Document Detail


Home parenteral nutrition in children with Crohn's disease: an effective management alternative.
MedLine Citation:
PMID:  109347     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Seventeen pediatric patients, ages 9.25--20.5 yr, were placed on a program of home parenteral nutrition (HPN) for severe, symptomatic Crohn's disease. Prior therapy with sulfasalazine in 14, adrenocorticosteroids in 12, inpatient total parenteral nutrition in 7, and/or surgical resections in 6 failed to suppress disease activity. Remission was attained in 12 of the 17 after one course of HPN alone. Four patients had surgical procedures and 1 required steroids in addition to HPN. Remissions have been maintained in 4 of those 12 for a mean duration of 315 days after discontinuation of HPN. Of the 8 who relapsed after a mean duration of 68 days, second courses of HPN were undertaken in 7 and third courses in 2. All 17 had a marked improvement in disease symptoms while receiving HPN in addition to gaining weight sufficient to place them at a higher percentile on standard growth charts. Ten patients demonstrated "catch-up" growth and 4 others increased their height appropriately. A chromium 51-labeled albumin stool collection of greater than 1% in 5 of 7 patients at the completion of a HPN course correlated with relapse within 4 mo. Serial radiographic contrast studies and erythrocyte sedimentation rates were not predictive of prolonged remissions. Home parenteral nutrition complications were minimal, with only one episode of sepsis per 5.8 catheter experience years. It is concluded that HPN is a safe and effective means of inducing remissions and providing optimal nutritional support in pediatric patients with severe Crohn's disease. Patients with less than adequate response to standard medical management should be considered candidates for this therapeutic modality.
Authors:
C T Strobel; W J Byrne; M E Ament
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Gastroenterology     Volume:  77     ISSN:  0016-5085     ISO Abbreviation:  Gastroenterology     Publication Date:  1979 Aug 
Date Detail:
Created Date:  1979-09-01     Completed Date:  1979-09-01     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0374630     Medline TA:  Gastroenterology     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  272-9     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Blood Sedimentation
Catheterization / adverse effects
Child
Crohn Disease / diet therapy*
Deficiency Diseases / etiology
Dermatitis / etiology
Evaluation Studies as Topic
Female
Hematocrit
Home Care Services*
Humans
Iron / blood
Male
Parenteral Nutrition* / adverse effects
Parenteral Nutrition, Total* / adverse effects
Remission, Spontaneous
Serum Albumin / analysis
Zinc / deficiency
Chemical
Reg. No./Substance:
0/Serum Albumin; 7439-89-6/Iron; 7440-66-6/Zinc

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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