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Cholelithiasis in Home Parenteral Nutrition (Hpn) Patients – Complications of the Clinical Nutrition: Diagnosis, Treatment, Prevention

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Ławiński M., Jachnis A., Ukleja A., Pertkiewicz M.
Polish Journal of Surgery
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2015
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vol. 86
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issue 3
111-115
EN
Long-term home parenteral nutrition (HPN) is an important factor for cholelithiasis. An individualized nutrition program, trophic enteral nutrition and ultrasound bile ducts monitoring is a necessity in those patients. The aim of the study was to evaluate the usefulness of prophylactic cholecystectomy in patients with asymptomatic cholelithiasis requiring HPN. Material and methods. 292 chronic HPN patients were analyzed in the period from 2005 to 2012. Patients were divided into four groups: A - without cholelithiasis, B - with asymptomatic cholelithiasis, C - urgent cholecystectomy because of cholecystisis caused by gallstones, D - cholecystectomy in patients without cholelithiasis performed during an operation to restore the continuity of the digestive tract. The patients were additionally divided depending on the extent of resection of the small intestine and colon. Results. 36.9% of chronic HPN patients had cholelithiasis confirmed using ultrasonographic examination. Cholecystectomy due to acute cholecystitis symptoms was performed in 14.4% of the patients. The remaining 22.6% patients had asymptomatic cholelithiasis. Prophylactic cholecystectomy was performed in 5.5% patients with no signs of cholelcystisis during the planned operation to restore the continuity of the digestive tract. Conclusions. Cholelithiasis in chronic HPN patients is a frequent phenomenon. It seems useful to perform prophylactic cholecystectomy during primary subtotal resection of the small intestine, because the risk of cholelithiasis in this group of patients is very high.
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Quality of Life Considering Patients with Chronic Inflammatory Bowel Diseases - Natural and Parenteral Nutrition

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Raczkowska A., Ławiński M., Gradowska A., Zielińska-Borkowska U.
Polish Journal of Surgery
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2015
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vol. 86
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issue 9
410-417
EN
One of the elements of treatment considering inflammatory bowel diseases is nutritional therapy. The duration of the above-mentioned depends on the prevalence of such symptoms as fever, bowel move-ments, length of the functioning gastrointestinal tract, stoma and intestinal fistula presence. Nutritional therapy is an essential element of successful treatment alongside pharmacological, surgical, and biological therapy, as well as other methods. Crohn's disease and ulcerative colitis considered as chronic diseases, lead towards physical and biopsychosocial disability, being responsible for the reduction in the quality of life. The aim of the study was to determine the quality of life after surgical procedures in case of patients diagnosed with Crohn's disease and ulcerative colitis, subjected to natural and parenteral nutrition. Material and methods. The study group comprised 52 patients from the Department of Gastroen-terology, Military Medical Institute, and Department of Surgery and Clinical Nutrition, Clinical Hospital in Warsaw. The study was performed between October, 2011 and April, 2012. The World Health Organization Quality of Life Instrument - Bref (WHOQOL-BREF) questionnaire was used to deter-mine the patients’ quality of life. conclusions. A lower quality of life was observed in case of patients subjected to parenteral nutrition, poor education, disease symptoms exacerbation, in the majority-rural inhabitants. The quality of life does not depend on gender, type of disease, family status, and additional medical care.
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Quality of life of patients on chronic parenteral nutrition before and after gastrointestinal tract continuity restoration

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Ławiński M., Kot-Mielczarska E., Gradowska A.
Polish Journal of Surgery
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2015
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vol. 87
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issue 4
153-159
EN
The issue of the quality of life considering patients with a temporary or permanent intestinal stoma, as well as the necessity for chronic parenteral nutrition at home remain a poorly understood problem. Daily care of the intestinal stoma and the need to comply with sterile procedures required for parenteral nutrition require such patients to commit their time, which secondarily is associated with the broad aspects of social and personal life. The aim of the study was to analyse the quality of life considering patients with intestinal stomas subjected to chronic parenteral nutrition, before and after gastrointestinal tract continuity restoration. Material and methods. The survey was conducted between May and July, 2014 on a group of 71 patients (33 female and 38 male) who were under the care of the Department of General Surgery and Clinical Nutrition, Warsaw Medical University, operated during the period between 2007 and July, 2014 with a present stoma (32 patients - 45%), as well as after stoma closure (39 patients - 55%). The analysed questionnaire contained 31 questions, and the SF-36 questionnaire was additionally used, determining the quality of life. Results. Analysis of the study material showed differences in the quality of life, considering three most important determinants. Significantly worse assessment of the quality of life was reported by patients with a stoma and subject to intravenous nutrition (83.2±30.5), as compared to those after stoma closure subject to normal nutrition (52.3±33.8). Based on the SF-36 questionnaire differences between patients with a stoma and those without amounted to t(69)=2.84 (p=0.006) demonstrating that those with a stoma reported a lower quality of life. Analysis between younger and older patients, based on the SF-36 questionnaire (t(62.87)=2.49; p=0.016) showed that younger patients achieved lower results, considering dissatisfaction with life (61.55±27.5), as compared to the elderly (80.8±36.9). Conclusions. The group of patients without a stoma seem to be more independent- the vast majority do not use the help of family members (43.6%), or friends (64.1%). Patients with a stoma more often withdraw from social life. The factor that mostly reduces the quality of life is the presence of a stoma, which impairs daily functioning a lot more than the sterile procedures associated with parenteral nutrition. All patients after stoma closure consider that their overall functioning has significantly improved.
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Evaluation Of Irritable Bowel Syndrome Symptoms Amongst Warsaw University Students

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Niemyjska S., Ukleja A., Ławiński M.
Polish Journal of Surgery
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2015
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vol. 87
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issue 5
252-259
EN
Irritable bowel syndrome (IBS) belongs to functional gastrointestinal disorders and is characterized by abdominal pain and change in stool consistency and/or bowel habits. Etiological factors include gastrointestinal peristalsis disturbances, visceral hypersensitivity, chronic inflammation of the mucous membrane, dysbacteremia, intestinal infections, psychosomatic and nutritional factors. Gastrointestinal motility disturbances in case of IBS are manifested by the inhibition of the intestinal passage, which favors the development of constipation or occurrence of diarrhea. The aim of the study was to evaluate IBS symptoms and demonstrate the relationship between physical activity and place of residence amongst Warsaw University students. Material and methods. The study was conducted in march, 2014 using a specific questionnaire, amongst Warsaw University students. The study group comprised 120 female patients, aged between 19 and 27 years (M=23.43; SD=1.29). The chi-square test was used for analysis, p<0.05 was considered as statistically significant. Results. The BMI of investigated patients ranged between 16.30-31.22 kg/m2 (M=21.27; SD=2.71). The majority of respondents (76.6%) weighed within the normal limits. Abdominal pain or discomfort occurred more frequently in the group of students who considered their physical activity as low. In case of respondents with a low physical activity bowel movement disorders and stool continence changes occurred more often, as compared to those with moderate physical activity. The most common symptom was rectal tenesmus, the least common-presence of mucous in the stool. Analysis showed that students with low physical activity were more frequently absent from school/work, due to abdominal symptoms. The respondents with moderate activity more often considered their abdominal symptoms, being associated with stress. Conclusions. IBS symptoms are common amongst Warsaw University students. In case of respondents with low physical activity, abdominal pain or discomfort occurred more often. It has been demonstrated that diet and stress might contribute to the occurrence of abdominal symptoms, being evidence of IBS.
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Method of Nutrition of Patients After Major Oral and Craniofacial Surgery and its Effects on BMI Changes During a Half-Year Period of Observation

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Jaworska E., Lewandowski Z., Samolczyk-Wanyura D., Ławiński M., Pertkiewicz M.
Polish Journal of Surgery
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2015
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vol. 86
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issue 7
305-311
EN
Injuries, deformations and tumours of the facial part of skull, oral cavity or neck often hamper or prevent normal food consumption. After surgery of these structures food intake may be decreased due to postoperative wounds, pain, swelling and trismus. The aim of the study was to evaluate nutritional state of patients treated surgically in the craniomaxillo- facial surgery department and determination of factors affecting body weight changes after surgery. Material and methods. The study included 83 patients operated between 2008 and 2010 in the department of cranio-maxillo-facial surgery, due to: maxillo-facial defects (30 individuals), malignant tumours (23 individuals), injuries (19 individuals), benign tumours (11 individuals). The study was prospective. A method of nutrition during the observation period and BMI (Body Mass Index) value on the first day of hospitalization and after 10, 60, 180 days after hospital admission were considered. For statistical analysis of results a general regression analysis was used. Results. Significant reduction of BMI was observed in all patients after 10 and 60 days from the start of hospitalization. A significant increase of this parameter was observed between Day 60 and Day 180 of observation, however the BMI values after 180 days were still significantly lower than the baseline. A dependency between these changes and a cause of hospitalization as well as nutrition during and after the stay at hospital has been shown. Conclusions. There is a distinct relationship between the worsening of nutritional state after craniofacial surgery and nutrition during and after hospitalization, and therefore special attention should be paid to the issue of nutrition during this period
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Liver Disease in Patients Qualified for Home Parenteral Nutrition – A Consequence of a Failure to Adjust Rtu Bags in the Primary Centre?

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Ławiński M., Bzikowska A., Omidi M., Majewska K., Zielińska-Borkowska U.
Polish Journal of Surgery
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2015
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vol. 86
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issue 6
279-284
EN
If planned improperly, parenteral nutrition may result in a number of severe metabolic complications caused by insufficient or excessive delivery of individual nutrients. One of the most common and the most dangerous complication is parenteral nutrition-associated liver disease (PNALD). Such a complication may also result from using RTU (ready-to-use) bags that are not adjusted adequately to individual patients. The aim of the study was the analysis of prevalence and determining the cause of liver disease in patients who had been receiving parenteral nutrition in primary centres prior to the implementation of home parenteral nutrition in the specialist centre. Material and methods. The study enrolled 146 patients who were referred to the Clinic in the period of 2006-2012 in order to be qualified for home parenteral nutrition. Interview and medical documentation revealed that 100 patients had been receiving parenteral nutrition by means of ready-to-use (RTU) bags in their primary centres. In the remaining 46 patients, such feeding had not been implemented. Upon admission, the following parameters were evaluated: bilirubin, aspartate aminotransferase (AspAT), alanine aminotransferase (AlAT), lactate dehydrogenase (LDH), gamma-glutamyltranspeptidase (GGTP), alkaline phosphatase (AP), triglycerides (TG), cholesterol, protein, albumins, amylase, urea, creatinine and C-reactive protein (CRP). The analysis of the results was conducted with the use of the Student’s T-test. Results. The patients who had been receiving parenteral nutrition manifested significantly increased (p < 0.05) levels of total bilirubin, TG, AlAT, LDH, GGTP, AP and CRP. 23% of patients were diagnosed with jaundice, in 70%, GGTP > 100 i.u. and a half manifested biochemical features of cholestasis. No correlation was observed between the CRP level and results of liver function tests. Conclusions. It was found that there is a correlation between parenteral nutrition with RTU bags and liver disease. The probable cause of liver disease associated with parenteral nutrition received prior to the transfer to the Clinic is excessive administration of lipids. It can be accompanied by excessive administration of glucose. Modification of parenteral nutrition helped to compensate for liver disorders in all patients
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Food, Mechanic and Septic Complications in Patients Enterally Nutritioned in Home Conditions

88%
Kalita M., Majewska K., Gradowska A., Karwowska K., Ławiński M.
Polish Journal of Surgery
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2015
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vol. 86
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issue 10
466-472
EN
Home enteral nutrition (HEN for short) allows practically normal living for patients who cannot be fed orally but at the same time do not have to stay in hospitals, which is often found to decrease their mental condition, increase of probability of complications and costs of medical treatment. The aim of the study was to analyze the frequency of nutritional, mechanical and septic complications in patients fed enterally in home conditions. Material and methods. The study performed using retrospective analysis of study results and reports from control visits for patients in the period between 2012-2013. 147 patients fed enterally using HEN method participated in the study, including 70 men and 77 women aged 19 to 99 years (average 65 years). The following type of gastrointestinal tract access was used for patients: PEG in 113 (76.5%), feeding jejunostomy - 21 (1.4%), PEG-PEJ - 5 (3.5%), in case of the remaining 8 patients the nasogastric gavage (5.5%) was used. Results. The most common complication were infections (of gastric tract, skin soft tissue in the region of nutritional fistula entry, in three cases the aspiration pneumonia was diagnosed) found in 55 (49.1%) of cases. Mechanical complications were found out in 29 (25.9% of all complications), nutritional complications were present 28 times, which constituted 25% of all complications. Conclusions. In the studied group of patients with an implemented HEN procedure, septic complications were the most common problem. The longest average nutrition time with PEG-PEJ probably results from the effective protection of the patient against aspiration pneumonia.
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Gastrojejunostomy Inserted Through Peg (Peg-J) in Prevention of Aspiration Pneumonia. Clinical Nutrition Complication in Dysphagic Patients

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Ławiński M., Gradowski Ł., Bzikowska A., Goszczyńska A., Jachnis A., Forysiński K.
Polish Journal of Surgery
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2015
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vol. 86
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issue 5
223-229
EN
Percutaneous endoscopic gastrostomy (PEG) is the most commonly used method of access to the gastrointestinal tract in long‑term home enteral nutrition (HEN) in patients with neurogenic deglutition and stenosis of the upper gastrointestinal tract caused by tumour. One of the most common complications of HEN is pneumonia resulting from aspiration of saliva or food. The risk of aspiration and the potential consequent sudden death is further increased by concomitant delayed gastric emptying and gastroesophageal reflux disease. The aim of the study was to evaluate the efficacy of changing percutaneous endoscopic gastrostomy to a gastrojejunostomy inserted through the PEG (PEG-J) in the prevention of aspiration pneumonia. Materiał and methods. The study involved 158 patients receiving HEN by percutaneous endoscopic gastrostomy (PEG), aged 19 to 90 years. Indications for enteral nutrition in the study subjects included: neurogenic dysphagia - 95 patients (60%), and obstruction of the upper gastrointestinal tract due to cancer - 63 patients (40%). Results. The pulmonary and gastrointestinal complications were observed in 28 patients receiving gastric nutrition through PEG within one to nine months following the start of the feeding. In 20 patients, because of the symptoms of aspiration pneumonia with accompanying gastroesophageal reflux and delayed gastric emptying, PEG was changed to PEG-J as an alternative. There were no reports on food reflux and aspiration pneumonia in patients whose PEG has been replaced by PEG-J. Conclusions. The use of PEG-J appears to prevent the occurrence of aspiration pneumonia in patients receiving home enteral nutrition in the long‑term
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