Introduction: Intestinal failure (IF) is the inability to maintain protein-, energy- and/or fluid- and electrolyte balance because of reduced absorption with the necessity of parenteral support (PS). The ability to adapt is mainly determined by the functional anatomy (type-I: jejunostoma, type-II: jejunocolic anastomosis, type-III: jejuno-ileo-colonic anastomosis). We determined the dynamical changes of PS over time and as a result of reconstructive surgery or medication with Teduglutide.

Methods: Monocentric analysis of 56 patients with IF. Analysis of the relation of the PS-composition, anatomic type, surgery and Teduglutide to BMI over time (initially, time of max. support, last contact).

Results: 50/56 patients were followed for 869 ± 750 days (range 41 - 4011) with 8 ± 6 observation time points (mean interval 92 days) per patient. At the initial contact 27 patients had type-I-, 16 type-II-, 2 type-III-anatomy and 5 functional IF. During the observation period 4 type-I-patients were converted to type-II-anatomy and 7 to type-III-anatomy. At the initial contact type-I-patients received 2926 ml volume, 244 mmol Na and 24 kcal/kg per day and type-II-patients received 1515 ml volume, 107 mmol Na and 19 kcal/kg per day. At this time they were on PS for 1157 ± 1756 days (range 0 – 6202). Based on urinary Na and volume we increased PS volume, Na and energy: type-I patients: +277 ml/d, +2 kcal/kg/d, +65 mmol/d; type-II-patients: +284 ml/d, +3 kcal/kg/d, +45 mmol/d. Due to intestinal adaptation and/or surgery is was possible to reduce all three parameters significantly (type-I: -1982 ml/d, -17 kcal/kg/d, -192 mmol/d; type-II: -635 ml/d, -7 kcal/kg/d, -69 mmol/d). The BMI increased over time (type-I: +2,4; type-II: +1,9). In the exploratory analysis, increased sodium support was more strongly associated with increasing BMI than increased volume or energy support.

Conclusion: Significant dynamic adjustments were required during the course of IF. Initially often intensification of volume, Na and energy support was necessary even if these were already provided at high doses. Sufficient sodium support appears to have the strongest impact on the recovery of BMI. Spontaneous (or medically enhanced) adaptation as well as reconstructive surgery allow reductions and in some cases weaning of PS over time.