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Enteral Therapy – Definition and Application

Enteral therapy is a medical nutrition approach that delivers nutrients directly through the gastrointestinal tract, usually via a feeding tube, when normal oral intake is not possible.

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Things worth knowing about "Enteral Therapy"

Enteral therapy is a medical nutrition approach that delivers nutrients directly through the gastrointestinal tract, usually via a feeding tube, when normal oral intake is not possible.

What is Enteral Therapy?

Enteral therapy is a form of clinical nutrition support in which nutrients are delivered directly via the gastrointestinal (GI) tract. It is used when patients are unable to consume adequate nutrition orally, but the digestive tract remains at least partially functional. Nutrient delivery typically occurs via a feeding tube, though it may also include specialized oral nutritional supplements.

Indications

Enteral therapy is applied across a wide range of clinical conditions, including:

Swallowing disorders (dysphagia), e.g., following stroke or in neurological diseases
Tumors of the mouth, throat, or esophagus
Severe burns or polytrauma
Unconsciousness or intensive care treatment
Severe undernutrition or malnutrition
Inflammatory bowel diseases (e.g., Crohn's disease)
Premature infants and critically ill neonates

Forms of Enteral Therapy

Oral Nutritional Supplements

For patients who can still swallow but cannot consume sufficient calories and nutrients, high-calorie oral nutritional supplements are prescribed. These are available in various flavors and formulations, and can be tailored to the specific needs of the patient.

Nasogastric Tube

A nasogastric tube is inserted through the nose into the stomach. It is the most commonly used short-term tube feeding solution and is suitable for periods ranging from a few days to several weeks.

Nasojejunal Tube

A nasojejunal tube is passed through the nose and advanced beyond the stomach into the small intestine (jejunum). It is used when gastric emptying is impaired or when there is a high risk of aspiration.

PEG (Percutaneous Endoscopic Gastrostomy)

For longer-term tube feeding, a PEG tube is often preferred. This involves endoscopically creating an opening through the abdominal wall directly into the stomach. It is more comfortable for the patient and enables long-term nutritional support at home or in care facilities.

PEJ (Percutaneous Endoscopic Jejunostomy)

Percutaneous endoscopic jejunostomy (PEJ) is used for longer-term enteral nutrition when the stomach cannot be used. The tube is placed directly into the small intestine.

Composition of Enteral Formulas

Specially designed enteral formulas provide all essential macronutrients (carbohydrates, proteins, fats), micronutrients (vitamins, minerals, trace elements), and water. Various types are available:

Standard formulas: Suitable for most patients
Disease-specific formulas: Tailored for conditions such as diabetes, renal insufficiency, or pulmonary disease
Elemental diets: Contain pre-digested nutrients for patients with reduced digestive capacity

Advantages Over Parenteral Nutrition

Compared to parenteral nutrition (nutrient delivery via the bloodstream), enteral therapy offers several advantages: it preserves intestinal structure and function, reduces the risk of gut atrophy and bacterial translocation, is more cost-effective, and is associated with fewer complications. Modern intensive care medicine therefore follows the principle: Whenever possible, prefer enteral nutrition.

Risks and Complications

Like any medical intervention, enteral therapy carries potential risks:

Aspiration: Inhalation of formula into the lungs, especially in unconscious patients
Diarrhea or constipation due to inappropriate formula or flow rate
Tube blockage or displacement
Local skin irritation or infection at the insertion site (PEG/PEJ)
Electrolyte imbalances or refeeding syndrome in severely malnourished patients

Administration and Monitoring

Enteral therapy is planned and monitored by a multidisciplinary team including physicians, dietitians, nurses, and where appropriate, speech therapists. Regular monitoring of body weight, laboratory values, and overall nutritional status is essential to continuously adapt the therapy to the patient's needs.

References

Arends J. et al. - ESPEN guidelines on nutrition in cancer patients. Clinical Nutrition, 2017. DOI: 10.1016/j.clnu.2016.07.015
Singer P. et al. - ESPEN guideline on clinical nutrition in the intensive care unit. Clinical Nutrition, 2019. DOI: 10.1016/j.clnu.2018.08.037
World Health Organization (WHO) - Malnutrition: Key Facts and Clinical Management Guidelines, 2022. Available at: www.who.int

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