P942 - PATIENTS WITH HYPERMOBILITY DISORDERS ON INTESTINAL FAILURE UNITS - A MULTI-CENTRE UK SURVEY

P942

PATIENTS WITH HYPERMOBILITY DISORDERS ON INTESTINAL FAILURE UNITS - A MULTI-CENTRE UK SURVEY

C. Lam¹, P. Paine ², P. Mooney³, S. Gabe⁴, S. Lal², M. Mcalindon¹, A. Fikree⁵, T. Hollingworth⁶, T. Smith⁶, N. Zarate-Lopez⁵, S. Sharma⁷, T. Konbal⁴, E. Croft⁴, E. Routledge⁸, S. Faloon⁸, K. Fragkos⁵, L. Chong³, K. Morris⁶, R. Farooq⁵, A. Woods³, G. Amarasinghe^4,*

¹Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, ²Gastroenterology, Salford Royal NHS Foundation Trust, Salford, ³Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, ⁴Gastroenterology, St Mark's Hospital , ⁵Gastroenterology, UNIVERSITY COLLEGE LONDON HOSPITALS NHS FOUNDATION TRUST, London, ⁶Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, ⁷Gastroenterology, SHEFFIELD CHILDREN'S NHS FOUNDATION TRUST, Sheffield, ⁸Gastroenterology, BARTS HEALTH NHS TRUST, London, United Kingdom

 

Rationale: Patients with hypermobility disorders (HD) increasingly present to intestinal failure units (IFUs) for parenteral nutrition (PN) without intestinal failure (1).

Aims: Describe indications, complications, comorbidities and medication in this population.

 

Methods: Questionnaire of anonymised retrospective data from 2012 to 2022 from 7 UK HPN centres.

 

Results: 84 patients (82 female) were included, mean age 35 (range 18-70). 56% remain on PN.  

 

Indication for CANH. Multiple indications in some cases. (n=84).
Intolerance of oral/enteral nutrition due to symptomd	70/84
Weight loss	22/84
Enteral tube complications	55/84
Small bowel dysmotility	19/84
Delayed gastric emptying	13/84
Median arcuate ligament syndrome	10/84
Malabsorption	19/84
Autonomic symptoms	1/84

 

Comorbidities: POTS 65%; MCAS 15%; constipation 33%; eating disorder 8%; fibromyalgia 8% functional neurological disorder 9%; gastroparesis 27%; bladder pathology 21%; osteoporosis 13%; migraine 12%; chronic pain 14%; depression 11%; CIPO 5%; rectal prolapse 2%, anxiety 5%. 

 

Total number of admissions was 370 (7943 inpatient bed days). Mean length of stay was 21 days, median 11 days, range 1-386, due to catheter related blood steam infections (CRBSI)102, line complications 32, exit site infection 5, enteral tube complication 8 and tube site infection 5.

 

79% were on opioids and 21% on parenteral cyclizine.

Conclusion: Initiation of CANH in patients with HD differs to usual practice (2). CRBSI rates are higher than usual at 12.84/1000 inpatient bed days (3). High rates of opioid and parenteral cyclizine use seen.

 

The escalating provision of CANH in patients with HD exposes patients to considerable unwarranted harm given increased complications and atypical indications. Robust evaluation of the indication for provision of CANH is recommended. 

References:         1. Vasant DH et al 2020 doi: 10.1111/nmo.13937

        2. Lal S et al doi: 10.1111/nmo.14853.

        3. Bond A et al doi: 10.1136/flgastro-2018-101094.

Disclosure of Interest: None declared