Khursheed N Jeejeebhoy1. 1. Division of Gastroenterology, University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada. khushjeejeebhoy@compuserv.com
Abstract
PURPOSE OF REVIEW: Enteral nutrition is now the preferred route of nutritional support in malnourished and ICU patients. Studies providing evidence of its efficacy, techniques of administration, and outcome are appearing daily in the literature. This review presents the most important publications in this area and critically reviews them. In this way, the reader can rapidly access important publications from all those that are being published each year. RECENT FINDINGS: A diverse group of studies is covered in this review. The subjects of these studies include the role of enteral and parenteral nutrition in the perioperative patient; reinfusion of succus to promote increased absorption in patients with a fistula or short bowel; enteral nutrition in patients with head injury, in liver disease, and in pancreatitis; bone marrow transplantation; and delivery of enteral nutrition. SUMMARY: Enteral nutrition is an established modality of nutritional support that has received wide acceptance. However, it is not clear in which conditions it improves patient outcome and how to optimize its delivery. In this review, articles addressing the outcome of patients and methods to optimize delivery of enteral nutrition are reviewed. Unfortunately, with few exceptions, most studies are based on few patients or do not have a placebo arm. The usual comparison is with total parenteral nutrition, and in such comparisons, the studies fail to make the two groups comparable in terms of energy intake and the occurrence of a major risk factor for sepsis, namely, hyperglycemia.
PURPOSE OF REVIEW: Enteral nutrition is now the preferred route of nutritional support in malnourished and ICU patients. Studies providing evidence of its efficacy, techniques of administration, and outcome are appearing daily in the literature. This review presents the most important publications in this area and critically reviews them. In this way, the reader can rapidly access important publications from all those that are being published each year. RECENT FINDINGS: A diverse group of studies is covered in this review. The subjects of these studies include the role of enteral and parenteral nutrition in the perioperative patient; reinfusion of succus to promote increased absorption in patients with a fistula or short bowel; enteral nutrition in patients with head injury, in liver disease, and in pancreatitis; bone marrow transplantation; and delivery of enteral nutrition. SUMMARY: Enteral nutrition is an established modality of nutritional support that has received wide acceptance. However, it is not clear in which conditions it improves patient outcome and how to optimize its delivery. In this review, articles addressing the outcome of patients and methods to optimize delivery of enteral nutrition are reviewed. Unfortunately, with few exceptions, most studies are based on few patients or do not have a placebo arm. The usual comparison is with total parenteral nutrition, and in such comparisons, the studies fail to make the two groups comparable in terms of energy intake and the occurrence of a major risk factor for sepsis, namely, hyperglycemia.