Audit of the Treatment of Malnutrition Due to Chronic Intestinal Pseudo‐Obstruction With Enteral Nutrition

Abstract

Purpose: Chronic intestinal pseudo‐obstruction (CIP) can result in significant malnutrition and weight loss. Although parenteral nutrition can be a useful adjunct in the management of CIP, it is expensive and not without complications. Aim: To determine the outcome of enteral nutrition with nonelemental isotonic formulas in patients with CIP in a tertiary referral center, over the time period 1980 to 1998. Methods: A retrospective medical record review of patients with CIP receiving enteral nutrition. Median follow‐up was 3 years (range, 1 to 8 years) Results: 30 patients (20 women, 10 men; mean age at diagnosis, 49 years) with scleroderma (n = 10), amyloidosis (n = 10), and idiopathic CIP (n = 10) were studied. All had failed oral feeding and had a feeding tube placed. Jejunal tubes were placed in 19 patients and gastric tubes in 11 patients. Continuous feedings were used in 24 patients, and 6 patients received intermittent gravity feedings. Initially, the goal rate of delivery using a standard isotonic enteral formula (mean, 70 mL/h) was met in all patients. Hydration and body weights were maintained. Complications: Documented aspiration related to tube feeding occurred in 3 patients receiving gastric feeding and in none of the patients fed via the jejunal tube. Mild diarrhea occurred in 7 patients (4 jejunal fed and 3 gastric fed). At last follow‐up skin irritation of the tube site occurred in 3 patients with a surgically placed jejunal tube and 1 patient with a gastrostomy. At the time of the last follow‐up, 10 patients (scleroderma, n = 4; idiopathic pseudo‐obstruction, n = 5; amyloidosis, n = 1) developed worsening abdominal pain, were unable to meet their goal of formula delivery, and were placed on parenteral nutrition. These 30 patients were managed successfully on enteral nutrition for a mean of 2 years, (range, 1 to 8 years). Conclusions: Enteral nutrition with a standard nonelemental isotonic formula is a safe and effective means of nutrition delivery in patients with CIP who fail oral intake. Jejunal feeding using a continuous infusion is associated with less complications and is the preferred route of nutritional delivery in CIP.