Intestinal failure associated liver disease: A one-year prospective study

Intestinal Failure Associated Liver Disease (IFALD), represented by cholestasis, steatosis, inflammation and fibrosis, is a major complication occurring in patients on home parenteral nutrition (HPN) for chronic intestinal failure due to benign disease (CIF). The natural history of IFALD is poorly known. The incidence and the evolution of IFALD in adult patients with CIF were assessed by a one-year prospective survey.Adult patients who initiated HPN for CIF between 2016 to 2019 were included in the study. Liver function tests and ultrasound were assessed at the beginning of HPN (T0) and every six months. Diagnostic criteria: IFALD-cholestasis (a value ≥1.5 ULN on two of ɣGT, ALP, conjugated bilirubin for ≥ 6 months); IFALD-steatosis (liver ultrasound, US); IFALD-fibrosis (FiB4= age (years) x AST)/ Platelets (109/L) x ALT ½) and FibroScan. Results: Thirty-one patients were enrolled (F 61%, median age 48 years, Short Bowel Syndrome 71%). The data of the 9 patients who completed the two-years follow up are reported. Frequency at T0 and every six-month interval: cholestasis, 42%,16%,13%,14%,22%; steatosis, 45%,44%,50%,63%,75%; fibrosis: 13%,16%,16%,7%,11%. Incidence of IFALD (new cases after T0): cholestasis 0%; steatosis 25%; fibrosis 7%. Resolution of IFALD (disappearance after T0): cholestasis 38%; steatosis 7%; fibrosis 50%. Conclusion: All the types of IFALD may be present at initiation of HPN, fibrosis being the less represented. During the first two-years of HPN: a resolution of IFALD may occur.