Malnutrition in healthcare settings and the role of gastrostomy feeding

Abstract

support. In this review we explore the spectrum and consequences of malnutrition in differing 35 healthcare settings. We then specifically review gastrostomies as a method of providing 36 nutritional support. The review highlights the origins of gastrostomies, and discusses how 37 endoscopic and radiological advances have culminated in an increased demand and 38 placement of gastrostomy feeding tubes. Several studies have raised concerns about the 39 benefits derived following this intervention and also about the patients selected to undergo 40 this procedure. These studies are discussed in detail in this review, alongside suggestions for 41 future research to help better delineate those who will benefit most from this intervention, 42and improve understanding about how gastrostomies influence nutritional outcomes. 43 44 45

High variation between healthcare professionals in nutrition therapy plans of patients with feeding tubes admitted to a long‐term rehabilitation center from an acute‐care hospital

“…6 Moreover, malnutrition is associated with negative health outcomes among hospitalized patients, including physical and psychological dysfunctions. 6,27 Among orally fed and tube-fed nursing home residents, malnutrition was significantly related to nausea/vomiting, constipation, pressure ulcers, dehydration, infections, antibiotic use, and hospitalization. 6 In a study of older adult patients in the hospital setting, Stratton et al showed that those with malnutrition (58%) had greater mortality rates, both in-hospital and after discharge, and a longer length of stay compared with those without malnutrition.…”

Cui bono? PEG feeding

“…To date, the indications for PEG tend to come under four main headings: cerebrovascular disease, neurodegenerative Authors: A gastroenterology registrar, Royal Hallamshire Hospital, Sheffield, UK; B professor of gastroenterology, Royal Hallamshire Hospital, Sheffield, UK diseases, oropharyngeal malignancy and cerebral contusions. 5 With ongoing advancements in medicine, there continues to be an increasing number of conditions that may benefit from a PEG. For example, percutaneous endoscopic jejunostomies (PEJ) can be used to improve medication effectiveness in patients with Parkinson's disease by delivering medications directly into the small bowel.…”

Trends Regarding Racial Disparities Among Malnourished Patients With Percutaneous Endoscopic Gastrostomy (PEG) Tubes

“…Other complications of PEG placement involve damage to intra-abdominal vasculature, resulting in intra-or retroperitoneal bleeding and damage to various intra-abdominal organs [5]. Complications of PEG use include ostomy infection (18%), gastrointestinal bleeding (2.5%), aspiration pneumonia, and "buried bumper syndrome" (1.9%), which describes the migration of the internal bumper of the feeding tube into the stoma with subsequent growth of the gastric mucosa over the displaced internal bumper [5][6][7][8][9].…”

“…Gastric feeding tubes are placed to maintain proper nutrition in at-risk patients, with evidence suggesting that placement results in weight gain in malnourished patients, however, other literature reviews suggest that in patients with dementia, PEG placement does not ameliorate poor nutritional status or survival rates [5,[8][9][10].…”