Gastro-Intestinal

ADULT

ENTERAL

NUTRITION

THERAPEUTIC FIELDS

GASTRO-INTESTINAL

Back To List

Gi Intolerance Can Affect Patient Outcomes

Feeding patients who are malnourished or at risk of malnutrition, whether by oral or enteral routes, can be a challenge since not all formulas are well tolerated. This can result in elevated gastric residuals, vomiting, diarrhoea, malab- sorption and/or abdominal pain.

The side effects resulting from GI intolerance have an impact on patient care.

GI INTOLERANCE CAN AFFECT PATIENT OUTCOMES

GI intolerance is a state in which one or more of the GI tract’s functions (digestion, absorption, motility, and barrier) is affected. Therefore, GI intolerance is a complex problem which presents itself as diarrhoea, vomiting and high gastric residuals.8
GI intolerance can lead to poor clinical outcomes, potentially increasing care costs, due to the utilisation of more expensive therapies and extended lengths of stay in ICU.

ENTERAL NUTRITION AND USING THE GUT CAN HELP IMPROVE GI TOLERANCE

It is important to use the patient's gut if it works. Enteral nutrition (EN) is preferred over parenteral nutrition (PN) because it helps to maintain normal intestinal structure and function.

ENTERAL NUTRITION IS PREFERRED FOR THE GUT

The following image shows intestinal mucosa in the ‘fed’ state. EN delivers nutrients and attracts blood flow to the gut; this stimulates the growth of the intestinal mucosal cells and maintains gut integrity. Gut integrity prevents bacterial translocation (when bacteria move from the GI tract into the bloodstream because the mucosal barrier is not functional or is weak), and reduces the risk of sepsis.

The bottom image shows the consequences of not using the gut. The intestinal villi have atrophied and their surface area for digestion and absorption is reduced. The junctions in the mucosal barrier have become less ‘tight’ and bacteria can pass through them, i.e. translocate through the gut wall.^8,9

ENTERAL NUTRITION IS BETTER FOR PATIENTS THAN PARENTERAL NUTRITION

The use of EN promotes intestinal trophism, stimulates insulin secretion and the immune system, and reduces the incidence of bacterial translocation and sepsis. Additional benefits of EN is reduced episode of hyperglycemia and reduced risk of liver dysfunction.^{5, 9, 10}
Furthermore, EN is associated with fewer complications and costs less than PN.

SOME ENTERAL FORMULAS ARE DESIGNED TO IMPROVE GI TOLERANCE

The type of enteral formula given during a nutritional intervention plays an important role in feeding tolerance. In order to best meet nutritional needs, the formula selected for each patient should:^4,11-13

Deliver the appropriate nutrients in the appropriate amounts
Preserve lean body mass
Maintain immune function and favourably modulate the immune response
Avert metabolic complications and attenuate the metabolic response to stress
Be delivered as early as possible to maintain gut integrity, reduce complications, decrease length of stay in the ICU, and have a positive effect in patients’ clinical outcomes

PATIENTS IN THE INTENSIVE CARE UNIT

The prevalence of both acute and chronic malnutrition in critically ill children and adults is well documented. Early enteral nutrition is generally accepted as the standard of care for most hospitalised patients; however, delayed feeding still occurs with relative frequency. Early enteral nutrition is associated with decreased overall length of hospital stay in adult trauma, surgical and medical ICU patients.^1-3,10,15

Barriers to optimal enteral nutrition to meet patients’ nutritional goals include lack of enteral access, vasoactive medications, neuromuscular blocking medications, fluid restriction, feeding intolerance (such as elevated gastric residuals, vomiting, constipation, diarrhoea and abdominal distension) and interruption of feeds due to procedures.^5,17,18

PATIENTS WITH CHRONIC DIARRHOEA

Diarrhoea associated with malabsorption is a major health problem affecting both children and adults. A variety of terms have been used to describe this condition, including persistent diarrhoea and chronic diarrhoea. Researchers have shown that peptide-based formulations may be best absorbed by those with chronic diarrhoea.^19-21

PATIENTS WITH CEREBRAL PALSY

Gastro-oesophageal reflux occurs in as many as 77% of patients with cerebral palsy.22
The rate of gastric emptying associated with any given formula is affected by the type of protein the enteral formula contains. In 1992, researchers reported a significant reduction in episodes of vomiting in patients fed a whey-based formula versus a casein-based formula. Gastric emptying times were significantly shorter with whey-based formulas compared to casein-based formulas. The authors of the study concluded that whey-based formulas reduce the frequency of vomiting by improving the rate of gastric emptying.²³

WE HAVE THE ATTRIBUTES

Feed the gut and feed the patient: The first and only enzymatically hydrolysed 100% whey protein formula; high amount of MCT; balanced peptide profile. Designed for improved tolerance & absorption, providing optimal nutritional support and supporting optimal growth and development in children.
Tried and tested: Feeds the gut to make even the most difficult patients thrive and grow, built on evidence and experience (60 clinical studies, 23+ years of successful clinical experience, preferred by dieticians in the US).
Practical tools and services: Offering tools like ‘optimising the ICU ecosystem’s performance with Nx’ training sessions and new healthcare protocols, like PEP UP.
Proven return on investment: Reducing the cost of care associated with GI intolerance.
Use at home: For exclusive enteral nutrition to manage certain GI conditions, or to help patients adapt to solid food again during recovery.

References

DRI. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. Food and Nutrition Board, Institute of Medicine, National Academy of Science 2005.
Demling RH. Nutrition, anabolism, and the wound healing process: an overview. Eplasty 2009;9:e9.
Barazzoni R, Deutz NEP, Biolo G, et al. Carbohydrates and insulin resistance in clinical nutrition: recommendations from the ESPEN expert group. Clin Nutr 2016;36:355-63.
Bauer J. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN 2002;26:1-138.
Cresci G. Early minimal enteral supplementation in severely burned children receiving parenteral nutrition. CRC Press 2005.
Mueller C, ed. The A.S.P.E.N. Adult Nutrition Support Core Curriculum. 2nd ed2012.
Finnerty CC, Mabvuure NT, Ali A, Kozar RA, Herndon DN. The surgically induced stress response. JPEN 2013;37:21S-9S.
Vanzant EL, Lopez CM, Ozrazgat-Baslanti T, et al. Persistent inflammation, immunosuppression, and catabolism syndrome after severe blunt trauma. J Trauma Acute Care Surg 2014;76:21-9.
Adib-Conquy M, Cavaillon JM. Compensatory anti-inflammatory response syndrome. Thromb Haemo 2009;101:36-47.
Blackburn G, Wollner S, Bistrian B. Nutrition Support in the Intensive Care Unit. Arch Surg 2010;145:533-8.
Gibbs M, Harrington D, Starkey S, Williams P, Hampton S. Diurnal postprandial responses to low and high glycaemic index mixed meals. Clin Nutr 2014;33:889-94.
El Khoury D, Brown P, Smith G, et al. Increasing the protein to carbohydrate ratio in yogurts consumed as a snack reduces post-consumption glycemia independent of insulin. Clin Nutr 2013;33:29-38.
Chwals WJ. Early minimal enteral supplementation in severely burned children receiving parenteral nutrition. Ped Crit Care Med 2013;14:332-3.
Mehta NM, Bechard LJ, Cahill N, et al. Nutritional practices and their relationship to clinical outcomes in critically ill children—an international multicenter cohort study. Crit Care Med 2012;40:2204-11.

PEPTAMEN MOA