Can success be achieved in the treatment of short bowel syndrome patients in Hungary?

Aim: Depending on the severity of the bowel deficiency short bowel syndrome patients require Home Parenteral Nutrition (HPN) after their temporary hospital treatment. Our aim was to prove that short bowel syndrome patients can be successfully rehabilitated by means of long term home parenteral nutrition in Hungary, too. Patients, method: Retrospective assessment of short bowel syndrome (SBS) patients treated by the Hospital Nutrition team of Szent Imre Hospital in 2009 and 2010. Of our 19 SBS patients we excluded those who did not receive HPN treatment. There remained 5 patients to be assessed. We reviewed their underlying syndrome, the changes in their nutrition status, degree of their rehabilitation and also the frequency of complications. The follow-up period was two years. Average BMI prior to and after HPN: 17.9kg/m2 and 22kg/m2, respectively. Underlying syndrome: in four cases vascular and in one case M. Crohn disease. Gender distribution of patients: 4 male and 1 female. Average age: 56 years. Result: Out of 5 HPN patients one is fully fit for work and three are self-dependent pensioners who can leave their residence. One is home ridden in need of partial care. Two out of five SBS patients had grade 1 SBS (the most severe type, i.e. the small bowel terminates in a stoma), three had grade 2 SBS (less severe form: no stoma, the length of residual small intestine exceeds 30cm). Complications: severe and mild cholestasis in 1 and 3 patients, respectively. After 1000 CVC-days the frequency of cannula sepsis was 3.63. Pathogens involved: Staphylococcus aureus, Enterococcus fecalis, Staphylococcus coag neg., Enterococcus cloacae, Serratia marcescens, MRSA. Conclusion: The modern treatment for serious SBS patients is HPN, which is currently illegal in Hungary. This treatment allows a full or partial rehabilitation of a vast majority of patients accompanied by a complication frequency that is acceptable even by international standards. Their rehabilitation is independent of the severity of SBS.