April 13, 2024

Beyond Oral Intake: Harnessing the Potential of Enteral Nutrition

Introduction :
Enteral nutrition refers to feeding through the gastrointestinal tract using tubes that deliver nutrients directly to the stomach or small intestine. It is commonly required for patients who are unable to consume oral nutrition due to medical conditions affecting the ability to eat. Enteral tube feeding allows patients to receive balanced nutrition to meet their dietary needs and prevent malnutrition.

Types of Enteral Tube Feeding
There are different types of enteral tubes used for feeding depending on the patient’s condition and preferences.

Nasoenteric Tubes
Nasoenteric tubes are the most common type and are inserted through the nose into the stomach or small intestine. Nasogastric tubes deliver nutrients directly into the stomach, while nasojejunal tubes are placed further down into the jejunum portion of the small intestine. Nasoenteric tubes are well-tolerated by most patients as they require minimal preparation and insertion. However, long-term use can cause nausea, nasal irritation, and tube dislodgement.

Gastrostomy Tubes
For patients requiring enteral nutrition for an extended period, gastrostomy tubes are often used. These tubes are surgically inserted directly through the abdominal wall and into the stomach. Common types include percutaneous endoscopic gastrostomy (PEG) tubes and radiologically inserted gastrostomy (RIG) tubes. Gastrostomy tubes provide secure access and are less prone to dislodging compared to nasoenteric tubes. They also improve tolerance and eliminate nasal tube issues. However, tube insertion requires a minor surgical procedure under local anesthesia.

Jejunostomy Tubes
For patients unable to tolerate gastric feeding, jejunostomy tubes can be used to bypass the stomach and deliver nutrients directly into the jejunum. Similar to gastrostomy tubes, jejunostomy tubes are placed surgically through the abdominal wall into the small intestine below the stomach. They are useful in conditions where gastric feeding worsens symptoms like diarrhea or reflux.

Tube Formulations and Delivery Methods

Liquid Formulas
Most commercial enteral formulas come in liquid form and are designed to provide balanced nutrition for the whole life cycle from infants to older adults and individuals with specific medical conditions. Liquid formulas offer standard macronutrient content and can be given continuously or as bolus feeds throughout the day. They are easy to administer through feeding pumps or by gravity.

Semi-Solid Formulas
For patients unable to tolerate the high volume of liquid feeds, semi-solid formulas in paste or pudding form are available. These thickened formulas require less volume per feeding but have similar nutritional profiles to liquids. They can be given by syringe or pump and come in flavors to enhance appetite.

Powdered Formulas
Certain enteral formulas are available in powdered form which require mixing with water prior to administration. Powdered formulas offer high portability and shelf stability. They can be mixed on-site as needed based on the scheduled feeding amount and frequency.

Continuous vs. Bolus Feeding
Enteral feeds can be delivered either continuously over longer durations using pumps or feeding tubes, or as bolus feeds given over shorter intervals multiple times per day. Continuous feeding is ideal for stable patients requiring full nutritional goals to be met. Bolus feeds work best for those who can only tolerate small intake amounts at a time. Pumps and gravity methods are commonly used for continuous feeds.

Indications and Considerations for Enteral Tube Feeding

Malnutrition Risk
Patients at high risk of malnutrition due to medical conditions inhibiting sufficient oral intake are considered suitable for enteral tube feeding. This includes those with impaired consciousness, severe neurological impairment, oral-motor dysfunction, or surgical gastrointestinal issues preventing eating. Early initiation of enteral nutrition prevents further malnutrition and related risks.

Inability to Meet Nutritional Needs
If oral intake alone is not able to meet a minimum of 60-80% of estimated daily nutritional requirements over 7-10 days, enteral nutrition should be considered. For critically or chronically ill patients where oral intake appears insufficient, enteral access allows standardized feeding to support recovery and healing.

Needs Beyond Oral Feeding Capacity
Patients needing nutritional support beyond what is feasible to consume orally on an ongoing basis require long-term enteral access for optimized nourishment. This helps prevent weight loss, muscle wasting, and other negative health outcomes from prolonged undernourishment.

tube feeding provides an effective means of artificial nutrition support in such cases.

Impaired Gastrointestinal Function
Conditions severely impacting gastrointestinal absorption and function including short bowel syndrome, chronic pancreatitis, intestinal failure, or severe malabsorption disorders may necessitate enteral nutrition interventions. By administering directly into the small bowel, nutrient availability can be maximized despite functional limitations.

Health and Nutritional Benefits of Enteral Tube Feeding

Importance of Nutrition Support
For hospitalized patients unable to maintain adequate food and fluid intake orally or at high medical risk if nil per os (NPO), enteral tube feeding is considered standard care. Critically ill individuals benefit greatly from the preventative nutrition that tube feeding provides versus nothing by mouth status. Enteral nutrition support has been shown to:

Reduce risks of malnutrition complications like infections, impaired wound healing, loss of muscle function, and mortality when instituted early for at-risk inpatients.

Improve recovery outcomes and shorten hospital length of stay compared to IV nutrition or no supplemental feeding in many cases.

Provide immune support and gut barrier maintenance during periods where the gastrointestinal tract would otherwise be deprived of nutrients and microbial exposure.

Maintain normal gastrointestinal integrity and motility versus long-term fasting or dependence on IV nutrition alone. Feeding the gut helps prevent feeding tube complications like bacterial overgrowth and loss of absorptive ability over time.

Improve quality of life for individuals unable to achieve adequate food and fluid intake orally through other means and avert weight loss, weakness, and muscle wasting from prolonged undernourishment at home.

In summary, enteral tube feeding is a safe and effective option for providing balanced nutrition in patients who cannot meet their dietary requirements through oral intake. By administering directly into the gastrointestinal tract, it supports nutritional goals, prevents and treats malnutrition, and aids recovery from illness. With appropriate medical supervision and home care support, enteral tube feeding improves outcomes and quality of life for individuals facing challenges with oral nutrition.

1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile