Gastric and postpyloric total enteral nutrition

Abstract

The provision and maintenance of good nutrition in patients with acute and chronic illness is a fundamental part of standard medical and surgical care. Recently, there is great interest in using enteral nutritional support to reverse the morbidity and mortality associated with malnutrition. Enteral nutrition is preferred over parenteral nutrition because it is more physiologic, maintains intestinal structure and function, limits bacterial translocation, has less morbidity, has fewer complications, and is less expensive. However, the decision to feed into the stomach or into the small bowel (postpyloric) continues to be a matter of some debate and continued clinical investigation. Although the gastric route of enteral feeding is easier and less expensive, some physicians worry that gastric feeding may predispose to aspiration and pneumonia, especially in critically ill patients who frequently have delayed gastric transit. In these critically ill patients, small bowel function usually remains relatively intact and placement of a postpyloric feeding tube may permit more effective delivery of nutrients. However, it should be noted that placement of postpyloric feeding tubes can be challenging, and this may lead to a delay in initiation of nutritional support.

Severity of Illness Influences the Efficacy of Enteral Feeding Route on Clinical Outcomes in Patients with Critical Illness

“…Enteral nutrition, traditionally delivered directly into the stomach or postpylorus, is generally preferred over parenteral nutrition because it is more similar to natural physiological processes and reduces the incidence of complications, mortality, the cost, and the length of hospital stay. [1][2][3] Several randomized controlled trials have compared gastric and postpyloric feeding among patients with critical illnesses, but the results of these studies have been inconclusive and/or contradictory. 4 Neumann and DeLegge 5 have demonstrated that gastric tube feeding offers a safe and efficient means of enteral nutrition compared with small bowel feeding in a medical intensive care unit (ICU).…”