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EFFICACY OF TEDUGLUTIDE IN PATIENTS WITH SHORT BOWEL SYNDROME ON HOME PARENTERAL NUTRITION: A REAL LIFE STUDY
SINPE conference abstracts / Nutrition 65 (2019) 110580
88.3 mg/dL (§12.7) after 6 and 12 months. Detailed data are shown in the table 4. Our multidisciplinary experience in bariatric patient management demonstrates that a proper pre-surgical selection of candidates and a regular follow up are effective in obtaining a substantial weight loss, preventing SAE, and ensuring long-term compliance in order to avoid weight regain and malnutrition. 1-SICOB
EFFICACY OF TEDUGLUTIDE IN PATIENTS WITH SHORT BOWEL SYNDROME ON HOME PARENTERAL NUTRITION: A REAL LIFE STUDY N. Regano *, S. Mazzuoli, S. Lamacchia, F.W. Guglielmi U.O.C Gastroenterologia-Ospedale San Nicola Pellegrino, Trani, Italy Teduglutide is a GLP-2 analogue indicated for treatment of adults with short bowel syndrome (SBS) reducing parenteral support (PS) requirements. The present report aims to describe the effects of teduglutide in 3 patients on HPN for SBS clinically heterogeneous and with variable length of parenteral support from 4 to 25 years. Between 2017 and 2018, 3 patients with short bowel syndrome in home parenteral nutrition, clinically stable for at least 6 months, receveid daily subcutaneous injection of 0,05 mg/kg/day teduglutide. All patients had undergone, before treatment, a colonoscopy/ileoscopy for the purpose of polyp surveillance and a abdomen ultrasound which was normal. A history of cancer with fewer than 5 years was excluded. A clinically significant reduction from baseline in weekly parenteral support volume and calories was observed in patients, respectively ranging from about -31,8% and -31,1% at 3 months, -49,1% and -48,2% at 12 months. This was associated with an increase in parenteral nutrition-free days, ranging from about 2,3 days/week in 3 months and 4 days/week in 12 months. Stool frequency and volume decreased and consistency increased. Nutritional status evaluation revealed stability in body weight and food intake altrought parenteral support reduction. No serious adverse events were observed during treatment. Patients reported an improvement of quality of life, assessed using SF-36. This real life study demonstrated safety and efficacy of teduglutide suggesting reduction in parenteral support is associated with improvement of quality of life.
INTESTINAL FAILURE IN SYSTEMIC SCLEROSIS: A STRATEGY ATTEMPT FOR INTESTINAL REHABILITATION O. Colombo *,1, G. Alari 2, A. Assolari 2, A.L. Brucato 2, F. Cortinovis 1, M.L. Maglio 2, M. Mancino 1, E. Rodeschini 1 1 UOSD Dietetics and Clinical Nutrition, Papa Giovanni XXIII Hospital, Bergamo, Italy 2 UOC Internal Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy Objective: Aim of our group was to define etiopathogenesis of severe malnutrition in an highly compromised severely underweight patient, and to define the most high-benefit/low-risk nutritional intervention. Research Methods & Procedures: A 62-years-old women affected by systemic sclerosis (SS) was admitted because of asthenia, dyspnea and weight loss: -38% of her usual body weight (BW) in 6 years, -23% BW in the last 6 months; current BW was 31kg (Body Mass Index 12.1kg/m2). Nutritional assessment at admission excluded the hypothesis of both anorexia nervosa and dysphagia. After prompt thiamin and multivitaminic/multimineral supplementation, we started night-time enteral nutrition support (EN) through naso-gastric tube (SNG) with semi-elemental mixture. Neither BW nor prealbumin improved despite rich oral intakes, as documented by the dietitian’s monitoring, plus EN support. Risks from parenteral nutrition (PN), mainly infective ones, were too high with respect to the patient. We then decided to stop oral nutrition and to give the patient total enteral nutrition (TEN) with semi-elemental mixture in slow, continuous administration.
5
Results: Fourteen days after the beginning of TEN, prealbumin increased from 10 to 21 mg/dL. Refeeding Syndrome was adequately prevented. The patient well tolerated slow, continuous TEN and felt subjective clinical improvement. Conclusions: SS can provoke motility disorders associated with inflammation, leading to intestinal failure and, consequently, to severe malnutrition. Nutritional assessment and follow-up after SS diagnosis could positively influence this evolution. Anyway, when intestinal failure is already present, an attempt to intestinal rehabilitation is demanded, especially when risks from PN are too high for the patient.
UNDERESTIMATED PROTEIN ENERGETIC MALNUTRITION (PEM) IN PATIENTS AFFECTED BY RETROPERITONEAL SARCOMA (RPS) F. Sodi *,1, A. Cardani 1, D. Codazzi 1, C. Colombo 2, J. Colombo 4, A. Crespi 1, M. Faustini 1, M. Fiore 2, L. Fumagalli 1, A. Gronchi 2, L. Mariani 3, G. Papagni 1, P. Previtali 1, P. Proto 1, F. Valenza 1, I. Vecchi 1 1 Anaesthesiology and Intensive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy, Milan, Italy 2 Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy 3 Biometrics and Statistics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy 4 Cardiovascular and Thoracic Anaesthesia, Niguarda Hospital, Milan, Italy RPS are mesenchymal non-epithelial neoplasms. Prevalence of PEM in patients with RPS is unknown. A prospective feasibility study enrolled 35 patients affected by primary RPS candidate to surgery. Patients were screened for PEM (according to SINPE Guidelines 2002). Preoperative high protein-beta-hydroxy-betamethyl butyrate oral nutritional support (ONS) was provided according to PEM degree (Figure1). After surgery, nutritional support followed standard practice targeting 20-25 Kcal/Kg/die within 3rd postoperative day (pod). PEM was re-evaluated before surgery, at 10th pod, at 4 and 12 months. Primary outcome was patient’s compliance to preoperative ONS. PEM was documented in 46% patients; although only 8.6% had been clinically undernourished. ONS had a 91% adherence, overall well tolerated. After ONS, PEM lowered to 38% (P=.45). Postoperative caloric target was reached on day 4.1 (SE§2.7), with 51% of protocol adherence. In 34% patients a naso-jejunal tube was positioned; Delayed gastric emptying (DGE) occurred in 38% patients. On 10th pod the majority of patients experienced serious PEM, and worsening was greater after resection of 4 organs (P=.06). At 4 and 12 months, almost all fully recovered (Figure 2). Relevant PEM prevalence in RPS, at risk to be clinically underestimated, is documented for the first time. In this setting, preoperative ONS was feasible and safe, and partially recovered PEM. Disease-related factors for PEM and ideal perioperative caloric target need to be further investigated. A wider use of jejunal access should be evaluated, considered the incidence of DGE. Nutritional support should be included in ERAS programs for RPS.
BIOELECTRICAL IMPEDANCE PHASE ANGLE IN UNDERWEIGHT PATIENTS A. Mascheroni *, B. Tamburelli, A. Asta, C. Chiariello, M.E. Tirelli, A.M. Misotti ASST Melegnano e Martesana / UOSD Dietologia e Nutrizione Clinica, Melegnano (MI), Italy The aim of this analysis is to evaluate the results from Bioimpedance Vector Analysis (BIVA) performed in underweight patients and possible correlations between sex or subgroup (constitutionally lean CL or anorexia nervosa AN). Underweight (BMI < 18,5) patients (CL or AN), from May 2017 to July 2018 were included in the results. Weight was measured to the nearest 0.1 kg and height to the nearest 0.5 cm. BIVA was performed with a single-frequency bioimpedance analyzer (BIA 101 RJL, Akern Bioresearch, Italy). Results are presented as mean and standard deviation.
88.3 mg/dL (§12.7) after 6 and 12 months. Detailed data are shown in the table 4. Our multidisciplinary experience in bariatric patient management demonstrates that a proper pre-surgical selection of candidates and a regular follow up are effective in obtaining a substantial weight loss, preventing SAE, and ensuring long-term compliance in order to avoid weight regain and malnutrition. 1-SICOB
EFFICACY OF TEDUGLUTIDE IN PATIENTS WITH SHORT BOWEL SYNDROME ON HOME PARENTERAL NUTRITION: A REAL LIFE STUDY N. Regano *, S. Mazzuoli, S. Lamacchia, F.W. Guglielmi U.O.C Gastroenterologia-Ospedale San Nicola Pellegrino, Trani, Italy Teduglutide is a GLP-2 analogue indicated for treatment of adults with short bowel syndrome (SBS) reducing parenteral support (PS) requirements. The present report aims to describe the effects of teduglutide in 3 patients on HPN for SBS clinically heterogeneous and with variable length of parenteral support from 4 to 25 years. Between 2017 and 2018, 3 patients with short bowel syndrome in home parenteral nutrition, clinically stable for at least 6 months, receveid daily subcutaneous injection of 0,05 mg/kg/day teduglutide. All patients had undergone, before treatment, a colonoscopy/ileoscopy for the purpose of polyp surveillance and a abdomen ultrasound which was normal. A history of cancer with fewer than 5 years was excluded. A clinically significant reduction from baseline in weekly parenteral support volume and calories was observed in patients, respectively ranging from about -31,8% and -31,1% at 3 months, -49,1% and -48,2% at 12 months. This was associated with an increase in parenteral nutrition-free days, ranging from about 2,3 days/week in 3 months and 4 days/week in 12 months. Stool frequency and volume decreased and consistency increased. Nutritional status evaluation revealed stability in body weight and food intake altrought parenteral support reduction. No serious adverse events were observed during treatment. Patients reported an improvement of quality of life, assessed using SF-36. This real life study demonstrated safety and efficacy of teduglutide suggesting reduction in parenteral support is associated with improvement of quality of life.
INTESTINAL FAILURE IN SYSTEMIC SCLEROSIS: A STRATEGY ATTEMPT FOR INTESTINAL REHABILITATION O. Colombo *,1, G. Alari 2, A. Assolari 2, A.L. Brucato 2, F. Cortinovis 1, M.L. Maglio 2, M. Mancino 1, E. Rodeschini 1 1 UOSD Dietetics and Clinical Nutrition, Papa Giovanni XXIII Hospital, Bergamo, Italy 2 UOC Internal Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy Objective: Aim of our group was to define etiopathogenesis of severe malnutrition in an highly compromised severely underweight patient, and to define the most high-benefit/low-risk nutritional intervention. Research Methods & Procedures: A 62-years-old women affected by systemic sclerosis (SS) was admitted because of asthenia, dyspnea and weight loss: -38% of her usual body weight (BW) in 6 years, -23% BW in the last 6 months; current BW was 31kg (Body Mass Index 12.1kg/m2). Nutritional assessment at admission excluded the hypothesis of both anorexia nervosa and dysphagia. After prompt thiamin and multivitaminic/multimineral supplementation, we started night-time enteral nutrition support (EN) through naso-gastric tube (SNG) with semi-elemental mixture. Neither BW nor prealbumin improved despite rich oral intakes, as documented by the dietitian’s monitoring, plus EN support. Risks from parenteral nutrition (PN), mainly infective ones, were too high with respect to the patient. We then decided to stop oral nutrition and to give the patient total enteral nutrition (TEN) with semi-elemental mixture in slow, continuous administration.
5
Results: Fourteen days after the beginning of TEN, prealbumin increased from 10 to 21 mg/dL. Refeeding Syndrome was adequately prevented. The patient well tolerated slow, continuous TEN and felt subjective clinical improvement. Conclusions: SS can provoke motility disorders associated with inflammation, leading to intestinal failure and, consequently, to severe malnutrition. Nutritional assessment and follow-up after SS diagnosis could positively influence this evolution. Anyway, when intestinal failure is already present, an attempt to intestinal rehabilitation is demanded, especially when risks from PN are too high for the patient.
UNDERESTIMATED PROTEIN ENERGETIC MALNUTRITION (PEM) IN PATIENTS AFFECTED BY RETROPERITONEAL SARCOMA (RPS) F. Sodi *,1, A. Cardani 1, D. Codazzi 1, C. Colombo 2, J. Colombo 4, A. Crespi 1, M. Faustini 1, M. Fiore 2, L. Fumagalli 1, A. Gronchi 2, L. Mariani 3, G. Papagni 1, P. Previtali 1, P. Proto 1, F. Valenza 1, I. Vecchi 1 1 Anaesthesiology and Intensive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy, Milan, Italy 2 Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy 3 Biometrics and Statistics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy 4 Cardiovascular and Thoracic Anaesthesia, Niguarda Hospital, Milan, Italy RPS are mesenchymal non-epithelial neoplasms. Prevalence of PEM in patients with RPS is unknown. A prospective feasibility study enrolled 35 patients affected by primary RPS candidate to surgery. Patients were screened for PEM (according to SINPE Guidelines 2002). Preoperative high protein-beta-hydroxy-betamethyl butyrate oral nutritional support (ONS) was provided according to PEM degree (Figure1). After surgery, nutritional support followed standard practice targeting 20-25 Kcal/Kg/die within 3rd postoperative day (pod). PEM was re-evaluated before surgery, at 10th pod, at 4 and 12 months. Primary outcome was patient’s compliance to preoperative ONS. PEM was documented in 46% patients; although only 8.6% had been clinically undernourished. ONS had a 91% adherence, overall well tolerated. After ONS, PEM lowered to 38% (P=.45). Postoperative caloric target was reached on day 4.1 (SE§2.7), with 51% of protocol adherence. In 34% patients a naso-jejunal tube was positioned; Delayed gastric emptying (DGE) occurred in 38% patients. On 10th pod the majority of patients experienced serious PEM, and worsening was greater after resection of 4 organs (P=.06). At 4 and 12 months, almost all fully recovered (Figure 2). Relevant PEM prevalence in RPS, at risk to be clinically underestimated, is documented for the first time. In this setting, preoperative ONS was feasible and safe, and partially recovered PEM. Disease-related factors for PEM and ideal perioperative caloric target need to be further investigated. A wider use of jejunal access should be evaluated, considered the incidence of DGE. Nutritional support should be included in ERAS programs for RPS.
BIOELECTRICAL IMPEDANCE PHASE ANGLE IN UNDERWEIGHT PATIENTS A. Mascheroni *, B. Tamburelli, A. Asta, C. Chiariello, M.E. Tirelli, A.M. Misotti ASST Melegnano e Martesana / UOSD Dietologia e Nutrizione Clinica, Melegnano (MI), Italy The aim of this analysis is to evaluate the results from Bioimpedance Vector Analysis (BIVA) performed in underweight patients and possible correlations between sex or subgroup (constitutionally lean CL or anorexia nervosa AN). Underweight (BMI < 18,5) patients (CL or AN), from May 2017 to July 2018 were included in the results. Weight was measured to the nearest 0.1 kg and height to the nearest 0.5 cm. BIVA was performed with a single-frequency bioimpedance analyzer (BIA 101 RJL, Akern Bioresearch, Italy). Results are presented as mean and standard deviation.