Su2011 – Short Bowel Syndrome Patients with Residual Colon in Continuity Have Limited Adherence to Recommended Dietary Guidelines

Background & aims: In this study of patients with non-malignant short bowel syndrome (SBS), who initiated home parenteral support (HPS), we estimated survival and investigated risk factors of mortality.We also examined the cumulative incidence of weaning off and predictors of regaining enteral autonomy.Methods: Patients were retrospectively included from 1970 to 2016 from the Copenhagen Intestinal Failure Database.The inclusion criteria at HPS initiation were pathophysiological classification of SBS, remnant small bowel length of 200 cm or less, and intestinal failure (IF).Patients with SBS due to malignant disease were excluded.Demographical data and duration of HPS treatment were obtained from the Copenhagen IF Database.Mortality data were retrieved from the Danish Register of Causes of Death.Data were analyzed with Kaplan-Meier method, Cox proportional hazard regression, and an Aalen-Johansen estimator.Results: A total of 331 patients with a median age of 54.9 years (interquartile range: 42.8-65.8)initiated HPS in the period from 1970 to 2016.The majority (84.9%) had a jejuno-/ileostomy at initiation.Surgical alterations of the bowel anatomy were frequent during HPS treatment (n=163 patients, 49.2%).The five-year survival rate after HPS initiation was 89.1% (95%CI: 81.4%-96.7%) in patients under 40 years of age, 80.2% (95%CI: 73.1%-87.2%) in patients aged 40 to 60 years, and 55.1% (95%CI: 45.0%-65.3%) in patients aged 60 years and above.In a multivariate analysis, patients who regained enteral autonomy had a significantly reduced hazard of death.Age at initiation and diagnosis other than IBD were significantly related to increased hazard (table 1).Preliminary results indicate that 17.2% of deaths in patients receiving HPS were due to HPS related complications (21 deaths out of 122).The estimated cumulative incidence of weaning off was 33.6% after 1 year and 41.1% after 5 years.In a multivariate cox regression with allowance of anatomy changes, anatomy of the remnant bowel was significantly associated with the ability to wean off (table 2).Conclusion: Mortality in patients with SBS initiating HPS is highly dependent on age at initiation and regaining enteral autonomy.However, it cannot be concluded that HPS itself causes this increased hazard.Preliminary results indicate that 17% of deaths in HPS dependent patients were caused by HPS related complications.In patients younger than 40 years, we report a 5-year survival of 89.1%.We confirm that total weaning off HPS is closely related to the anatomy of the remnant bowel and is highly unlikely to occur if the length of the remnant small bowel is less than 100 cm and there is no colon in continuity.