Intestinal Failure Unit

Specialist unit looks back on three decades of ground-breaking work

New research at Salford Royal’s pioneering Intestinal Failure Unit has suggested that some patients could return to regular eating without having surgery – even after years of intravenous feeding.

Patients travel from all over the UK and beyond to the Intestinal Failure Unit, the first specialist centre of its kind in the UK for patients whose intestines cannot absorb the nutrition that the body needs. This could be because of conditions such as Crohn’s disease or other bowel illnesses, or complications from other surgeries on the abdomen.

These patients rely on intravenous feeding for survival and some spend the rest of their lives being fed through a catheter into a vein in their chest, a process also known as home parenteral nutrition.

In some cases, reconstructive surgery can mean that a patient can come off parenteral nutrition and for some patients, their bowels adapt over time so that the parenteral nutrition can be tapered off and they return to regular eating.

Until now, it’s been thought that this process of adaptation mainly happened in the first two years after intestinal failure and was only recorded up to five years later.

But research into the records of 545 patients who had been treated at the Intestinal Failure Unit between 1978 and 2011, showed that almost half of surviving patients no longer needed home parenteral nutrition 15 years after the onset of their intestinal failure. Half of these underwent surgical reconstruction.

Consultant Gastroenterologist Dr Simon Lal said: “Intestinal failure is a very serious condition that can affect the survival of people affected.

“But with the support of our specialist multi-disciplinary team, patients can do very well and survive this debilitating illness. People on home parenteral nutrition are able to have a good quality of life, to work and travel. Our research is based on the largest group of patients over the longest time from a specialist referral centre and it shows some really positive outcomes for patients who get this expert help.”

Complications associated with parenteral feeding include catheter-related blood stream infections but the review* also showed very low rates of this in the patients who’d been treated at Salford Royal. Specialists in the unit put this down to a very focused system for managing patients with suspected catheter infections, with prompt treatment as soon as it has been diagnosed.

*Martyn Dibb, Mattias Soop, Antje Teubner, Jon Shaffer, Arun Abraham, Gordon Carlson, Simon Lal: Survival and nutritional dependence on home parenteral nutrition: Three decades of experience from a single referral centre (Clinical Nutrition).