Tube feeding for different patients

for an optimum outcome

Tube feeding in older patients

Older people are at risk of malnutrition when living in the community, as well as in hospital and in care homes. Malnutrition in older patients may arise from loss of appetite, dysphagia and neurological, digestive or metabolic impairments.1,2

Tube feeding in Geriatrics

The loss of body weight and muscle mass may also result in a cycle of frailty.3 When the required intake of energy and protein cannot be met by oral nutrition, then enteral tube feeding may bridge the gap and prevent the progression of frailty. 4,5

The following four example cases illustrate how different patients in the geriatric field may benefit from tube feeding:

  • Long term tube feeding after stroke
  • Tube feeding with gastoparesis
  • Tube feeding due to aspiration pneumonia
  • Tube feeding with depression

Tube feeding in neurological patients

Patients with neurological diseases are often affected by impaired nutrition. Resulting consequences have a negative impact on morbidity and thus on the patients’ mortality. For this reason, implementing appropriate nutritional management is a matter of significant importance.1

Implications of malnutrition are numerous. Cognitive impairments but also difficulties in swallowing play an important role. Patients concerned with dysphagia caused, for example, by neurological diseases like amyotrophic lateral sclerosis or dementia and stroke, are therefore exposed to a heightened risk – not least by an increased risk of infections, frequent hospital admissions and accelerated functional decline. For example, 2/3 of patients with stroke are affected by dysphagia and therefore are at a higher risk of mortality. In these cases, enteral tube feeding is able to compensate for impaired swallowing.2,3

Managing the risk of malnutrition is important when dealing with surgical patients and those with gastrointestinal diseases. Perioperative nutrition should be considered to maintain a good nutritional status – not least to be able to avoid postoperative complications but also to trigger positive effects on the general well-being of the patient.1

Tubefeeding in surgery patients

Malnutrition plays a decisive role as an independent risk factor regarding postoperative complications. Gastrointestinal diseases, like Crohn’s disease, also present nutritional

risk and inversely nutrition can play a major role coping with such diseases. Enteral nutrition can help to maintain and improve the nutritional status, which in addition has positive effects on the patients’ quality of life.2,3

The following four example cases illustrate how different patients undergoing surgery and/or treatment for gastrointestinal diseases may benefit from tube feeding.

  • Short-term supplemental feeding following emergency bowel surgery
  • Gastrostomy tube feeding in cystic fibrosis following lung transplantation
  • Cardiac surgery and enteral tube feeding
  • Exclusive enteral nutrition in Crohn’s disease
References Tube feeding in older patients:
1. Wells JL, Dumbrell AC. Nutrition and aging: assessment and treatment of compromised nutritional status in frail elderly patients. Clin Interv Aging. 2006;1(1):67–79.
2. Stratton RJ, Green CJ, Elia M. Disease-related malnutrition: An evidence-based approach to treatment. CABI Publishing, Wallingford, UK 2003.
3. Deutz NE, Bauer JM, Barazzoni R, Biolo G, Boirie Y, Bosy-Westphal A, et al. Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN expert group. Clin Nutr. 2014;33(6):929–936.
4. Volkert D, Berner YN, Berry E, Cederholm T, Coti Bertrand P, Milne A, et al. ESPEN Guidelines on Enteral Nutrition: Geriatrics. Clin Nutr. 2006;25(2):330–360.
5. Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14(6):392–397.
References Tube feeding in neurological patients:
1. Rosenfeld J, Ellis A. Nutrition and dietary supplements in motor neuron disease. Phys Med Rehabil Clin N Am. 2008;19(3):573–589.
2. Nunes G, Santos CA, Grunho M, Fonseca J. Enteral feeding through endoscopic gastrostomy in amyotrophic lateral sclerosis patients. Nutr Hosp. 2016;33(5):1015–1021.
3. Dionyssiotis Y, Papachristos A, Petropoulou K, Papathanasiou J, Papagelopoulos P. Nutritional Alterations Associated with Neurological and Neurosurgical Diseases. Open Neurol J. 2016;10:32–41.
References Tube feeding in cancer patients:
1. Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017;36(1):11–48.
2. Aoyagi T, Terracina KP, Raza A, Matsubara H, Takabe K. Cancer cachexia, mechanism and treatment. World J Gastrointest Oncol. 2015;7(4):17–29.
References Tube feeding in surgical and gastroinstinal patients:
1. Lochs H, Dejong C, Hammarqvist F, Hébuterne X, Leon-Sanz M, Schütz T, et al. ESPEN Guidelines on Enteral Nutrition: Gastroenterology. Clin Nutr. 2006;25(2):260–274.
2. Turck D, Braegger CP, Colombo C, Declercq D, Morton A, Pancheva R, et al. ESPENESPGHAN-ECFS guidelines on nutrition care for infants, children, and adults with cystic fibrosis. Clin Nutr. 2016;35(3):557–577.
3. Braga M, Ljungqvist O, Soeters P, Fearon K, Weimann A, Bozzetti F. ESPEN Guidelines on Parenteral Nutrition: surgery. Clin Nutr. 2009;28(4):378–386.