Home Parenteral Nutrition as Primary Therapy in Patients with Extensive Crohn's Disease of the Small Bowel and Malnutrition

Seven patients with extensive Crohn's disease have received nightly supplementary home parenteral nutrition (HPN) for a total of 120 patient months. Indications for HPN were short bowel in 5, growth failure in 1, and gastric outlet obstruction in 1. Before HPN, body weight averaged 72% of ideal body weight in 5 patients; 1 adolescent was less than the third percentile in weight. Anthropometry in 6 patients confirmed decrease in fat and lean body mass in all. All patients were anemic and serum albumin was low in 6 of 7 (1.8 to 3.0 g per dl). During HPN average weight gain was 11 kg in the 6 patients treated for 6 months or longer. Hemoglobin increased an average of 1.5 g per dl and serum albumin increased an average of 1.0 g per dl. There were 50% fewer hospitalizations after HPN was begun compared with similar time periods before HPN. HPN did not prevent or reverse complications of Crohn's disease other than malnutrition. Major complications were displacement of the catheter on two occasions in 1 patient and metabolic acidosis in 2 patients. Sepsis did not occur. Conclusion: HPN is justified in selected patients with extensive Crohn's disease and malnutrition in that patients gain weight, nutritional parameters improve, and patients' activities increase as number of hospitalizations decrease.