Chronic Feeding Intolerance: Management in Geriatric Palliative Care

Abstract

Feeding intolerance, with symptoms of anorexia, esophageal reflux and pulmonary aspiration, is caused either by an anatomic obstruction of the stomach or jejunum, or by a neuromuscular dysfunction of the upper gastrointestinal tract. The materialization of feeding intolerance is an increased gastric residual volume. However, feeding intolerance expands beyond impaired gastric emptying; so jejunal feeding does not always eliminate the risk of aspiration of gastric content. Proper diagnosis of feeding intolerance and its mechanism is made by endoscopy, radio-scintigraphy for assessment of the gastric transit time and/ or measurement of the gastric residual volume. Studies on feeding intolerance come from critical care medicine; few longitudinal studies have been published in the internal medicine and palliative medicine literature. Three case histories from our institution illustrate a spectrum of challenges in the management of chronic feeding intolerance. Remarkable are the following observations: a quick gastric transit by using a small volume of gastrographin does not exclude feeding intolerance, neurogenic feeding intolerance may be transient, and recovery of gastric emptying after pyloroplasty may be prolonged. Patience and perseveration may be worth.