P0314Clinical Characteristics of Chronic Intestinal Failure in Crohn’s Disease Requiring Long-Term Parenteral Nutrition: A 20-Year Experience From a Single Tertiary Center

Abstract Background Intestinal failure (IF), the rarest yet one of the most severe complications of Crohn’s disease (CD), may result from repeated bowel resections, postoperative sepsis, mucosal inflammation, or intestinal fistulas.1-3 Although the incidence of IF in CD has decreased in the biologics era,4 the rising prevalence of CD and the cumulative burden of chronic complications such as IF are expected to raise its overall prevalence in Korea. These trends highlight the need for greater clinical and research attention to this population. However, data on CD-related IF remain scarce. The primary aim of this study was to describe the incidence, clinical characteristics, complications, and prognosis of chronic IF in CD patients requiring long-term home parenteral nutrition (HPN). Methods This retrospective cohort study was conducted at Asan Medical Center, a tertiary referral hospital in Korea. Adult patients (≥18 years) with CD who developed chronic IF and received HPN for at least 6 months between 2000 and 2024 were identified from the prospectively maintained inflammatory bowel disease (IBD) registry and enrolled in the study. Data on demographics, surgical history, bowel anatomy, parenteral nutrition, and clinical outcomes were extracted from the IBD registry and electronic medical records. Results Twenty patients with CD–related IF who received HPN for ≥6 months were included. The cumulative incidence of IF after CD diagnosis was 0.3% at 10 years, 0.6% at 15 years, and 1.2% at 20 years. Fourteen patients (70%) were female, with a median age at diagnosis of 19.5 years (IQR, 18.2–31.4); 95% were diagnosed before 2010. IF developed after a median of 12.2 years (IQR, 9.2–15.9), at a median age of 32.6 years (IQR, 27.6–44.9). Seventeen patients (85%) had received advanced therapy before IF onset. Short bowel syndrome was the leading etiology (n = 14, 70%), followed by fistulizing disease (n = 4, 20%) and mucosal disease (n = 2, 10%). Catheter-related bloodstream infection occurred in 55% of patients, with an incidence rate of 0.64 per catheter-year (95% CI, 0.51–0.81). The rate of inpatient or emergency department contacts was 0.92 per patient-year (95% CI, 0.84–1.02). At last follow-up, 11 patients (55%) remained HPN-dependent, whereas 9 (45%) achieved nutritional autonomy. Depression occurred in 5 patients (25%) and long-term opioid use in 4 (20%). Conclusion IF is a rare complication of CD, with a cumulative incidence of 0.3% at 10 years, but it can be a severe and life-threatening condition. More than half of patients remain permanently dependent on HPN despite advanced therapies. The high rates of surgical interventions, HPN-related complications, and psychiatric comorbidities emphasize the need for comprehensive multidisciplinary management. References: 1. Nightingale J, O’Keefe SJ, Van Gossum A, et al. Causes and prognosis of intestinal failure in Crohn’s disease: an 18-year experience from a national centre. Aliment Pharmacol Ther. 2007;25(5):543–552. 2. Adamina M, Bonovas S, Raine T, et al. ECCO-ESCP Consensus on Surgery for Crohn’s Disease. J Crohns Colitis. 2018;12(1):1–16. 3. Pironi L, Arends J, Baxter J, et al. ESPEN guideline on chronic intestinal failure in adults: Update 2023. Clin Nutr. 2023;42(7):1273–1312. 4. Hansen T, Duerksen DR, Jeppesen PB. The natural history of Crohn’s disease leading to intestinal failure: a Danish population-based cohort study. J Crohns Colitis. 2022;16(3):452–461. Conflict of interest: Prof. Dr. Park, Sang Hyoung: No conflict of interest Byeon, Jeong-Sik: No conflict of interest Park, Jung-Bin: No conflict of interest Soyeong, Ahn: No conflict of interest