Two separate diseases make up inflammatory bowel disease, also called IBD, a chronic inflammation of the intestinal tract. Crohn's disease and ulcerative colitis can have similar effects but different causes. Over one million people suffer from IBD, which usually starts between the ages of 15 and 30, but can occur in children or older people as well, the American College of Gastroenterology reports. Total parenteral nutrition, or TPN, can sometimes benefit people with IBD by allowing the damaged intestines time to recover.
Definition
Total parenteral nutrition given through an intravenous infusion into a vein alleviates the need to eat by supplying the nutrients and calories necessary for growth. The TPN infusion, a white fluid, runs over a number of hours with the hourly volume controlled by a pump, often while you sleep. If you're going to receive TPN for any amount of time, a central venous port that can be easily accessed is usually placed into a large vein, usually in the chest. You must take care when accessing the port to maintain sterile technique and avoid contaminating the line, which could lead to infection.
Differences
Both Crohn's disease and ulcerative colitis damage the intestine, but in different ways. Inflammation that leads to ulcerative colitis normally starts in the inner layer of the lower part of the large intestine and moves upward, while Crohn's disease can infect any area from the mouth to the large intestine. In Crohn's disease, normal areas may be found between the damaged areas, while in ulcerative colitis, damage is linear. Total parenteral nutrition may help people with Crohn's disease more than those with ulcerative colitis, Gregory Rose, M.D. of the University of Washington reports his website.
Purpose
Symptoms of IBD include diarrhea, weight loss, rectal bleeding, fever, abdominal pain and abscesses in the bowel. Fistulas, abnormal openings in the bowel that often become infected may make regular nutrition impossible until the areas heal. Because TPN relieves of the bowel of the need to digest and process food, it allows damaged areas to heal.
Home Administration
An article published in the May-June 2003 issue of the "Journal of Gastrointestinal Surgery" described a study conducted by Mount Sinai Hospital at the University of Toronto on the use of home-administered TPN as an alternative to early surgery or prolonged hospitalization. All patients had serious bowel complications related to IBD. The average length of time for TPN administration was 75 days; 80 percent of the patients had success using TPN at home, with 53 percent having planned surgery and 27 percent not requiring surgery after TPN therapy.
Complications
Total parenteral nutrition can cause complications, including sepsis related to the central venous catheter, which occurs in 50 percent of patients and liver and blood sugar abnormalities, which affect 90 percent, according to the Merck Manuals Online Medical Library. Gallbladder problems, osteoporosis and adverse reactions to the lipid solution such as dizziness, nausea, headache and back pain can also occur.
References
- PubMed: Home Total Parenteral Nutrition: An Alternative to Early Surgery For Complicated Inflammatory Bowel Disease; J. Evans et al; May-June 2003
- University of Washington; Inflammatory Bowel Disease
- American College of Gastroenterology: Inflammatory Bowel Disease
- The Merck Manuals Online Medical Library: Total Parenteral Nutrition
