Semin Liver Dis 2007; 27(3): 251-258
DOI: 10.1055/s-2007-985070
Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Intestinal Failure-Associated Liver Disease: Management and Treatment Strategies Past, Present, and Future

Beth A. Carter1 , Saul J. Karpen1
  • 1Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, Houston, Texas
Further Information

Publication History

Publication Date:
08 August 2007 (online)


Liver disease is estimated to develop in 40% to 60% of infants on long-term parenteral nutrition (PN) secondary to intestinal failure. The etiology of intestinal failure-associated liver disease (IFALD) is multifactorial with primary contributors including prematurity, sepsis, deficiencies or hepatotoxicities of infusates, and lack of enterally stimulated bile flow. IFALD treatment strategies have historically emphasized the following: choleretics such as ursodeoxycholic acid, bowel decontamination for small bowel bacterial overgrowth, bowel tapering and lengthening procedures, and manipulations of PN prescriptions (e.g., cycling). This review highlights current and proposed novel treatment and management strategies for IFALD. These include a discussion of state-of-the art central line care practices, novel bowel-lengthening procedures such as serial transverse enteroplasty, isolated liver transplant for IFALD, probiotics and glutamine for bowel decontamination, hormonal therapies for achieving bowel adaptation, and a discussion of new PN formulations that may have emerging roles in IFALD.


Beth A Carter, M.D. 

Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine

6621 Fannin Street, CCC 1010.00, Houston, TX 77030