Gut and the Immune System: Enteral Nutrition and Immunonutrients

Abstract

Nutritional support is an important part of caring for critically ill patients. Total parenteral nutrition (TPN), established many years ago, was life-saving for many patients. It is recognized today that TPN produces many problems, although in certain patients it is necessary. In addition, the gastrointestinal (GI) tract, which was thought for years to remain quiescent in sick patients, undergoes many changes during illness. Disuse atrophy, permeability changes, bacterial translocation, and other changes may contribute to the illness. For this reason and others, enteral nutrition has become the best way to support the gut, prevent deleterious changes, and provide nutrients. Enteral nutrition, provided in the proximal small intestine by nasogastric-jejunal or transcutaneous-jejunal tubes is well tolerated in many sick patients during and after operations. It is currently recognized that the small intestine continues to function even when there may be ileus of the stomach and colon. Modulation of the inflammatory response, or the acute-phase response, by nutritional support may decrease the possibility of developing systemic inflammatory response syndrome (SIRS), multiple organ dysfunction syndrome (MODS), and multiple organ failure (MOF).