Sometimes, medical conditions leave people unable to eat any, or enough, food. They may have difficulty swallowing, decreased appetite, abnormality of the mouth or esophagus, or recovering from surgery. These challenges make it necessary to receive nutrition in a different way, such as enteral and enterostomy feeding. Enteral feeding is also referred to as enteral nutrition or tube feeding.
With normal digestion, food enters the mouth and flows down the esophagus, where large food molecules break down in the stomach by gastric acid, which becomes a thick liquid called chyme. The chyme passes through the pyloric sphincter valve into the duodenum, where it mixes with enzymes and bile. Next, it passes into the small intestines, further breaking down the molecules and eventually being absorbed into the bloodstream. Enteral feeding is necessary for individuals who have a functioning GI tract but are unable to eat enough food orally. It involves delivering a special liquid food diet containing essential nutrients, such as carbohydrates, proteins, fats, minerals, and vitamins, through a tube directly into the small intestine or stomach. The feeding tube is used for a few weeks, months, or indefinitely.
People who have disease-related physiological stress may have high metabolic demands combined with considerably reduced capacity for food intake. Prolonged calorie restriction may result in malnutrition, symptoms of which include lack of energy, loss of weight and muscle mass, irritability, and generalized or localized fluid accumulation that can mask weight loss. Malnourished individuals can suffer from pressure ulcers, poor healing, an impaired immune system, and emaciation. If untreated, the condition can lead to osteomalacia, osteoporosis, pancytopenia, muscle weakness, osteopenia, an increased fracture risk, and low prealbumin and albumin levels.
There are several enteral feeding procedures, including gastrotomy (through the abdominal wall into the stomach), jejunostomy (directly inserted through a portion of the small intestine), and nasoenteric (through the nose, down the esophagus, and into the stomach or small intestines).
There are two main types of feeding tubes: Prepyloric tubes insert through the nose into the stomach, just above the pyloric sphincter, and physicians use these for intermittent feeding and to enhance gastric absorption. Postpyloric tubes go beyond the pyloric sphincter and are usually placed in individuals with tracheoesophageal fistula, recurrent aspiration, acute pancreatitis, hyperemesis, and gastroparesis. A doctor determines the best feeding tube, the liquid nutrition combination required, and the anticipated duration of the treatment.
There are several categories of enteral feeding formulas, such as feeding modules, polymeric, specialized or disease-specific, and elemental formulas. Doctors choose the formula that meets each person's unique needs and nutritional demands considering various factors, including weight, age, medical conditions, current nutritional status, and activity level. Practitioners calculate the appropriate volume to deliver by considering the total fat, carbohydrates, and protein levels needed to maintain or restore health. A basic formula of 25 to 35 calories per kilogram can adjust to suit unique requirements.
From young children and infants to octogenarians, individuals of any age are eligible for enteral nutrition. Those who require tube-feeding can live on formulas for as long as necessary. However, in most cases, enteral feeding is for short-term use; the physician removes the tube once the patient can eat food orally.
Even though tube feeding delivers essential nutrients, it poses risks to some users, and complications can include tube dislodgment, agitation, insertion-site infection, fluid imbalance, and refeeding syndrome. Once starting enteral feeding, a doctor must thoroughly assess and closely monitor the individual to ensure they catch potential problems. early.
Gastrostomy tube feedings may cause pulmonary aspiration, the breathing of liquids or food into the airways. Aspiration can be caused by including supine positioning, high volume of intake, high residual gastric volume, or conditions affecting the esophageal sphincter. To help reduce the risk of pulmonary aspiration, physicians monitor gastric residual volumes every four hours. Some medical practitioners advise against tube feeding for individuals with low gastric residual volumes.
Sometimes, medical practitioners improperly place feeding tubes, though they should always confirm the position through a radiograph. After the initial placement, problems such as GI tract perforation or bleeding may arise if the tube becomes fully or partially dislodged. Checking placement regularly can prevent these complications.
People with malnutrition are at risk for refeeding syndrome, which can lead to serious medical complications, such as multisystem dysfunction and arrhythmias. Refeeding syndrome occurs when a person who's malnourished or starving receives food too quickly. The rapid introduction of food causes metabolic shifts that lead to electrolyte imbalances that can affect the heart and other organs. Health care providers typically monitor intolerance by assessing electrolyte levels, heart rate, and rhythm.
Various ethical issues exist surrounding enteral tube feeding. Tube feeding is a medical treatment method, which means the placement, continued treatment, and termination of the process require consideration of the person's wishes. When someone cannot communicate a request for enteral feeding, the practitioner may decide in their best interest, which may require consultation with other providers and family members.
This site offers information designed for educational purposes only. You should not rely on any information on this site as a substitute for professional medical advice, diagnosis, treatment, or as a substitute for, professional counseling care, advice, diagnosis, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other healthcare professional.