IrSPEN policy Seminar 2017 highlights urgent need for intestinal failure unit

Services for patients with complex nutritional problems in Ireland are inadequate, experts have insisted.

Good nutrition is key among people affected by or recovering from illness, however malnutrition and disease often go hand in hand.

Malnutrition refers to under-nutrition that affects a person’s health and wellbeing. It can come about if the body cannot use food properly, which can lead to a person losing weight and developing nutritional deficiencies. Certain diseases, such as cancer, can also lead to appetite suppression.

Malnutrition can occur quite quickly, even in those who are overweight or obese. One of the most serious conditions that can result from this is intestinal failure. When this occurs, a person cannot digest food or absorb fluids.

However, a conference hosted by the Irish Society for Clinical Nutrition & Metabolism (IrSPEN) has highlighted the lack of specialist services available for patients affected by this serious condition.

Ireland currently has no specialist unit for the 80-100 adults who develop intestinal failure every year. This is contrary to all expert guidelines and practice elsewhere in Europe.

IrPSEN is calling on the HSE to ring fence €4.2 million to establish an eight-bed national centre for intestinal failure at St James’s Hospital to help manage those affected by this condition.

“This relatively small group of patients with highly complex needs challenge even the most experienced clinicians. The current dispersal of patients to non-specialist hospitals poses unacceptable risks for them and puts significant pressures on resources and on nurses and clinicians to provide effective treatment and care management,” explained Dr David Kevans, a consultant gastroenterologist at St James’s Hospital.

He pointed out that if this condition is managed correctly within a specialist facility, those affected ‘may avoid a long-term requirement for parenteral nutrition (feeding a person intravenously) or nutrition could be provided in the home through home parenteral nutrition’.

“This would significantly improve their quality of life and avoid serious complications including infections, which result in frequent emergency hospital admissions and even death,” Dr Kevans noted.

He told the conference that an estimated 12-20 avoidable deaths occur every year as a result of intestinal failure. Furthermore, the costs associated with the inadequate provision of services for these patients are ‘undoubtedly considerably higher than the cost savings accrued from the provision of specialist care’.

“International experience attests to specialist intestinal failure and intravenous nutrition programmes being associated with reduced morbidity and mortality, reduced length of hospital stay, and improved outcomes and quality of life in patients on intravenous nutrition,” he added.

Meanwhile, the conference also looked at the many issues surrounding complex obesity. Delegates were told that almost 8% of affected Irish adults are potentially eligible for gastric band surgery, however the current provision of this procedure in the public system meets the actual need of less than 0.1% of patients who would benefit.

“Obesity is a complex and chronic disease that requires personalised treatment programmes for each individual that can include diet, exercise, medical and surgical interventions. IrSPEN wants the right treatment for the right person at the right time to help reduce the effects of obesity-related diseases, reduce disease management costs and improve quality of life. But unfortunately, specialist intensive intervention is often not available,” commented Prof Carel Le Roux, of the Diabetes Complications Research Centre in the Conway Institute, UCD.

He pointed out that while the population of Sweden is twice as large as Ireland’s, it has half the obesity rate, ‘so both countries have the same number of people with complex obesity’.

“Yet, 6,000 bariatric or gastric band operations are performed in Sweden annually versus about 60 in Ireland, again showing a severe under-utilisation of specialist treatment to reduce obesity-related disease in Ireland,” he said.

The IrSPEN biennial conference and policy seminar is taking place in Dublin today (March 28).

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