PD331 - DYSMOTILITY OR NOT DYSMOTILITY: THAT IS THE QUESTION!

PD331

DYSMOTILITY OR NOT DYSMOTILITY: THAT IS THE QUESTION!

M. Eckhardt^1,*, A. Sharma¹, M. V. Teso ¹, A. Sasegbon¹, A. Abraham¹, T. Vanuytsel², P. Paine¹, S. Lal¹

¹Intestinal Failure Unit, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom, ²Leuven Intestinal Failure and Transplantation , Leuven University Hospital, Leuven, Belgium

Rationale: Intestinal dysmotility resulting from Chronic Intestinal Pseudo-Obstruction (CIPO) or Enteric Dysmotility (ED) is a recognised mechanism of intestinal failure (IF). However, patients with Disorders of Gut–Brain Interaction (DGBI) are increasingly being initiated on home parenteral support (HPS) and misclassified as having dysmotility. This study aimed to categorise patients with motility disorders or DGBI leading to HPS commencement, re-classify them into appropriate dysmotility or DGBI subgroups, and assess long-term outcomes.

Methods: This cohort study included adults with motility disorders or DGBI-related small bowel feeding intolerance initiated on HPS between 2010-2023 at a national IF Reference Centre. Classification into CIPO, ED, Opioid Bowel Dysfunction (OBD), Dysmotility off opioids, Narcotic Bowel Syndrome (NBS) and DGBI off opioids was based on radiology, histology, manometry and transit studies.

Results: Sixty-six patients were included (Figure 1). Median follow-up time was 6.2 years (range 0.05–15 years). Most had CIPO (47.0%), followed by NBS (22.7%), DGBI off opioids (18.2%), OBD (7.6%), and ED (4.5%). There were no patients with “Dysmotility off opioids”. The cumulative incidence of nutritional autonomy at 5 years was 7.9%, 0%, 20%, 43% and 33% for CIPO, ED, OBD, NBS and DGBI off opioids, respectively (p=0.015). 5-year survival rate was 48%, 100%,100%,79% and 92% for CIPO, ED, OBD, NBS and DGBI off opioids, respectively (p<0.001).

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Conclusion: There is an emerging cohort of patients with pain-related small intestinal feeding intolerance likely related to DGBI rather than an objective motility disorder; such patients are more likely to wean from HPS than those with CIPO. While the indications for HPS for patients with dysmotility and IF are clear, the appropriateness of offering HPS to patients without dysmotility needs careful consideration.

Disclosure of Interest: None declared