Lone Tjellesen

Effect of intravenous ranitidine and omeprazole on intestinal absorption of water, sodium, and macronutrients in patients with intestinal resection.

Background—H2 receptor blockers and proton pump inhibitors reduce intestinal output in patients with short bowel syndrome. Aims—To evaluate the effect of intravenous omeprazole and ranitidine on water, electrolyte, macronutrient, and energy absorption in patients with intestinal resection. Methods—Thirteen patients with a faecal weight above 1.5 kg/day (range 1.7-5.7 kg/day and a median small bowel length of 100 cm were studied. Omeprazole 40 mg twice daily or ranitidine 150 mg twice daily were administered for five days in a randomised, double blind, crossover design followed by a three day control period with no treatment. Two patients with a segment of colon in continuation were excluded from analysis which, however, had no influence on the results. Results—Omeprazole increased median intestinal wet weight absorption compared with no treatment and ranitidine (p<0.03). The effect of ranitidine was not significant. Four patients with faecal volumes below 2.6 kg/day did not respond to omeprazole; in two absorption increased by 0.5-1 kg/day; and in five absorption increased by 1−2 kg/day. Absorption of sodium, calcium, magnesium, nitrogen, carbohydrate, fat, and total energy was unchanged. Four high responders continued on omeprazole for 12–15 months, but none could be weaned from parenteral nutrition. Conclusion—Omeprazole increased water absorption in patients with faecal output above 2.50 kg/day. The effect varied significantly and was greater in patients with a high output, but did not allow parenteral nutrition to be discontinued. Absorption of energy, macronutrients, electrolytes, and divalent cations was not improved. The effect of ranitidine was not significant, possibly because the dose was too low.

Assessment of the longitudinal changes in bone mineral density in patients receiving home parenteral nutrition.

BACKGROUND Low bone mineral density (BMD) is commonly reported in patients receiving home parenteral nutrition (HPN), but it remains unclear whether or not an accelerated bone loss occurs during HPN therapy. We evaluated the spinal, hip, and forearm bone mass density longitudinally in a cohort of 75 patients receiving HPN. METHODS A total of 943 regional dual-energy x-ray absorptiometry scans, 335 spinal, 318 hip, and 290 forearm, obtained between 1995 and 2003 in 75 patients receiving HPN, were used for the analysis of the annual changes in BMD. The average (SD) number of scans per patients was 4.4 (2.9), and follow-up time was 4.1 (1.9) years. Diagnoses were Crohns disease (n = 35) and other conditions (non-Crohns diseases; n = 40). Data were analyzed using a linear random coefficient model. RESULTS There was a statistically significant overall decline over time in spinal, hip, and forearm BMD, corresponding roughly to a 1% annual loss (p < .005); however, the loss was not significantly larger than that of age and sex-matched healthy subjects. In Crohns disease patients, model estimates of spinal and hip BMD on the initiation of HPN therapy were significantly reduced compared with normal, whereas values were not significantly reduced in non-Crohns disease patients. CONCLUSIONS With the current protocols for HPN treatment, the annual decline in BMD is moderate and not significantly larger than in age- and sex-matched healthy subjects. A considerable part of the metabolic bone disease in these patients is related to the underlying disease for which the HPN was indicated.

Su2095 Survival and Cause-Specific Mortality in an Intestinal Failure Cohort Depending on Home Parenteral Nutrition (HPN) in a Referral Centre From 1970 to 2010

G A A b st ra ct s enhanced microbial fermentation of dietary fiber and dysregulation of choline metabolism. The OPLS-DA model constructed based on samples collected post DI (R2X=30.7%, Q2Y= 0.37) showed higher concentrations of glutamate and 6-aminosalicylic acid in AA compared with AF. Microbial data acquired using HITChip was integrated with fecal profiles using OPLS. At the phylum level, 2 out of 22 identified phyla were significantly correlated with fecal profiles, which are Cyanobacteria and uncultured Mollicutes significantly correlating with fecal glutamate and valerate. By statistically integrating the fecal metabonome and the 130 microbial genus, Bacteroides vulgates et rel. and Bacteroides plebeius et rel. were observed to be correlated with choline, whereas Uncultured Clostridiales II was correlated with pyroglutamate. Uncultured Mollicutes, Eubacterium siraeum et rel and Aneurinibacillus demonstrated similar metabolic activity. Conclusions: These findings indicate that after only two-weeks of a dietary exchange diet, the fecal metabolic profile is significantly altered and that these metabolic changes are closely associated with alterations in the structure and function of the gut microbial network.

Effect of Cyclical Intravenous Clodronate Therapy on Bone Mineral Density and Markers of Bone Turnover in Patients Receiving Home Parenteral Nutrition

Background: Patients receiving home parenteral nutrition (HPN) because of intestinal failure are at high risk of developing osteoporosis. Objective: We studied the effect of the bisphosphonate clodronate on bone mineral density (BMD) and markers of bone turnover in HPN patients. Design: A 12-mo, double-blind, randomized, placebo-controlled trial was conducted to study the effect of 1500 mg clodronate, given intravenously every 3 mo for 1 y, in 20 HPN patients with a bone mass T score of the hip or lumbar spine of less than –1. The main outcome measure was the difference in the mean percentage change in the BMD of the lumbar spine measured by dual-energy X-ray absorptiometry. Secondary outcome measures included changes in the BMD of the hip, forearm, and total body and biochemical markers of bone turnover, ie, serum osteocalcin, urinary pyridinoline, and urinary deoxypyridinoline. Results: The mean (±SEM) BMD of the lumbar spine increased by 0.8 ± 2.0% in the clodronate group and decreased by 1.6 ± 2.0% in...

Alendronate increases lumbar spine bone mineral density in patients with Crohn's disease. A double blind controlled study

BACKGROUND & AIMS Low bone mineral density (BMD) is a common complication of Crohns disease and may lead to increased morbidity and mortality because of fractures. We investigated the effect of treatment with the bisphosphonate alendronate on bone mass and markers of bone remodeling in patients with Crohns disease. METHODS A 12-month double-blind, randomized, placebo-controlled trial examined the effect of a 10-mg daily dose of alendronate. Thirty-two patients with a bone mass T score of -1 of the hip or lumbar spine were studied. The main outcome measure was the difference in the mean percent change in BMD of the lumbar spine measured by dual-energy x-ray absorptiometry. Secondary outcome measures included changes in BMD of the hip and total body and biochemical markers of bone turnover (S-osteocalcin, urine pyridinoline, and urine deoxypyridinoline excretion). RESULTS Mean (+/-SEM) BMD of the lumbar spine showed an increase of 4.6% +/- 1.2% in the alendronate group compared with a decrease of 0.9% +/- 1.0% in patients receiving placebo (P < 0.01). BMD of the hip increased by 3.3% +/- 1.5% in the alendronate group compared with a smaller increase of 0.7% +/- 1.1% in the placebo group (P = 0.08). Biochemical markers of bone turnover decreased significantly in the alendronate group (P < 0.001). Alendronate was well tolerated, and there was no difference in adverse events among treatment groups. CONCLUSIONS Treatment with alendronate, 10 mg daily, significantly increased BMD in patients with Crohns disease and was safe and well tolerated.

577 A Potential Association Between Remnant Bowel Anatomy and the Incidence of Catheter-Related Blood-Stream Infections (CRBSIS) in Adult Intestinal Failure (IF) Patients Depending in Home Parenteral Nutrition(HPN)

Patients with intestinal failure (IF) depend on parenteral support through a central line for survival, but are challenged by the risk of catheter-related bloodstream infections (CRBSIs). Employing the Copenhagen HPN database, we investigated the association between the remaining bowel anatomy and the incidence and infectious species in CRBSIs with the aim of identifying risk factors. Methods: The CopenhagenHPNdatabase is based on a retrospective annually review of all charts from adult patients, who have received HPN from Rigshospitalet, Denmark. The diagnosis of a CRBSI required clinical signs of a systemic infection and positive blood cultures, with the exclusion of other causes of infections. Results: From 1970 to 2010, 510 IF patients were discharged with HPN, in total contributing to 1745 HPN years. In 256 of the IF patients 873 CRBSI were detected: 595 mono-bacteraemia, 140 polybacteraemia, 85 fungemia and 49 combinations of bacteraemia and Candidemia. The species of bacteraemia and Candidemia were determined in 869 CRBSIs, while 4 positive cultures were recorded without species. The cohort were divided into three groups according to remain bowel anatomy (-colon, +colon and no-surgical). The overall incidence of CRBSIs in HPN were 1.37 per 1000 HPN days. In the group without colon, the incidence of CRBSIs were 1.54 per 1000 HPN days. The median remaining small intestine was 125 cm, and the median age at complication was 57.8 years. The group were subdivided dependent on the remaining small intestine ( 200cm) with minor variations in incidence (1.59, 1.69, 1.42 and 1.60 per 1000 HPN days). The CRBSI incidence in IF patients with remaining colon was 0.92 per 1000 HPN days. The median small intestine was 100 cm, and the patients had a median of 70.5% of remaining colon. The median age at complication in this group was 49.1 years. The colon-group was first split into two: less/ above 50% remaining colon with CBRSI incidences of 0.42 and 1.06 per 1000 HPN days. Staphylococcus spp were detected in 55 % of blood cultures in IF patients with colon, while only seen in 30 % in IF patients without remaining colon. In the no colon group enterobacteriaceae were more frequent (50 %) with the exception of IF patients with < 50 cm small intestine (24 %). Candidemia were detected in 14 % of the cultures from IF patients without colon, while only 6.8 % in IF patients with colon. Conclusion: The CRBSI incidence rate in IF patients without colon is almost two fold higher compared to IF patients with remaining colon. Most frequently IF patients with a colon had bacteraemia with Staphylococci, while CRBSI in patients without a colon as frequently were caused by enterobacteriaceae. Candidemia was most frequently seen in patients without colon. The role of remaining bowel on the incidence of CRBSI needs further investigation. Tabel 1: Incidence of CRBSIs in HPN years and 1000 HPN days.

PP175-SUN CONSEQUENCES OF CATHETER-RELATED INFECTIONS IN PATIENTS WITH INTESTINAL FAILURE. RESULTS EXTRACTED FROM THE WORLD LARGEST SINGLE CENTER DATABASE

lead to a stabilisation or even an improvement of the bone mineral density (BMD) on the long range. Methods: Retrospective study of patients under HPN followed by the Gastroenterology Service of St-Luc Hospital from 2004 to 2011. Exclusion criteria were the lack of data on BMD or the absence of an osteodensitometry at the beginning of the HPN. Follow-up included regular visits with an endocrinologist, an initial dual energy X-ray absorptiometry at the start of HPN and every two years thereafter. BMD at the hip (g/cm2) were collected and their evolution was measured. A reduction or an increase in BMD was considered significant for a drop or a rise of 0.04 g/cm2 respectively. Results: 44 patients under HPN were identified. Data on BMD were collected for 30 individuals. A mean of 4 dual energy X-ray absorptiometry were performed for each patient. On average, we observed a drop of 0.01 g/cm2 (95% confidence interval (CI); drop of 0.03 rise of 0.01 g/cm2) in BMD for the entire follow-up. Globally, more than 70% of individuals showed a stabilisation or an increase in their BMD on the long range. It looks like there was no difference in the evolution of the bone status between people with osteoporosis initially and those without osteoporosis at the beginning of HPN. In addition, a small waiting time between the diagnosis of intestinal insufficiency and the beginning of HPN seems to ensure a better constancy of the BMD (odds ratio: 5.8; P value = 0.19). This trend seems similar when the duration of HPN was short (odds ratio: 4.5; P value = 0.16). Conclusion: An adequate follow-up of patients under HPN ensures a stabilisation of BMD on the long range.