Summary
Intestinal failure is a condition in which the gut cannot absorb sufficient macronutrients and/or water and electrolytes to maintain health and growth, necessitating intravenous supplementation. The most common cause is short bowel syndrome. Clinical features of intestinal failure vary based on the underlying cause, chronicity, and the resulting degree of metabolic disturbance. Management of chronic intestinal failure focuses on intravenous supplementation and intestinal rehabilitation through diet and pharmacological treatment.
Definitions
- Intestinal failure: a condition in which the gut cannot absorb sufficient macronutrients and/or water and electrolytes to maintain health and growth, necessitating intravenous supplementation [1]
- Intestinal insufficiency: reduced absorption of macronutrients and/or water and electrolytes in the gut without the need for intravenous supplementation to maintain health and/or growth [1]
Epidemiology
- Chronic intestinal failure
- Prevalence: 5–80 per million in Europe [2]
- Incidence: 7.7–15 per million per year in Europe [2]
Epidemiological data refers to the US, unless otherwise specified.
Etiology
- Reduced absorptive surface of the mucosa [1]
- Short bowel syndrome (most common cause of chronic intestinal failure) [2]
- Congenital causes of short bowel, e.g.: [2]
- Intestinal fistula [1]
- Intestinal dysmotility (e.g., Ogilvie syndrome) [1]
- Mechanical obstruction [1]
- Extensive small bowel mucosal disease (e.g., Crohn disease, chemotherapy-related enteritis) [1]
Classification
- Type I: acute, short-term (e.g., secondary to postoperative ileus) [1]
- Type II: subacute, requiring complex care and intravenous supplementation for weeks to months [1]
- Type III: chronic, requiring intravenous supplementation for months to years (may be reversible or irreversible) [1]
Clinical features
- Clinical features of intestinal failure vary based on the underlying cause, chronicity, and the resulting degree of metabolic disturbance.
- See "Clinical features of short bowel syndrome." [3]
Diagnosis
- Consult a registered dietitian if intestinal failure is suspected.
- Diagnostic criteria [1]
- Decreased absorption of macronutrients and/or water and electrolytes due to loss of gut function
- Need for intravenous supplementation
Management
- Acute intestinal failure: self-limited and resolves with treatment of the underlying cause
- Subacute and chronic intestinal failure: multidisciplinary management [2]
- For details on the management of chronic intestinal failure, see "Management of short bowel syndrome."
Complications
- Metabolic and organ dysfunction, e.g.: [3]
- Depression [2]
- Severe fatigue [2]
We list the most important complications. The selection is not exhaustive.
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