausea and vomiting (15 vs. 17% patients, p = 0.025), overall complication rate (11 vs. 10, p = 0.021), median length of hospital stay (overall and after surgery, p = 0.022 and 0.002, respectively). Conclusions: ERAS protocol can be successfully used for ECF patients. Prescheduled audits can contribute to the improvement of care.

IntroductionSevere gastrointestinal dysmotility (GID) can be sub-classified into Chronic Intestinal Pseudo-obstruction (CIPO) and Enteric Dysmotility (ED) subtypes. We surveyed current opinions on the diagnosis and management of GID amongst experts from different countries.MethodsAn survey questionnaire developed by the European society for Clinical Nutrition and Metabolism (ESPEN) was circulated electronically to members of ESPEN, European Society of Neurogastroenterology and Motility, and United European Gastroenterology. Only participants that completed all required components were included in the analysis.ResultsOf 154 included participants, 82% were European, the majority were attending clinicians/professors (85%), based at either national/regional referral centres and/or academic institutions (87%). Almost all (93%) agreed that CIPO and ED should be classed separately. Most (73%), reported increased incidence of GID, with 69% reporting an increase in ED. GID associated with hypermobile Ehlers-Danlos Syndrome was the group with the largest increase in referrals (37%), however this trend was driven by observations from UK participants only (P<0.0001). Almost all clinicians (95%) find diagnosing GID difficult, with 57% finding ED more challenging and 32% find both types equally difficult. GID diagnosis is often delayed (CIPO: by >5 years according to 16%; ED: by >5 years according to 19%). Moreover, by the time of diagnosis, >10% of patients have had inappropriate operations according to 82% of clinicians. Small Bowel Manometry, a test mandated to diagnose ED, is surprisingly never used by 44%, and is only used in >50% cases by 21%. Full thickness biopsies are usually requested from planned/previous resections (33%) or when the diagnosis is unclear (43%), but seldom change medical treatment (12%), nutritional management (16%) and prognosis (25%). Very few treatments are useful for >50% of patients, with antibiotics for SIBO, prucalopride, and psychology felt to be the most useful. Parenteral Nutrition (PN) rarely leads to improvement in symptoms (28%), and is associated with PN dependency at 5-years according to the majority (56%).ConclusionThese data highlight the difficulties with diagnosing and managing GID, even in ‘expert’ hands, and inform the urgent need for international, multidisciplinary, clinical practice guidelines.

IntroductionPregnancy in patients with chronic intestinal failure (CIF) is a relatively rare occurrence but is an important contemporary topic given both the increasing use of home parenteral nutrition (HPN) and the demographics of patients with CIF.MethodAn opinion-based survey was produced in a multidisciplinary manner, which was then distributed internationally, via the European Society for Clinical Nutrition and Metabolism network, using a web-based survey tool for healthcare professionals with a specialist interest in the management of CIF.ResultsSeventy specialists from 11 countries completed the survey. Fifty-four per cent of the respondents reported some experience of managing pregnancy in patients with CIF. However, 60% stated that they did not feel that it was their role to discuss the topic of pregnancy with their patients, with fewer than 10% stating that they routinely did so. Respondents felt that an individualised approach was required when considering alterations to parenteral support prior to conception, during pregnancy and in the postnatal period. Most respondents also felt there was no increased risk of catheter-related blood stream infections, while catheter-related thrombosis was deemed to be the most significant HPN-related complication for pregnant women.ConclusionThis study reports a variable experience, knowledge and confidence of healthcare professionals when considering pregnancy in patients with CIF. The risk of HPN-related complication was felt to be greater during pregnancy, with an individualised approach being the preferred route for most aspects of care. The findings support the need for an international registry and subsequent consensus guidelines for the management of pregnancy in CIF.

Background Home parenteral nutrition (HPN) is a life-preserving therapy for patients with chronic intestinal failure (CIF) indicated for patients who cannot achieve their nutritional requirements by enteral intake. Intravenous lipid emulsions (ILEs) are an essential component of HPN providing energy and essential fatty acids, but can become a risk factor for intestinal failure-associated liver disease (IFALD). In HPN patients, major effort is taken in the prevention of IFALD. Novel ILEs containing a proportion of omega-3 polyunsaturated fatty acids (n-3 PUFA) could be of benefit, but the data on the use of n-3 PUFA in HPN patients are still limited. Methods The HOME study is a prospective, randomized, controlled, double-blind, multicenter, international clinical trial conducted in European hospitals that treat HPN patients. A total of 160 patients (80 per group) will be randomly assigned to receive the n-3 PUFA enriched medium/long-chain triglyceride (MCT/LCT) ILE (Lipidem / Lipoplus ® 200 mg/ml, B. Braun Melsungen AG) or the MCT/LCT ILE (Lipofundin ® MCT/LCT / Medialipide ® 20%, B. Braun Melsungen AG) for a projected period of eight weeks. The primary endpoint is the combined change of liver function parameters (total bilirubin, aspartate transaminase and alanine transaminase) from baseline to final visit. Secondary objectives are the further evaluation of safety and tolerability as well as the efficacy of the ILEs. Discussion Currently, there are only very few randomized controlled trials (RCTs) investigating the use of ILEs in HPN, and there are very few data at all on the use of n-3 PUFAs. The aim of the HOME study is to demonstrate that the n-3 PUFA enriched ILE is safe and well tolerated especially with regard to liver function in patients requiring HPN. The study will provide data from a considerable number of CIF patients and thus contribute to broaden the present evidence on the use of ILEs in HPN.

Beneficial dietary and pro-health values, have resulted in the increasing consumption importance of barley. Therefore, genotypes and cultivation methods are sought that guarantee high functional value of grain. The aim of the study was to assess the content of phenolic acids, flavonoids, chlorophylls, anthocyanidins, phytomelanin and antioxidant activity of grain of three barley genotypes depending on agricultural technology. Two of them are primary genotypes with dark grain pigmentation Hordeum vulgare L. var nigricans and H . vulgare L. var. rimpaui , the third is a modern cultivar ’Soldo’ H . vulgare with yellow grain, which is the control sample. Evaluated the effect of foliar application of a amino-acids biostimulant on the functional properties of grain under the conditions of organically and conventionally cultivations. The results indicated a higher antioxidant activity and the concentration of phenolic acids, flavonoids and phytomelanin in the black-grain genotypes. Organic cultivation and application of amino acids had increased the content of phenolic compounds in grain. The antioxidant activity was correlated with the content of syringic acid, naringenin, quercetin, luteolin and phytomelanin. Organically cultivation and the foliar application of an amino acid biostimulant improved the functional properties of barley grain, in particular the original, black-grained genotypes.