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Enteral Nutrition – Definition and Clinical Use

Enteral nutrition is a form of clinical nutrition that delivers liquid nutrients directly into the gastrointestinal tract via a feeding tube, used when patients cannot eat sufficiently by mouth.

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Things worth knowing about "Enteral Nutrition"

Enteral nutrition is a form of clinical nutrition that delivers liquid nutrients directly into the gastrointestinal tract via a feeding tube, used when patients cannot eat sufficiently by mouth.

What is Enteral Nutrition?

Enteral nutrition is a method of artificial nutritional support in which specially formulated liquid nutrient solutions are delivered directly into the gastrointestinal tract through a feeding tube. Unlike parenteral nutrition, which bypasses the gut and delivers nutrients intravenously, enteral nutrition makes use of the body´s natural digestive pathway. It is indicated when a patient is unable to consume adequate nutrition orally but still has a functional gastrointestinal tract.

Indications – When is Enteral Nutrition Used?

Enteral nutrition is used in a wide range of clinical scenarios:

Swallowing disorders (dysphagia), for example after a stroke or in neurological conditions
Reduced consciousness or unconsciousness, when oral intake is not possible
Severe malnutrition, where oral intake alone is insufficient
Oncological conditions, such as cancers affecting the mouth, throat, or esophagus
Critical illness in intensive care settings
Inflammatory bowel disease, particularly Crohn's disease
Premature or newborn infants with an insufficient sucking reflex

Access Routes

Nutrient solutions are delivered to the gastrointestinal tract through various tube systems:

Nasogastric Tube (NGT)

A nasogastric tube is passed through the nose into the stomach. It is the most common access route for short-term enteral nutrition (up to approximately 4 weeks) and is straightforward to place, though less suitable for long-term use.

Nasojejunal Tube

In this approach, the tube is advanced beyond the stomach into the small intestine (jejunum). This is preferred in patients with a high risk of aspiration or delayed gastric emptying.

Percutaneous Endoscopic Gastrostomy (PEG)

A PEG tube is inserted directly through the abdominal wall into the stomach using an endoscope. It is the preferred method for long-term enteral nutrition (more than 4 weeks) and provides greater patient comfort and stability.

Percutaneous Endoscopic Jejunostomy (PEJ)

Similar to a PEG, but the tube is placed directly into the small intestine. This is used when the stomach must be bypassed, for example in cases of gastroparesis or following certain surgical procedures.

Types of Enteral Formulas

The nutritional solutions used are specially formulated commercial products that contain all essential macro- and micronutrients:

Standard formulas: Complete, balanced nutrient mixtures for general nutritional requirements
Disease-specific formulas: Adjusted compositions for specific conditions (e.g., renal failure, diabetes, liver disease, pulmonary disease)
High-calorie formulas: For patients with increased energy needs in a reduced volume
Fiber-enriched formulas: To support bowel function and prevent constipation

Administration Methods

Enteral nutrition can be administered in several ways:

Continuous infusion: Nutrients are delivered at a steady rate over an extended period (e.g., 16 to 24 hours) using an enteral feeding pump.
Intermittent bolus feeding: Nutrition is given in several portions spread throughout the day, mimicking a natural meal pattern.
Nocturnal feeding: Supplemental enteral nutrition provided overnight when daytime oral intake is still possible.

Advantages of Enteral Nutrition

Compared to parenteral (intravenous) nutrition, enteral nutrition offers several key benefits:

Preservation of the intestinal mucosa and natural gut function
Lower risk of infection
More physiological nutrient utilization
Lower cost
Support of the immune system through maintenance of the gut barrier

Possible Complications and Risks

Like any medical intervention, enteral nutrition can be associated with complications:

Aspiration: Inhalation of feed into the lungs, particularly in patients with swallowing difficulties
Gastrointestinal symptoms: Diarrhea, nausea, vomiting, bloating, or constipation
Tube-related complications: Blockage, displacement, or inflammation at the insertion site (especially with PEG tubes)
Refeeding syndrome: Dangerous electrolyte shifts that can occur when severely malnourished patients are refed too rapidly
Infections: Particularly at the insertion site of PEG or PEJ tubes

Monitoring and Care

Regular monitoring is essential during enteral nutrition therapy and includes:

Assessment of nutritional status and body weight
Regular verification of tube position and patency
Laboratory monitoring (electrolytes, blood glucose, renal function)
Hygienic care of the tube insertion site
Adjustment of the nutritional therapy according to current needs

References

Arends J. et al. - ESPEN guidelines on nutrition in cancer patients. Clinical Nutrition, 2017.
Weimann A. et al. - ESPEN guideline: Clinical nutrition in surgery. Clinical Nutrition, 2017.
McClave S.A. et al. - Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient. Journal of Parenteral and Enteral Nutrition, 2016.

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