Background and aims: Patients with intestinal failure often need long-term home parenteral support (PS). We aimed to determine how the underlying diagnosis, complications and survival had changed over the last 36 years in the UK's largest IF centre. Methods: 978 adult home PS patient records were analysed from January 1979 until October 2016. The age, sex, underlying aetiology, complications and survival was compared over 5-year periods. Results: Pre-1990 to 2011-2016, numbers increased from 29 to 451, the mean age of patients increased from 31 +/- 16.5 to 52 +/- 17.6 years. The percentage of patients with IF due to surgical complications increased (3.4%-28.8%, p < 0.001)), while those with inflammatory bowel disease decreased (37.9% -22.6%, p < 0.001). Complication of home PS reduced: catheter related blood stream infections (CRBSI) 71.4% to 42,2%, CVC thrombosis 34.5%-5.3%. Intestinal failure associated liver disease (IFLAD) 10.3%-1.8%. Patients with dysmotility, scleroderma and a congenital aetiology had the highest incidence of CRBSI and CVC Thrombosis. Overall survival was greater pre-1995 [HR 0.2-0.4 (p 1/4 0.02)] most likely associated with an increase in mean age. Survival for patients without malignancy was 90%, 66%, 55%, 45%, 33% and 25% at 1,5, 10, 15, 20 and 30 years respectively. Multivariate analysis demonstrated a relationship between survival and age of starting home PS; type of home PS; presence or absence of the colon in continuity; and underlying aetiology. Conclusion: Demand for home PS is increasing in particular for advanced malignancy, post-surgical complications and older more co-morbid patients. Complications of home PS are reducing over the last 30 years and 10-year survival for non-malignant aetiologies improving. Survival and changes in aetiology in intestinal failure. (c) 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

IntroductionIncidence of CRC in the young are increasing and it is defined when a diagnosis is made in individuals younger than 50 years of age. There is plethora of data on incidence and tumour characteristics in young. However, there is limited literature available regarding clinical presentation and tumour behaviour in young CRC. Aim is to assess the clinical presentation, tumour characteristics, management and mortality in young and to compare between older individuals.MethodologyIt is a retrospective review of prospectively collected data. We reviewed all CRC diagnosed at our hospital between 2014 – June 2019. Data were retrieved from trust cancer database, endoscopy reports, electronic clinical records and pathology reporting systems.ResultsA total of 12983 colonoscopies were performed during this period. 547 (age range 30–98 years) cases of CRC were diagnosed, 54% of them were males and 48 (8.7%) were less than 50 years of age. Clinical presentation and other characteristics were compared between young and old illustrated in table 1. Most common clinical presentations in young were; Anaemia (40%) Rectal bleeding(40%), change in bowel habits-CIBH (12%) while older patients were presented with anaemia(22%), CIBH (19%), rectal bleeding (21%) and abnormal imaging(19%). Significant proportion of young patients showed thrombocytosis when compared to older individuals (23% vs 14%, p=0.03). Most common sites were rectum and SC in both cohorts. In older population 43% of CRC were in proximal colon while only 14% in young had a proximal CRC (p=0.01) Majority of the CRC were adenocarcinoma (90%), and the remainder were anal squamous, neuro endocrine. 4.7% of cancers were not confirmed by histology. Significant proportion of patients were diagnosed at an advanced stage (3 and above) 31% and 32% in older and younger age group respectively. 59% of our cohort had elective or emergency surgery while the rest were treated with a palliative intent. One year mortality was 12.5% and 19% for young and older cohort respectively. 5 year survival rate was higher in young patients than older (77.8% vs 69.2%).ConclusionsIn our cohort younger CRCs presented with anaemia and rectal bleeding while older cohort with CIBH and anaemia/rectal bleeding. Thrombocytosis was a distinct feature in young CRCs. Even through significant proportion of younger CRCs presented with advanced disease, 5 year survival rate was higher in young.

Sarcopenia is a progressive and generalised disorder of skeletal muscle strength, function and mass, that is most commonly associated with the normal ageing process. It is increasingly recognised that sarcopenia can also develop as a consequence of malabsorptive and inflammatory conditions, such as those seen by gastroenterologists and hepatologists. It affects 1%-30% of the general population, but is seen in approximately 40% of patients with gastrointestinal conditions including inflammatory bowel disease and cirrhosis. Within this group of patients, it is associated with increased complications and mortality. The pathogenesis of sarcopenia is multifactorial with several risk factors implicated in its development including undernutrition, physical inactivity and coexistent multimorbidity. The SARC-F questionnaire has been developed to screen for patients at risk of sarcopenia, however, this focuses on the functional consequences and will therefore not identify those patients who are early in the progression of sarcopenia. There are several different non-invasive techniques available to assess muscle quantity and quality including; grip strength, dual energy X-ray absorptiometry, CT which can be used together to diagnose sarcopenia. Assessment and correction of malnutrition, particularly protein intake, in those at risk of sarcopenia is important in preventing the development and progression of sarcopenia. There are no specific drugs that are available for the treatment of sarcopenia, however, resistance exercise programmes combined with nutritional interventions show promise. It is important that this common condition is screened for and recognised, with any contributing factors addressed to reduce the risk of its progression.

Background & aims: Sarcopenia occurs in patients with intestinal failure (IF) and has been associated with poorer survival in several chronic diseases. CT can measure sarcopenia through a L3 skeletal muscle index (LSMI). We aim to describe the prevalence of sarcopenia in a section of our IF population using LSMI, & evaluate the effect of home parenteral support (PS) on LSMI & survival. Additionally, we aim to assess any association between LSMI, BMI & other anthropometric measurements. Methods: IF patients on PS treated at St Mark's Hospital between 1/1/2006-1/10/2016 were identified from a prospectively maintained database. Patients were included if they were on PS & had 2 CTs: the first <= 30 days before start of HPN (pre-PS); the second >= 100 days from PS start (post-PS). Patient records were reviewed to obtain clinical & demographic information & date of death. Anthropometric measurements & BMI contemporaneous to CT scans were recorded. Results: 64 patients met inclusion criteria (M:F 1:1). 83% of our cohort had LSMI below previously published thresholds for sarcopenia. Mean (SD) pre-PS LSMI was 36.5 (6.8)cm(2)/m(2). Mean BMI pre-PS was 22.1 (4.8) kg/m(2). Both BMI (22.1 kg/m(2) to 23.5 kg/m(2)) p < 0.001) & LSMI (36.5 cm(2)/m(2) to 38.4 cm(2)/m(2)) (p = 0.003) increased post-PS. A positive correlation was seen between BMI & LSMI pre (r = 0.47 p < 0.001) & post-PS (r = 0.37 p = 0.003). No correlation was seen between LSMI & anthropometric measurements pre-PS (p = 0.78) or post-PS (p = 0.96). 11 (17%) patients died during the study period; a low LSMI pre-PS was not a risk factor for mortality (HR 0.97 p = 0.55). Conclusions: This study is the first to look at sarcopenia & survival using CT defined LSMI (CT-LSMI) in the IF population. 83% of our cohort had a pre-PS LSMI below previously published thresholds, yet we found no relationship between lower baseline LSMI & survival. This may reflect the heterogeneity of the prognoses of the IF population, or that parenteral nutrition itself affects survival. Our study showed that LSMI & BMI improved following PS but demonstrated that other anthropometric measurements had poor correlation with LSMI & showed no significant improvement overall after PS, confirming the known problems of inter-operator & patient variability of these measurements. Whilst we found significant correlation between LSMI & BMI, BMI significantly underestimated the presence & degree of sarcopenia. LSMI has the potential to provide an objective & reproducible measure of sarcopenia in IF. Future larger studies should be performed to evaluate associations with patient outcomes & utility in clinical decision making. (C) 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Introduction Candidiasis is associated with significant morbidity & mortality. Central venous catheters (CVC) are commonly used for home parenteral nutrition (HPN) in patients with intestinal failure (IF) & are commonly linked to development of candidaemia. We aim to describe the long-term survival in patients with candidal catheter related blood stream infections (CRBSI) in the IF population & assess factors that may be associated with poorer outcome. Methods Clinical records of patients receiving HPN at our unit were reviewed between 1/1/2007 to 1/5/2018. Candidal CRBSI was defined as either: documented or reported positive cultures from the CVC line with negative peripheral cultures, peripheral cultures with time to positivity faster than CVC cultures, paired positive cultures from CVC & peripheral blood with symptoms of sepsis, or positive CVC tip culture following CVC removal. Demographic data, underlying aetiology, small intestinal length, colonic continuity, long-term survival & cause of death were recorded. Data were also collated on number of candidal CRBSI, candidal species, bacterial co-infection, antifungal resistance together with opiate & immunosuppression use at the time of infection. Differences between groups were analysed using Chi-Squared tests, Kaplan-Meier & Cox’s regression model were used to assess factors affecting survival. Results 66 patients were identified of whom 22 (33.3%) were male. The mean age was 49.4 (SD 16.5). 13 (19.7%) patients had multiple candidal CRBSI. Candida galbrata & albicans accounted for 32 (48.5%) of the index infections. 8 (12%) patients had candidal species that were resistant to ≥1 anti-fungal agent. 48 (72.7%) patients were receiving an opiate at the time of the fungal CRBSI, & 8 (12.1%) were receiving some form of immunosuppression. 25 (38%) patients died during the study period. The 1, 5 & 10 year survival rates were 97%, 67% & 53% respectively. From the time of first fungal CRBSI, the 1, 5 & 10 year survival rates were 85%, 55% & 27%. No difference was seen in survival between patients who had single & multiple candidal infections (log-rank p=0.669). On multivariate analysis increasing age (HR 1.08 p=0.02), increasing time of HPN prior to index infection (HR 0.45 p<0.005), length of residual small intestinal length (HR 0.76 p=0.06) underlying aetiology (HR 6.40 p=0.017) & opiate use (HR 39.5 p=0.003) were all associated with long-term survival. Conclusion Our data have shown long-term survival after index fungal CRBSI in the IF population are poor. A better prognosis is associated with a small intestinal length of ≥ 150cm & increasing length of time on HPN prior to first infection. A worse prognosis is associated with underlying aetiology including mesenteric infarction & scleroderma & the use of opiates.

Candidiasis is associated with significant morbidity & attributable mortality1. Central venous catheters (CVC) are commonly used as the mode of delivery for home parenteral nutrition (HPN) in patients with intestinal failure (IF) & are commonly linked to development of candidaemia. We aim to describe the long-term survival in patients with candidal catheter related blood stream infections (CRBSI) in the IF population & assess factors that may be associated with poorer outcome.

Aim This study aims to determine the prevalence of incisional hernia (IH) and enterocutaneous fistula (ECF) in patients with intestinal failure (IF) referred to a tertiary centre and to identify factors associated with their development. Method A retrospective case note review was undertaken of a prospectively maintained database of all patients on home parenteral nutrition between 2011 and 2016 at a UK tertiary referral centre for IF. Risk factors were identified using binary logistic regression. Results The database search identified 447 patients, of whom 349 (78.1%) had surgery prior to developing IF. Eighty-one (23.2%) patients had an IH and 123 (35.2%) had an ECF at the time of referral. Of these, 51 (14.6%) had both IH and ECF. IH was associated with a high body mass index (P = 0.05), a history of a major surgical complication resulting in IF (P = 0.01), previous emergency surgery (P = 0.04), increasing number of operations (P = 0.02) and surgical site infection (SSI; P = 0.01). ECF was associated with complications relating to earlier surgery. (P <= .001), previous treatment with an open abdomen (P = 0.03), SSI (P = 0.001), intra-abdominal collection (P <= 0.001) and anastomotic leak (P = 0.02). Conclusion In this series, patients with IF had a prevalence of IH which was more than double that expected following elective laparotomy (about 10%) and one in three had an ECF. Risk factors for IH and ECF are discussed.

INTRODUCTION Restorative proctocolectomy is a surgical treatment for patients with medically refractory ulcerative colitis and some cases of familial adenomatous polyposis. Intestinal failure, defined as an inability to maintain adequate hydration and micronutrient balances when on a conventionally accepted normal diet, is a rare complication of restorative proctocolectomy. We describe our experience of patients with restorative proctocolectomy who have developed intestinal failure requiring parenteral support. MATERIAL AND METHODS This was a retrospective analysis using a database of patients referred to our intestinal failure unit from January 1998 to January 2016. We analysed the records of all those patients who had restorative proctocolectomy who developed intestinal failure. RESULTS 807 patient records analysed, 35 patients were found to have had a restorative proctocolectomy (13 male and 22 female). Ninety-one percent (n = 32) of patients developed IF as a consequence of unpredictable complications which occurred after RPC formation. Potentially predictable complications were noted in 9% (n = 3) of patients. DISCUSSION AND CONCLUSIONS Most cases of intestinal failure in restorative proctocolectomy were unpredictable. In a small number of patients, accurate assessment and measurement of the small intestine may have better predicted the adverse outcome of intestinal failure allowing improved pre-operative counseling of patients.

Introduction Faecal Calprotectin (FC) is a marker of neutrophil activity, and is sensitive at detecting gastrointestinal inflammation. FC levels>150 µg/g are considered to be associated with a higher risk of endoscopically active inflammatory bowel disease. Meta-analyses report that the sensitivity and specificity at predicting active Crohn’s disease (CD) using a cut off FC >50 µg/g is 83%–91% and 47%–53% respectively; for FC >150 µg/g, the sensitivity and specificity is 75% and 71% respectively. Whilst the use of FC from stoma effluent has been studied in the context of predicting allograft rejection after small bowel transplant, its use in IBD has not been assessed, even though many CD patients have stomas. The aim of this study is to assess the accuracy of FC from stoma samples. Methods Consecutive patients with a stoma and CD were identified from a prospectively maintained clinical database. The FC from stoma effluent was categorised as: FC<50 µg/g, 50–100 µg/g, 100–150 µg/g and >150 µg/g. This was correlated to endoscopic and/or radiologic findings within 3 months of the FC result. An endoscopy was considered abnormal if the Simple Endoscopic Score for Crohn’s Disease (SES-CD) was ≥2 as rated by 2 blinded observers on the basis of the endoscopy report/pictures. An MRI or CT was considered abnormal if any evidence of active inflammation was reported. Results 47 FC results were analysed from 29 CD patients with a stoma (M:F 12:15). 16/29 patients had intestinal failure. 25 samples were from an ileostomy, 18 from a jejunostomy and 4 from a colostomy. 18 patients had one sample, 5 had 2 samples, 3 had 3 samples and 2 patients had 4 samples assessed. The median time between FC and imaging was 40 days (range 2–95); and between FC and endoscopy was 56 days (range 6–91). 29 patients had a CT or MRI, 9 had an endoscopy and 9 had both. Of the 4 colostomy samples: 3 had FC of <150 µg/g and none had evidence of active disease; one had a FC of 1130 µg/g and moderate inflammation of a jejunal segment on endoscopy. Of the 43 ileostomy samples: 29 had FC <150 µg/g, of which 3 had active disease (false negatives). The sensitivity at FC cut off of 50 µg/g and 150 µg/g was 80% and 73% respectively. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for three FC cut offs are shown in table 1. Conclusion We report that stoma FC has a sensitivity and specificity which is similar to stool FC at all three cut offs. These results suggest that FC is a useful adjunct to clinical assessment and investigations, and a prospective trial in which there is a shorter interval between FC and the diagnostic test is required.

Rationale: Sarcopenia is recognised in patients with intestinal failure (IF) & has been associated with poorer survival in several chronic diseases. CT can measure sarcopenia through a L3 skeletal muscle index (LSMI). We aim to evaluate the prevalence of sarcopenia in our IF population using LSMI, & evaluate the effect of home parenteral support (HPN) on LSMI & survival.

Introduction Sarcopenia is recognised in patients with intestinal failure (IF) and has been associated with poorer survival in several chronic diseases. CT can measure sarcopenia through a L3 skeletal muscle index (LSMI). We aim to evaluate the prevalence of sarcopenia in our IF population using LSMI, and evaluate the effect of home parenteral support (HPN) on LSMI and survival. Additionally, we aim to assess any association between LSMI, BMI and other anthropometric measurements. Methods IF patients on HPN treated at St Mark’s Hospital between 1/1/2006–1/10/2016 were identified from a prospectively maintained database. Patients were included if they were on HPN and had 2 CTs: the first ≤30 days before start of HPN (pre-HPN); the second ≥100 days from HPN start (post-HPN). Patient records were reviewed to obtain clinical and demographic information and date of death. Anthropometric measurements and BMI contemporaneous to CT scans were recorded. Results 64 patients met inclusion criteria (M:F 1:1). 83% of our cohort had LSMI below previously published thresholds for sarcopenia. Mean pre-HPN LSMI was 36.5±6.8 cm2/m2. Mean BMI pre-HPN was 22.1±4.8 kg/m2. Both BMI (p<0.001) and LSMI (p=0.003) increased post-HPN. A positive correlation was seen between BMI and LSMI pre (p<0.001) and post-HPN (p=0.003). No correlation was seen between LSMI and anthropometric measurements pre-HPN (p=0.78) or post-HPN (p=0.96). 11 (17%) patients died during the study period; a low LSMI pre-HPN was not a risk factor for mortality (HR 0.97 p=0.55). Conclusions This study is the first to look at sarcopenia and survival using CT defined LSMI in the IF population. 83% of our cohort had a pre-HPN LSMI below previously published thresholds, yet we found no relationship between lower baseline LSMI and survival. This may reflect the heterogeneity of the prognoses of the IF population, or that parenteral nutrition itself affects survival. Our study showed that LSMI and BMI improved following HPN but demonstrated that other anthropometric measurements had poor correlation with LSMI and showed no significant improvement overall after HPN, confirming the known problems of inter-operator and patient variability of these measurements. Whilst we found significant correlation between LSMI and BMI, BMI significantly underestimated the presence and degree of sarcopenia. We have shown LSMI can provide an objective and reproducible measure of sarcopenia in IF. Future larger studies should be performed to evaluate associations with patient outcomes and utility in clinical decision making.

Standard management of type 3 intestinal failure (IF) is long-term parenteral support (PS). While it is clear that PS is lifesaving treatment for IF, it carries significant morbidity and mortality, both dependent and independent of the underlying aetiology of the IF. We report the largest single-centre series assessing the long-term survival of adult patients on all forms of home PS (parenteral nutrition and parenteral fluids) for type 3 IF.

This study aims to compare the outcomes of posterior component separation and transversus abdominis release (PCSTAR) with the open anterior component separation (OACS) technique. OACS, first described by Ramirez et al. (Plast Reconstr Surg 86(3):519–526, 1990), has become an established technique for local myofascial advancement in abdominal hernia surgery. PCSTAR, described by Novitsky et al. (Am J Surg 204(5):709–716, 2012), is being used more frequently and is rapidly becoming the technique of choice in complex ventral hernia repair.

Intestinal failure (IF) occurs when there is reduced intestinal absorption causing malnutrition or dehydration. The management of this condition has changed since the very first patients were started on long-term parenteral support in the form of parenteral nutrition in the 1960s. At our unit our first patient was started on long-term parenteral support in the 1970’s. We now care for the largest number of HPN patients in the UK. We describe changes in aetiology as seen in our unit over the last 36 years.

Introduction The importance of presence of a nutrition support team (NST) and a nutrition steering committee (NSC) were recognised in 1994 by BAPEN with the recommendation that all major UK hospitals should appoint a NSC and at least one NST. It was recognised that delivering excellent nutritional care within hospitals required the co-ordination and oversight of a NSC. The NST’s role was to bring together a multi-disciplinary team that could support hospital staff in the provision of nutritional therapy, especially enteral and parenteral nutritional support, at a ward level. A NST should contain at least a doctor, nurse, dietician and pharmacist with specialist skills in nutritional support. NICE guidelines have also made recommendations about the provision of a NSC and NST in all acute trusts. In 2010 the NCEPOD report – A Mixed bag, reported only 60.2% of hospitals in the UK as having a NST of which only 59% had a full MDT provision. We aimed to assess the current provision of NSC’s and NST’s within the UK at this present time. Methods In June 2017 BAPEN sent a freedom of information (FOI) request to all trusts in England, health boards in Scotland and Wales and social care trusts in Northern Ireland. This requested information on the size of the trust, the presence and composition of the NST and their role within the hospital along with information about the trust’s NSC. Those responses received before 18th October were collated. Hospitals with fewer than 100 beds were excluded from the analysis. Results Of the 181 FOI requests made BAPEN received responses from 122 trusts representing 154 hospitals with more than 100 beds. 91% of trusts in the UK had a NSC and only 80% of trusts reported having a NST. Of this only 25% of social care trusts in Northern Ireland and 40% of health boards in Wales reported having an NST. 48% of trusts with an NST had a nutrition nurse, a dietician, a doctor and a pharmacist. 76% of trusts with an NST had a nutrition nurse, 79% had a pharmacist, 86% had a doctor and 88% had a dietician. 57% of NSTs performed a ward round more than once a week with 10% seeing patients as required and 4% providing an advisory role only. Conclusion There has been a clear improvement in the provision of NSC’s and NST’s within the UK over time. Sadly despite this increase in NSC’s and NST’s we have not managed to fulfil the aim of having one in each trust. Furthermore the majority do not have the full multi-disciplinary team provision required to provide the highest level of care. More work needs to be done to promote the importance of the NSC and NST and provide support in developing them in trusts that currently do not have them ensure that all trusts have access to them.

Background: Restorative proctocolectomy with ileal pouch-anal anastomosis (RPC-IPAA) removes the entire colon & rectum, while preserving the anal sphincter, maintaining intestinal continuity1–4. RPC-IPAA is offered to patients with ulcerative colitis (UC) refractory to treatment or associated with dysplasia, and some patients with familial adenomatous polyposis (FAP). Complications are well described, but intestinal failure (IF) requiring parenteral support (PS) is an uncommon complication of this surgery that carries with it significant morbidity & mortality. We report of the complication of IF as a complication of RPC-IPAA. Methods: Adult patients with RPC-IPAA as an underlying cause of IF who were treated at our institution, were identified between 1/1/1998 & 1/1/2016. Information on complications, small intestinal length & pathophysiological causes of IF were recorded7. Date & cause of death were also recorded. Comparison was made with other patients who had received PS for IF at the same unit during the same time period. Patients were excluded if RPC-IPAA was not a direct cause of IF, or if the cause of the IF was due to malignancy. Results: Of 807 in the IF database, 35 were identified with a RPC-IPAA and met the inclusion criteria. There were 13 male patients in the pouch group with IF. The pouch was formed for UC in 26, FAP in 6, & other reasons in 3. The pathophysiological classification of IF was short bowel in 49% (n=17), mechanical obstruction in 29% (n=10), intestinal fistulae in 14% (n=5), intestinal dysmotility in 6% (n=2) & small bowel mucosal disease in 3% (n=1). Survival was 96% at 1 year and 75% at, 5 years. This compared to 76% & 48% respectively in the non-pouch group (p=0.02). IF was a potentially avoidable complication in three patients (9%) with a pouch. Two developed IF due to short bowel after index pouch formation (residual small bowel length of 50–100cm). One patient underwent a pouch originally for ulcerative colitis but developed IF due to small bowel Crohn's disease with no prior small bowel imaging prior to pouch formation was documented. Figure 1. Survival pouches with IF vs non pouches with IF. Conclusions: IF is a rare complication of RPC-IPAA surgery, but carries with it a high disease burden. Our data has shown that survival is better in RPC-IPAA patients compared to patients who have IF for other conditions. We recommend documenting the pre and post-operative bowel length, with appropriate pre-operative imaging of the small bowel as standard practice in RPC-IPAA surgery.

Purpose of reviewTo examine the most recent literature on the clinical trials associated with the relevant growth factors that have been of interest in the treatment of short bowel.Recent findingsShort bowel is a rare but devastating condition that condemns patients to lifelong parenteral support. Historically, treatment options negating the need for parenteral support were limited. Therapeutic growth factor use is of interest, but the clinical trial data are inconclusive. The STEPS-2 trial was the first trial that showed a sustained positive effect of the growth factor glucagon-like peptide-2 (GLP-2). This led to a phase shift in the management of short bowel, with the US Food and Drug Administration approval of the GLP-2 analogue teduglutide in 2012. This review summarizes all the relevant clinical trials of growth factors in the treatment of short bowel.SummaryGLP-2 has shown that growth factors can revolutionize the treatment of short bowel. Data however are lacking with regards to the solitary use of other factors. This review highlights the need for further work using the factors in combination as well as considering their use in novel methods for example in the field of regenerative medicine.

Introduction: Intestinal failure (IF) occurs when there is reduced intestinal absorption causing malnutrition or dehydration[1]. The management of this condition has changed since the very first patients were started on long-term parenteral support in the form of parenteral nutrition in the 1960s. At our unit our first patient was started on long-term parenteral support in the 1970’s. We now care for the largest number of HPN patients in the UK. We describe changes in aetiology as seen in our unit over the last 36 years. Methods: Clinical records of 974 adult patients receiving home parenteral support for IF at our tertiary referral center were analyzed from a period from January 1979 until October 2016. Demographic data including age, sex, underlying aetiology, complication rates and survival was recorded. Difference between groups were analysed by with chi-squared tests, and the Cox’s regression model was used to assess survival. Results: The mean age of patients treated at our unit has increased from 31±16.5 to 52±17.6 years from pre 1989 to 2010–2016, Graph 1.FigureDuring the same period there has been a change in the underlying aetiology, with a greater percentage of patients with IF due to surgical complications (3.4% to 28.8% (p<0.001)), fewer with IBD as an underlying cause (37.9% to 22.6%) (p<0.001) and malignancy now forming a proportion of our patient cohort (0% to 8.4%) Graph 2.FigureIF related complications have reduced with significant change in percentage of patients with catheter related blood-stream infections (71.4% to 42.2%) (p<0.005) and central venous catheter associated thrombosis (36% to 5.3%) (p<0.001). Associated with these findings overall survival was better in the pre 1995 era HR 0.2-0.4 (p=0.02). Conclusions: At our institution there has been a significant change in the underlying aetiology and demographics of patients with IF. The age of initiation of home parenteral support is increasing, and there has been a reduction in the proportion of patients with IBD as the underlying cause of IF with an increase in surgical complications and malignancy as the underlying cause. Our data shows that there has been a reduction over time, in the percentage of patients with complications related to IF including catheter related blood stream infection rates and central venous thrombosis. Notably survival outcomes were significantly better in the period pre 1995, which is likely explained by the fact that we now are treating older patients with complex underlying conditions associated with poorer outcomes. References: 1. Pironi L et al. ESPEN endorsed recommendations. Definition and classification of intestinal failure in adults. Clin. Nutr. 2015 Apr;34(2):171–80

Introduction Intestinal failure (IF) occurs when there is reduced intestinal absorption causing malnutrition and/or dehydration. The management of this condition has changed since the very first patients were started on long-term parenteral support in the form of parenteral nutrition in the 1960s. At our unit our first patient was started on long-term parenteral support in the 1970’s. We now care for the largest number of HPN patients in the UK. We describe changes in aetiology as seen in our unit over the last 36 years. Method Clinical records of 974 adult patients receiving home parenteral support for IF at our tertiary referral centre were analysed from a period from January 1979 until October 2016. Demographic data including age, sex, underlying aetiology, complication rates and survival was recorded. Difference between groups were analysed by with chi-squared tests, and the Cox’s regression model was used to assess survival. Results The mean age of patients treated at our unit has increased from 31±16.5 to 52±17.6 years from pre 1989 to 2010–2016. During the same period there has been a change in the underlying aetiology, with a greater percentage of patients with IF due to surgical complications (3.4% to 28.8%% (p<0.001)), fewer with IBD as an underlying cause (37.9% to 22.6%)%) (p<0.001) and malignancy now forming a proportion of our patient cohort (0% to 8.4%)%). IF related complications have reduced with significant change in percentage of patients with catheter related blood-stream infections (71.4% to 42.2%)%) (p<0.005) and central venous catheter associated thrombosis (36% to 5.3%)%) (p<0.001). Associated with these findings overall survival was better in the pre 1995 era HR 0.2–0.4 (p=0.02). Conclusion At our institution there has been a significant change in the underlying aetiology and demographics of patients with IF. The age of initiation of home parenteral support is increasing, and there has been a reduction in the proportion of patients with IBD as the underlying cause of IF with an increase in surgical complications and malignancy. Our data also shows that there has been a reduction in the rates of complications related to IF including catheter related blood stream infection rates and rates of central venous thrombosis. Notably survival outcomes were significantly better in the period pre 1995, which is likely explained by the fact that we now are treating older patients with complex underlying conditions associated with poorer outcomes. Disclosure of Interest None Declared