The advent of general parenteral nutrition in the late 1960s meant that there was no longer a scenario in which a patient simply could not be fed. Unfortunately, general parenteral nutrition was confusing due to the severe infectious and metabolic effects that undermined the favorable effects of nutrient replenishment. Therefore, artistic tactics to repair the upper intestine serve as designed, based on semi-food nutrients and new feeding tube systems. The use of express protocols and acceptance of higher gastric residual volumes have allowed patients with maximum intensive care to be fed safely and early through a nasogastric tube. However, nasogastric nutrition is not suitable for patients whose gastric emptying is seriously compromised due to partial obstruction or ileus. These patients require the installation of a post-pyloric tube with simultaneous gastric decompression through dual-light nasogastric decompression and yeyunal feeding tubes. These tubes can be endoscopically placed four to 60 cm beyond the Treitz ligament to allow feeding without pancreatic stimulation. In patients with disorders lasting more than four weeks, the tubes are percutaneously repositioned by endoscopic, open or laparoscopic surgery. Together, advances in enteral access have taken a step forward in patient outcomes and led to 70-90% relief in overall parenteral nutrition demand.
Enteral feeding is more effective and is linked to fewer headaches than general parenteral nutrition
Patients who in the past would have depended on general parenteral nutrition would possibly be breastfed, improving their results
Patients with gastroesophageal reflux disease, subacute gastrodulytic obstruction, ileus and diarrhea can be effectively fed by side techniques.
Patients requiring enteral feeding for more than four weeks should be considered as installing a percutaneous feeding tube using endoscopy, radiology, laparoscopy or open surgery.
I thank NIH and NIDDK for their R01 DK56142 and R01 DK075803 grants. Charles P. Vega, University of California, Irvine, CA, is the writer and is only guilty of the content of the learning objectives, questions and answers of the Medscape Accredited Continuing Medical Education Activity related to this article.
SJD O’Keefe, Division of Gastroenterology, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213, United States [email protected]
Division of Gastroenterology, University of Pittsburgh School of Medicine, PA, USA.
Stephen J. D. O’Keefe
He does not claim any monetary interest in competition.
Release date: April 2009
DOI: https://doi.org/10.1038/nrgastro.2009.20