Introduction :
Enteral nutrition refers to the delivery of nutrients directly into the gastrointestinal tract. This is done through tubes inserted into the nose, mouth or directly through the abdominal wall into the stomach or small intestine. Enteral nutrition plays an important supportive role for various health conditions where oral intake of food is not possible or not adequate to meet nutritional requirements. In this article, we will discuss the different aspects of enteral nutrition like its indications, methods, benefits as well as challenges.
Indications for Enteral Nutrition
There are various medical conditions where enteral nutrition is indicated or recommended. Some of the common conditions include:
Craniofacial abnormalities: Conditions like cleft lip/palate or other facial abnormalities may make oral feeding difficult or inadequate. Enteral nutrition helps supplement nutrition in such cases.
Neurological illnesses: Diseases affecting the swallowing ability like stroke, Parkinson’s disease, motor neuron disease etc may require enteral tube feeding.
Gastrointestinal disorders: Conditions affecting the ability to consume or digest food through oral route like inflamed bowel disease, intestinal obstruction, short bowel syndrome indicate the need for enteral nutrition support.
Cancer: Patients undergoing cancer treatment like chemotherapy or radiation therapy often experience side effects like nausea, vomiting or mucositis that hinder oral intake. Enteral tube feeding is used for continued nutrition support in such patients.
Surgeries: Major abdominal or upper gastrointestinal surgeries may require a period of bowel rest along with enteral nutrition to aid recovery. This helps reduce stress on the digestive system.
Critical illness: Patients admitted to ICU with critical illnesses or injuries affecting oral intake are often administered enteral feed to meet their nutritional demands during the recovery period.
Methods of Enteral Feeding
The common methods for delivering enteral nutrition include:
Nasogastric tube: A small flexible tube is passed through the nose, down the esophagus and into the stomach. This is the most commonly used method as it is least invasive. However, it is unsuitable for long term use.
Nasojejunal tube: Similar to a nasogastric tube but passed further down the small intestine after the stomach. Used when gastric feeding is not advisable or absorbed. Requires placement under endoscopic or fluoroscopic guidance.
Percutaneous endoscopic gastrostomy (PEG): A feeding tube is surgically placed through the abdominal wall directly into the stomach under endoscopy. It provides long term access for feeding and does not require passage through mouth/nose.
Radiologically inserted gastrostomy (RIG): Similar to PEG but tube placement is guided by fluoroscopy or ultrasound instead of endoscopy.
Jejunostomy tube: A tube directly placed into the jejunum through an abdominal wall stoma during surgery. Used when gastric or duodenal feeding is contraindicated.
Benefits of Enteral Nutrition
When administered correctly under medical supervision, enteral nutrition provides several health benefits:
Maintains gut integrity: The presence of nutrients in the gut promotes gut barrier function, blood flow and prevents translocation of bacteria. This helps reduce infection risk.
Prevents malnutrition: Enteral nutrition helps meet calorie, protein and micronutrient requirements in conditions affecting oral intake. This prevents adverse effects of malnutrition.
Aids recovery: Supplemented nutrition supports recovery processes post-illness or injury by providing optimal nutrition for tissue repair and rebuilding.
Reduces hospital stay: Studies show enteral feeding when indicated in hospitalized patients helps reduce complications, recovery time, re-admissions and overall healthcare costs.
Improves quality of life: Provides nutrition support patients need to stay well-nourished during medical treatments and bounce back faster to regular life activities.
Challenges with Enteral Feeding
While enteral nutrition serves crucial supportive functions, it also presents some challenges:
Tube related issues: Nasogastric tubes can get dislodged easily. Long term tubes like PEG can get blocked or infected if not cared for properly. This disrupts feeding.
Gastrointestinal issues: Conditions like vomiting, diarrhea or tube blockages due to motility problems can interfere with effective nutrient delivery in some patients.
Social impacts: Depending tube fed can impact body image, self-esteem and social interactions for patients in long term enteral support. Counselling helps.
Cost implications: Enteral formula, tubes and repeat endoscopic/radiological procedures related to tube management involve significant healthcare costs.
Skill development: Tube feeding requires trained caregivers to prepare formulas, operate pumps correctly, monitor for complications to administer feeds safely.
Quality of life factors: Continuous tube deliver does not replace pleasure of eating and socializing over meals impacted in patients needing long term enteral nutrition support.
Conclusion
In conclusion, enteral nutrition plays an invaluable supportive role as an alternative route for delivering nutrients when oral intake is insufficient or not possible due to various medical conditions. When carefully prescribed and administered by trained professionals, it helps optimize patient’s health, recovery and quality of life. While posing some challenges, advancements in delivery devices and formulas are improving comfort and experience of enteral feeding over time. Overall, it serves as an important adjunct to health care.
*Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile