A Systematic Review of Enteral Feeding by Nasogastric Tube in Young People with Eating Disorders

Abstract

BackgroundAdolescents with severe restrictive eating disorders often require enteral feeding to provide lifesaving treatment.Nasogastric feeding (NGF) is a method of enteral nutrition often used in inpatient settings to treat medical instability, to supplement minimal oral intake or to boost nutritional intake. This systematic review sets out to describe current practice for NGF. MethodsA systematic review following PRISMA guidelines was conducted by searching AMED, EMBASE and MEDLINE databases from 2000-2020. Inclusion terms were: enteral feeding by nasogastric tube, under 18 years, eating disorders, and primary research. Exclusion terms: mental disorders other than eating disorders; non-primary research; no outcomes specific to NG feeding and over 18 years. Titles and abstracts were screened by all authors before reviewing full length articles. Quality assessment, including risk of bias, was conducted by all authors. Results29 studies met the full criteria. 86% of studies were deemed high or medium risk of bias due to the type of study: 34.4% retrospective cohort and 10.3% RCT; 17.2% were qualitative. Studies identified 1) a wide range of practices in different countries, settings, and the reason for initiation; 2) In the UK, standard practice is to introduce NGF if either oral intake is not met or patients are medically unstable; 3) NGF may enable greater initial weight gain due to increased caloric intake; 4) there are 3 main types of feeding regime: continuous, nocturnal and bolus; 5) high calorie feeds are not typically associated with increased risk of refeeding syndrome; 6) complications included nasal irritation, epistaxis, electrolyte disturbance, distress and tube removal; 7) length of stay in hospital is dependent on reason of initiating NGF; 8) psychiatric and medical wards differ in approach; 9) concurrent therapy is often used to facilitate NGF.ConclusionsNGF is currently often implemented in specialist settings where oral intake has been refused or insufficient, in hospital due to medical instability, nocturnally to supplement day-time oral intake, or continuously as standard protocol. Due to high risk of bias as a result of the nature of the studies conducted in adolescents with ED, recommendations for clinical practice cannot yet be justified.

The effect of oral refeeding compared with nasogastric refeeding on the quality of care for patients hospitalised with an eating disorder: A systematic review

“…There are two main methods to refeeding this population group, (1) via a nasogastric tube or (2) orally with food or oral nutrition support supplements. Nasogastric refeeding, otherwise referred to as enteral feeding, has been suggested as a lifesaving treatment when patients are physically unwell 6 . Nasogastric feeding involves insertion of a fine bore tube being passed via the nasal passage and into the stomach to provide nutrition 7 .…”

“…Nasogastric feeding involves insertion of a fine bore tube being passed via the nasal passage and into the stomach to provide nutrition 7 . Provision of nasogastric feeding can be delivered in different ways, either as a large bolus via gravity feeding or via a pump, continuously over a 24‐h period via a pump or provided intermittently overnight to supplement daytime oral intake 6 . Oral refeeding, otherwise known as meal‐based feeding, is where energy intake is provided via oral intake alone without the use of a nasogastric tube.…”

“…No previous systematic reviews were located that have directly compared the outcomes between nasogastric and oral refeeding methods. Current literature supports nasogastric refeeding as being an effective and safe method to increase energy intake and rate of weight gain for those individuals with anorexia nervosa 6,11 . One systematic review 3 examined different approaches to refeeding in patients with anorexia nervosa individually but did not directly or quantitatively compare the different approaches.…”

“…Nasogastric refeeding, otherwise referred to as enteral feeding, has been suggested as a lifesaving treatment when patients are physically unwell. 6 Nasogastric feeding involves insertion of a fine bore tube being passed via the nasal passage and into the stomach to provide nutrition. 7 Provision of nasogastric feeding can be delivered in different ways, either as a large bolus via gravity feeding or via a pump, continuously over a 24-h period via a pump or provided intermittently overnight to supplement daytime oral intake.…”