Role of home parenteral nutrition in gastroenterology

Czech version

Authors: J. Vejmelka; D. Čermáková; I. Lišková; M. Machava; V. Pospíšil; P. Kohout
Authors‘ workplace: Centrum domácí parenterální výživy, Interní klinika 3. LF UK a FTN Praha
Published in: Gastroent Hepatol 2026; 80(3): 217-224
Category: Digestive Endoscopy: Review Article
doi: https://doi.org/10.48095/ccgh2026217

Overview

Home parenteral nutrition (HPN) represents an established therapeutic modality for patients with chronic intestinal failure in whom adequate nutritional and fluid intake cannot be achieved via oral or enteral routes. This therapy enables long-term intravenous administration of nutrients, fluids, and electrolytes, thereby preventing or treating malnutrition, maintaining metabolic stability, and improving patients’ quality of life. Care for patients receiving HPN is organized in specialized centers and is based on multidisciplinary collaboration. In routine clinical practice, gastroenterologists play a key role in recognizing intestinal failure and referring patients to specialized HPN centers. The most common indication for HPN in gastroenterology is short bowel syndrome; however, HPN may also be required in other clinical conditions, such as severe intestinal motility disorders, multiple strictures or adhesions, complicated enterocutaneous fistulas, or radiation enteropathy. In selected cases, HPN may also be considered in palliative care. Recent therapeutic advances include pharmacological support of intestinal adaptation using glucagon-like peptide 2 analogues, which may reduce dependence on parenteral nutrition in selected patients with short bowel syndrome. In addition, technological innovations, including portable infusion pumps, allow better integration of parenteral nutrition into patients’ daily lives. When appropriately indicated and delivered within specialized centers, home parenteral nutrition enables long-term survival and preserves the quality of life in patients with chronic intestinal failure.

Keywords:

home parenteral nutrition – intestinal failure – short bowel syndrome – teduglutide – quality of life

Sources

1. Pironi L, Arends J, Baxter J et al. ESPEN guidelines on chronic intestinal failure in adults. Clin Nutr 2016; 35 (2): 247–307. doi: 10.1016/j.clnu.2016.01.020.

2. Pironi L, Boeykens K, Bozzetti F et al. ESPEN practical guideline: home parenteral nutrition. Clin Nutr 2023; 42 (3): 411–430. doi: 10.1016/j.clnu.2022.12.003.

3. Cuerda C, Pironi L, Arends J et al. ESPEN practical guideline: clinical nutrition in chronic intestinal failure. Clin Nutr 2021; 40 (9): 5196–5220. doi: 10.1016/j.clnu.2021.07.002.

4. Wanten GJA, Calder PC, Forbes A. Managing adult patients who need home parenteral nutrition. BMJ 2011; 342: d1447. doi: 10.1136/bmj.d1447.

5. Dibb M, Teubner A, Theis V et al. Review article: the management of long-term parenteral nutrition. Aliment Pharmacol Ther 2013; 37 (6): 587–603. doi: 10.1111/apt.12209.

6. Worthington P, Balint J, Bechtold M et al. When is parenteral nutrition appropriate? JPEN J Parenter Enteral Nutr 2017; 41 (3): 324–377. doi: 10.1177/0148607117695251.

7. Hashash JG, Elkins J, Lewis JD et al. AGA clinical practice update on diet and nutritional therapies in patients with inflammatory bowel disease: expert review. Gastroenterology 2024; 166 (3): 521–532. doi: 10.1053/j.gastro.2023.11.303.

8. Nightingale JM. Management of patients with a short bowel. World J Gastroenterol 2001; 7 (6): 741–751. doi: 10.3748/wjg.v7.i6.741.

9. Lal S, Teubner A, Shaffer JL. Review article: intestinal failure. Aliment Pharmacol Ther 2006; 24 (1): 19–31. doi: 10.1111/j.1365-2036.2006.02941.x.

10. Huisman-de Waal G, Schoonhoven L, Jansen J et al. The impact of home parenteral nutrition on daily life. Clin Nutr 2007; 26 (3): 304–313. doi: 10.1016/j.clnu.2006.12.004.

11. Winkler MF. Quality of life in adult home parenteral nutrition patients. JPEN J Parenter Enteral Nutr 2005; 29 (3): 162–170. doi: 10.1177/0148607105029003162.

12. Koudelková K, Waldauf P, Wohl P et al. The Czech Home Parenteral Nutrition Registry REDNUP: comprehensive analysis of adult patients’ data. Ann Nutr Metab 2024; 80 (3): 143–152. doi: 10.1159/000538232.

13. Messing B, Joly F. Guidelines for management of home parenteral support in adult chronic intestinal failure patients. Gastroenterology 2006; 130 (2 Suppl 1): S43–S51. doi: 10.1053/j.gastro.2005.09.064.

14. Kumpf VJ, Gray B, Monczka J et al. Parenteral nutrition at home/long-term parenteral nutrition. Am J Health Syst Pharm 2024; 81 (Suppl 3): S112–S120. doi: 10.1093/ajhp/zxae081.

15. Jeppesen PB, Pertkiewicz M, Messing B et al. Teduglutide reduces need for parenteral support among patients with short bowel syndrome with intestinal failure. Gastroenterology 2012; 143 (6): 1473.e3–1481.e3. doi: 10.1053/j.gastro.2012.09.007.

16. Jeppesen PB, Gilroy R, Pertkiewicz M et al. Randomised placebo-controlled trial of teduglutide in reducing parenteral nutrition and/or intravenous fluid requirements in patients with short bowel syndrome. Gut 2011; 60 (7): 902–914. doi: 10.1136/gut.2010.218271.

17. Jeppesen PB. Spectrum of short bowel syndrome in adults: intestinal insufficiency to intestinal failure. JPEN J Parenter Enteral Nutr 2014; 38 (1 Suppl): 8S–13S. doi: 10.1177/0148607114 520994.

18. Webster-Gandy J, Madden A, Holdsworth M et al. Oxford handbook of nutrition and dietetics. Oxford (UK): Oxford University Press 2020.

19. Guglielmi FW, Regano N, Mazzuoli S et al. Catheter-related complications in long-term home parenteral nutrition patients with chronic intestinal failure. J Vasc Access 2012; 13 (4): 490–497. doi: 10.5301/jva.5000133.

20. Oliverius M, Kohout P. Selhání střeva a transplantace tenkého střeva. Praha: Mladá fronta 2020.

21. Pironi L, Steiger E, Brandt C et al. Home parenteral nutrition provision modalities for chronic intestinal failure in adult patients: an international survey. Clin Nutr 2020; 39 (3): 585–591. doi: 10.1016/j.clnu.2019.03.019.

22. Wanten GJA, Calder PC. Immune modulation by parenteral lipid emulsions. Am J Clin Nutr 2007; 85 (5): 1171–1184. doi: 10.1093/ajcn/85.5.1171.

23. Cederholm T, Bosaeus I. Malnutrition in adults. N Engl J Med 2024; 391 (2): 155–165. doi: 10.1056/NEJMra2212159.

24. Cavicchi M, Beau P, Crenn P et al. Prevalence of liver disease and contributing factors in patients receiving home parenteral nutrition for permanent intestinal failure. Ann Intern Med 2000; 132 (7): 525–532. doi: 10.7326/0003-4819-132-7-200004040-00003.

25. Pironi L, Corcos O, Forbes A et al. Intestinal failure-associated liver disease: prevention and treatment. Clin Nutr 2018; 37 (6 Pt A): 1794–1799. doi: 10.1016/j.clnu.2018.06.966.

26. Gondolesi GE, Pape UF, Mason JB et al. Baseline characteristics of adult patients treated and never treated with teduglutide in a multinational short bowel syndrome and intestinal failure registry. Nutrients 2024; 16 (15): 2513. doi: 10.3390/nu16152513.

27. Baxter JP, Fayers PM, Bozzetti F et al. An international study of the quality of life of adult patients treated with home parenteral nutrition. Clin Nutr 2019; 38 (4): 1788–1796. doi: 10.1016/j.clnu.2018.07.024.

28. Saqui O, Fernandes G, Allard JP et al. Quality of life analysis during transition from stationary to portable infusion pump in home parenteral nutrition patients: a Canadian experience. Nutr Clin Pract 2014; 29 (1): 131–141. doi: 10.1177/0884533613516129.