# Improvement in Intestinal-Failure-Associated Liver Disease by Using Parenteral Fish Oil as Monotherapy: Case-Based Review of the Literature

## TL;DR

This paper discusses how using fish oil as the sole lipid source in parenteral nutrition can improve liver disease in infants with intestinal failure.

## Contribution

The novelty lies in demonstrating fish oil monotherapy as an effective treatment for intestinal-failure-associated liver disease.

## Key findings

- Switching to fish oil monotherapy reversed intestinal-failure-associated liver disease in an infant.
- Case reports and series support fish oil lipid emulsions as a treatment for this condition.
- Fish oil may be a viable alternative to standard lipid emulsions in managing this liver disease.

## Abstract

Intestinal-failure-associated liver disease (IFALD) is a common complication of prolonged parenteral nutrition (PN). Risk factors for IFALD include clinical features, as well as medical interventions, and its management was initially based on the decrease or interruption of parenteral nutrition while increasing enteral nutrition. However, the tolerance of full enteral nutrition in children with intestinal failure may require prolonged intestinal rehabilitation over a period of years. As a consequence, infants unable to wean from PN are prone to develop end-stage liver disease. We describe the case of an infant receiving long-term PN who was diagnosed with IFALD wherein we were able to reverse IFALD by switching lipid emulsions to fish oil monotherapy. A systemic review of case reports and case series on reversing IFALD using fish oil lipid emulsion follows the case description.