Polymeric Formula Research Articles

Global attitudes on and the status of enteral nutrition therapy for pediatric inflammatory bowel disease.

Enteral nutrition (EN) is a diet-remission therapy for inflammatory bowel disease (IBD) that plays a more important role in children than adults. EN includes exclusive enteral nutrition (EEN), partial enteral nutrition (PEN), and maintenance enteral nutrition (MEN). However, EEN remains an unstandardized treatment for pediatric IBD. The types and methods of EN differ around the world. The current study reviewed the EN literature on children with IBD. A total of 12 survey studies were identified that analyzed the current state of EN use, including clinical opinions, implementation methods, treatment course, EEN formula, IBD classification, progress, dietary reintroduction, and patient feedback. The findings revealed that EEN has a strong effect on mild to moderate Crohn's disease (CD). The usage rates of this treatment in different sites were ileum/colon (Paris classification L3) > ileum (L1) > upper digestive tract (L4) > colon (L2) > perianal disease (P) > ulcerative colitis (UC) > extraintestinal lesions. The polymeric formula was the most used EN formulation. New EN diets include a CD exclusion diet (CDED), a specific carbohydrate diet (SCD), and a CD treatment-with-eating (CD-TREAT) diet. Children with IBD responded similarly to EEN administered orally or using a feeding tube. Most guidelines recommended 6-8 weeks of EEN treatment to induce remission. Many clinicians preferred to combine drug medications during EEN and recommended that MEN accounts for at least 25-35% of daily caloric intake. EN remains an unstandardized therapy that requires teamwork across disciplines.

A high-protein peptide-based enteral formula improves diarrhea in tube-fed patients: A prospective multicenter study.

Diarrhea is a common problem in tube-fed patients. The relevant guidelines suggest using a peptide-based enteral formula in patients with diarrhea; however, sufficient evidence to support this recommendation is currently lacking. This study aimed to evaluate the effects of a high-protein peptide-based formula on gastrointestinal intolerance, mainly focusing on diarrhea symptoms in patients who were intolerant to polymeric formula feeding. This prospective, single-arm, open-label, multicenter study was conducted from March 2021 to March 2022 at two tertiary-care hospitals. Patients who presented with diarrhea during tube feeding with polymeric formula were assigned to receive a high-protein peptide-based formula for ≤7 days. Stool weight and frequency were monitored at baseline, on day 3, and on day 7 (or end of the study) as the primary outcomes. Twenty-eight tube-fed patients with diarrhea were recruited. After switching their feeding formula from polymeric to peptide based, significant improvements in stool frequency and stool weight were observed on day 3 and day 7 compared with the baseline (median [IQR] stool frequency: 5 (2), 2.5 (3.5), and 3 (3) times/day, respectively, p <0.001; median stool weight: 500 (370), 170 (285), and 275 (385) gram/day, respectively, p = 0.015). Stool consistency was assessed using the Bristol Stool Score and showed significant improvement with time. No serious adverse events were reported. A high-protein peptide-based enteral formula was effective in reducing stool weight and frequency in patients who experienced diarrhea during tube feeding with a polymeric formula.Trial registration: TCTR20210302006.

Preparations for enteral nutrition: an overview

Enteral nutrition is the delivery of specially formulated nutrients, called enteral preparations, either orally or via tubes to meet patients' nutritional needs and avoid malnutrition. These feeds can be life-changing or lifesaving for patients. There are three broad enteral feed types: polymeric; pre-digested and disease-specific; and immune-enhancing. This article outlines the importance and involvement of nurses in the enteral feed process, including the selection and administration of enteral feeds, as well as presenting a summary of enteral preparations, their safety and evidence-based efficacy. Nurses should work within a well-coordinated multidisciplinary team, use existing knowledge and resources and refer to national guidelines, as well as practising in line with their professional roles and responsibilities to select and administer enteral preparations and continually monitor patients receiving enteral nutrition. Research has identified that enteral nutrition intolerance is an issue, particularly among critically ill patients. However, polymeric formula has been found to improve daily energy intake and tolerance and it is more cost-effective compared with semi-elemental formula in brain-injured critically ill patients. Immune-enhancing enteral nutrition could improve the immune function in patients with severe neurological diseases. While these findings are promising and can support enteral nutrition, there is a need for more research into the efficacy of specific formulas for certain conditions and for continuing to address enteral nutrition intolerance.

Stability of vitamin A, E, C and thiamine during storage of different powdered enteral formulas

In this study, two different kinds of commercial enteral formulas were selected to evaluate the changes of vitamin A, E, C and thiamine during the different storage conditions of different temperature and relative humidity (60 ± 1 °C, 60 ± 5% for 5 and 10 days; 37 ± 1 °C, 75 ± 5% for 1, 2, 3, 5 and 6 months; 25 ± 1 °C, 60 ± 5% for 3, 6, 9, 12, 18 and 24 months). The results showed that as the temperature or time increased, the content of vitamin A, E and thiamine was gradually decreased whilst the level of vitamin C remained stable. The vitamins exhibited more stability at the storage of 25 ± 1 °C, RH 60 ± 5%. Vitamin A and thiamine decreased more in the polymeric formula (EFA) than that in the oligomeric formula (EFB), while, vitamin E decreased less in EFA than that in EFB. The kinetics of vitamin A, E and thiamine degradation during storage followed first order kinetic equations. Furthermore, the final levels of vitamins were higher than the minimum level recommended by legislation.

NOVEL PLANT-BASED PEDIATRIC FORMULA ALTERNATIVE FOR MANAGEMENT OF NON-IGE-MEDIATED FOOD ALLERGIES: A CASE STUDY

<h3>Introduction</h3> Traditional management of food protein-induced allergic proctocolitis (FPIAP) includes use of extensively hydrolyzed or elemental formula and/or the removal of dairy and soy from maternal diet for breastmilk-fed infants. This case outlines use of a novel plant-based pediatric formula in an infant diagnosed with dairy and soy-protein FPIAP. <h3>Case Description</h3> At 2 weeks of age, P presented with a dusky, distended belly and stridor within 24 hours of initial exposure to a polymeric cow milk-based infant formula. Following standard protocol for suspected FPIAP, he was transitioned to an elemental formula and his mother was placed on an elimination diet. Breastmilk was re-introduced after 10 days of elimination diet with formula supplementation. He was transitioned to supplemental extensively-hydrolyzed casein formula at 6 months. At age 10 months, due to U.S. infant formula shortages, P transitioned successfully to a novel plant-based pediatric formula sourced from almonds and buckwheat that is free of soy, rice, and pea proteins. P failed cow's milk challenge and subsequently pea-protein milk challenge upon turning 12 months, which both induced repeated gastrointestinal distress. Symptoms resolved upon re-introduction of the novel plant-based formula. <h3>Discussion</h3> This case demonstrates that an alternative protein-sourced formula has the potential to serve as a safe alternative therapy strategy to address patients with FPIAP unable to exclusively breastfeed and/or tolerate traditional formulas. These findings justify the need for further development and demonstration in a clinical setting of an alternative protein-sourced infant formula to be used in the standard management of food allergy disorders.

Effect of preoperative predigested formula vs. polymeric formula on bowel function recovery after definitive surgery for small intestinal entero-atmospheric fistula in patients with chyme reinfusion.

The purpose of this study is to compare the effect of preoperative predigested formula vs. polymeric formula on bowel function recovery following definitive surgery (DS) for small intestinal enteroatmospheric fistula (EAF). In this retrospective study, from January 2005 to December 2019, the patients with small intestinal EAF and receiving a DS were enrolled. During the preoperative treatment, each patient received enteral nutrition via nasojejunal feeding and chyme reinfusion. The enrolled subjects were classified into two groups, based on their formula type: polymeric formula and predigested formula. Then, propensity scores matching (PSM) was used to further divide these patients into PSM polymeric formula group or PSM predigested formula group. The clinical characteristics of the groups were analyzed. A total of 137 patients were finally enrolled, with 72 patients in the polymeric formula group and 65 patients in predigested formula group. The postoperative ileus was manifested in a total of 61 (44.5%) cases, with 27 (37.5%) in the polymeric formula group and 34 (52.3%) in the predigested formula group (P = 0.04). It was predicted that the polymeric formula could result in a reduction in postoperative ileus (OR = 0.47; 95% CI: 0.21-0.95; P = 0.04). After 1:1 PSM, there were 110 patients included. The postoperative ileus was observed in 47 patients, with 18 (32.7%) in the polymeric formula group and 29 (52.7%) in the predigested formula group (P = 0.03). After PSM, the polymeric formula demonstrated a reduction in the incidence of postoperative ileus (OR = 0.42; 95% CI: 0.19-0.92; P = 0.03). Compared with predigested formula, the preoperative polymeric formula appears to be associated with earlier recovery of bowel function after DS for EAF.

S2725 Enteral Nutrition in Crohns Disease With Abscess

Introduction: Enteral nutrition has emerged as a treatment option for patients with active Crohn’s disease. We report a patient achieving remission with enteral nutrition in conjunction with ustekinumab. Case Description/Methods: A 29-year-old Caucasian male with Crohn’s disease not on therapy presented with abdominal pain, nausea and vomiting. In the past 3 years, he had multiple visits to urgent care for symptoms, each treated with systemic steroids. On presentation, he had an elevated CRP of 143.9 mg/L and MR enterography showed inflammation in the small bowel and terminal ileum. The patient completed a 7-day course of piperacillin-tazobactam and was started on ustekinumab. He was readmitted 10 days later with WBC of 16.9 10*3/ul, CRP of 305.6 mg/L, tachycardia, night sweats and worsening abdominal pain. Imaging showed continued inflammation of small bowel and terminal ileum with a mesenteric abscess connected to the D4 portion of duodenum by a fistulous tract. Piperacillin-tazobactam was started for 14 days along with 5 weeks of exclusive enteral nutrition (EEN) with BOOST, ∼2145 kcals daily. Repeat imaging showed interval decrease in abscess size and then complete resolution. Disease remission was obtained with alleviation of abdominal pain and weight gain of 5 lbs. Labs normalized with CRP < 3 mg/L, at the end of the 5 weeks of EEN. Discussion: EEN is the administration of a polymeric formula as the sole source of nutrition for a limited period (4-8 weeks). In Crohn’s disease, EEN has been shown to help reach remission in 85-90% of patients. It has special consideration in achieving remission in CD patients who have steroid intolerance or contraindications to systemic steroids. The mechanism of EEN in treatment of Crohns disease is not completely understood but is hypothesized to be multifactorial and potentially involve alterations in gut microbiota, decreasing gut permeability, and allowing restoration of epithelial barrier. Limited studies have been conducted on concomitant use of EEN with biologic agents. These studies have primarily been done looking at anti-TNF agents, such as infliximab, and sustained remission rates. Induction therapy with such agents as ustekinumab take time to have clinical effect, 56% of patients have response in 6 weeks. In this patient, initiation of ustekinumab along with EEN was successful in achievement of clinical remission and reduction in inflammatory markers.

Early Enteral Nutrition with High-Protein Whey Peptide Digestive Nutrients May Improve Prognosis in Subarachnoid Hemorrhage Patients

Background and Objectives: Nutritional management in patients with subarachnoid hemorrhage (SAH) during the acute phase is important; however, there is no proper evidence or recommendations on the appropriate nutrients for early enteral nutrition. This study compared the influence the two different tube-feeding liquid diets for early enteral nutrition might have on the prognosis of patients with SAH. Materials and Methods: In a seven-year period, this single-center retrospective study included 245 patients with aneurysmal SAH who underwent craniotomy and aneurysm neck clipping and received enteral nutrition. The patients were divided into two groups according to the nutrient received: (1) high-protein whey peptide oligomeric formula diet (oligomeric group, 109 patients); and (2) high eicosapentaenoic acid-containing polymeric formula diet (polymeric group, 136 patients). The modified Rankin Scale (mRS) score at discharge was evaluated as the primary outcome. The presence or absence of diarrhea (watery stool and mushy stool) during the period from initiation of enteral nutrition to discharge from the stroke unit was also evaluated. Results: There were no significant differences in patient characteristics between groups. The time until initiation of enteral feeding in the oligomeric and polymeric groups was 2.8 ± 2.3 and 2.9 ± 2.2 days, respectively. The proportion of patients with mRS scores of 0–1 was significantly higher in the oligomeric group (25.7%) than in the polymeric group (14.7%) (p = 0.036), while the incidence of watery stool was significantly lower in the oligomeric group (15.8% to 34.3% in the polymeric group) (p = 0.003). Multivariate analyses confirmed that the oligomeric diet and the presence or absence of diarrhea significantly affected the mRS scores. Conclusions: The adoption of early enteral nutrition with high-protein whey peptide digestive nutrients might be associated with superior mRS scores at discharge and decreased diarrhea in patients with SA, indicating that the choice of nutrients might affect the outcome and prognosis.

Understanding the use and tolerance of a pediatric and an adult commercial blenderized enteral formula through real-world data.

Home enteral nutrition (HEN) is frequently prescribed to individuals who cannot consume adequate food orally. Commercial blenderized enteral formulas (CBEF) containing real-food ingredients are becoming more popular and more widely available; however, the demographics of patients receiving these formulas have rarely been evaluated, and little data are available on patient tolerance in the community. US claims data were obtained for children and adolescents/adults who used the CBEF of interest as the sole source of nutrition via enteral feeding tube in the community setting following discharge from acute care. Demographics, concomitant medications, clinical diagnoses, and Charlson Comorbidity Index scores were tabulated using descriptive statistics. Gastrointestinal (GI) symptoms before and after hospital discharge were compared using significance tests. The study included 231 participants (180 children, 51 adolescents/adults). CBEFs were prescribed to patients with a variety of diagnoses, of which the most common were digestive and respiratory disorders. Children experienced significantly lower rates of diarrhea, nausea, vomiting, constipation, and abdominal distension in the weeks following hospital discharge compared with the baseline (all P < 0.001). Adolescents/adults experienced significantly lower rates of constipation, nausea, and vomiting (all P < 0.05). Neither group increased their usage of GI medications following hospital discharge. These CBEFs, based on real-food ingredients, were prescribed to diverse patients in the community and were well tolerated. These formulas offer an alternative to standard polymeric formulas and an alternative or adjunct to homemade blenderized formulas.

Hospital supply of a polymeric enteral nutrition formula amongst inpatients at Patan Hospital, Nepal

Introduction: A retrospective quantitative descriptive study was undertaken to describe the provision of a standard polymeric nutritional supplement produced at Patan Hospital, Nepal, with the aim of assisting efforts to improve the nutritional care of malnourished patients.&#x0D; Method: All adult inpatients (18 years and above) who commenced this nutritional supplement between December 2017 and August 2019 were included. Data was collected from a register and descriptive analysis done. The use across specialty areas, patient weights, duration of use, main feeding route, main volume recommended and main reasons for cessation were among the characteristics described.&#x0D; Result: Total 894 record of the patients were analysed. Awareness-raising activities and launch of a modified supplement recipe, saw prescriptions increase from 13.3 to 47.4 patients per month. The general medical ward and medical intensive care unit initiated the greatest numbers of prescriptions (n=312, n=251 respectively). The nutritional supplement was most commonly prescribed as a 500 ml oral supplement. The average length of prescription was 9.8 d and the main reasons for ceasing was discharge (n=479) and patient expiry (n=158). Weight was recorded in 38% of patients (n=340) and mean weight was 50.5 kg. The average age of the study population was 57.8 y.&#x0D; Conclusion: For improving the nutritional care of malnourished patients, awareness raising activities appeared helpful in increasing prescriptions for the nutritional supplement. However, the use of the nutritional supplement remained low and practices varied significantly between wards.

WANITA 62 TAHUN DENGAN MALNUTRISI BERAT DAN TOXIC EPIDERMAL NECROLYSIS

Malnutrition and skin problems are interrelated; therefore malnutrition will reduce the function of innate and adaptive immunity. The skin contains immune cells that is crucial for host defense. A 62-year-old female patient was diagnosed with Toxic Epidermal Necrolysis (TEN) due to an unknown drug allergy and severe malnutrition. The patient has a history of inadequate intake for 1 year ago and has worsened in the last 2 weeks due to blisters all over the skin, especially in the labium oris area after taking an unknown analgetic medication. Nutrition therapy had given with a target of 1900 kcal/day gradually increased to 2200 kcal/day through enteral and parenteral with a protein of 1.5 grams/kgIBW/day. Because of patients has history of aversion to food types such as chicken, eggs, fish, cow's milk, and dairy products, so patient had given soy-based polymeric formula and Parenteral Nutrition Supplement to achieve nutrition requirement. Supplementations administered were zinc, vitamin A, vitamin B complex, and vitamin C. At the end of the treatment period there were metabolic improvement such as wound healing without secondary skin infection and improvement of albumin serum from 2,3 g/dL to 3,3 g/ dL. Patients experienced side effects due to systemic corticosteroids in the form of moon face, severe muscle wasting, hyperglycemia, and hypertension. However, the use of systemic corticosteroids should pay attention to whether the benefits outweigh the disadvantages.&#x0D; Keywords: toxic epidermal necrolysis, malnutrition, corticosteroid, aversion

Implementation of exclusive enteral nutrition in pediatric patients with Crohn\u2019s disease\u2014results of a survey of CEDATA-GPGE reporting centers

BackgroundExclusive enteral nutrition (EEN) is the first-line therapy for pediatric-onset Crohn’s disease (CD) patients. CEDATA-GPGE® is the largest patient registry for children and adolescents with inflammatory bowel disease (IBD) in Europe, collecting data from over 5000 patients since 2004 in Germany and Austria. Since the application of EEN over 8 weeks is difficult and a high dropout rate is often described, the mode of application including a supporting structure is crucial for success. The aim of this study was to ascertain the variation in the application of EEN across the participating centers and to associate these with the outcome.ResultsThirty-one centers responded to the survey (81.6%). 88.5% of CD patients were recommended EEN for induction therapy, 71.8% actually started with EEN, and 22.1% terminated the EEN prematurely. The duration of EEN typically lasted 6 to 8 weeks, and the polymeric formula was mainly used. 80.6% of the clinics added flavorings to the formulas. After EEN, the most preferred diet for maintenance therapy was a healthy, well-balanced diet considering individual intolerances.ConclusionsEEN is widely recommended as an induction therapy by the German and Austrian pediatric gastroenterologists for children and adolescents with CD. However, this questionnaire-based study has shown a wide variation in EEN protocols used by the different pediatric clinics of CEDATA-GPGE®.

Comparing Effectiveness of a Generic Oral Nutritional Supplement With Specialized Formula in the Treatment of Active Pediatric Crohn's Disease.

Exclusive enteral nutrition (EEN) is the recommended induction treatment of mild to moderate active pediatric Crohn's disease (CD). This study compared outcomes of 2 proprietary polymeric formulas. Treatment effectiveness was examined along with practical aspects of formula delivery and differences in estimated treatment costs. Data were retrospectively collected from patients with CD who received a generic oral nutritional supplement (Fortisip) across 2 centers (RCH, Melbourne and RHSC, Edinburgh). This was compared with a prospective cohort (RHC, Glasgow) that used a specialized formula (Modulen IBD). The data collected included patient demographics, remission rates, biochemical markers, administration method, and anthropometrics. The estimated treatment cost was performed by comparing price per kcal between each formula. One hundred seventy-one patients were included (106 Fortisip, 65 Modulen IBD, 70 female; median age 13.3 yrs). No difference was demonstrated in remission rate (Fortisip n = 67 of 106 [63%] vs Modulen IBD n = 41 of 64 [64%], P = .89), nonadherence rate (Fortisip n = 7 of 106 [7%] vs Modulen IBD 3 of 64 [5%], P = .57) or method of administration (NGT Fortisip use n = 16 of 106 [12%] vs Modulen IBD 14 of 65 [22%]; P = .31). There was no difference in reduction of biochemical disease markers between the groups (C-reactive protein , P = .13; erythrocyte sedimentation rate, P = .49; fecal calprotectin, P = .94). However, there was a cost-saving of around £500/patient/course if the generic oral nutritional supplement was used. The generic oral nutritional supplement and specialized formulas both had similar clinical effectiveness in induction of remission in pediatric CD. However, there is considerable cost-saving when using a generic oral nutritional supplement.

Effect of long-term aggressive nutrition therapy on survival in patients with alcohol-related cirrhosis: A randomized controlled trial.

The aim of this study was to assess the effect of long-term aggressive nutritional therapy on clinical outcomes and survival in patients with alcoholic liver cirrhosis (ALC). Malnourished patients assessed by Royal Free Hospital-Subjective Global Assessment (RFH-SGA) were randomized to control group (CG) (35-40 kcal and 1.2 g protein/kg/day; diet alone) or intervention group (IG) (40-45 kcal and 1.5 g protein/kg/day; diet plus polymeric formula) for 3 months. Patients were followed up at 3 and 12 months. Malnourished patients (age 44.0 ± 9 years; M [100%]; Child A:B:C [%] = 11:39:50) were randomized to the CG (n = 50) or IG (n = 54); 21 patients in CG and 27 in IG completed 3 months of follow-up. The RFH-SGA improved in 7 (33.3%; p = 0.016) in IG vs. 3 (14.2%; p = 0.625) in CG. Over 3 months, increments (CG vs. IG) were seen in calories (1554 ± 972 to 1823 ± 398; p = 0.001 vs.1542 ± 603 to 2254 ± 372; p=0.001), protein (53.1 ± 18.4 to 72.5 ± 19.6; p = 0.001 vs. 53 ± 21 to 86.9 ± 18.8; p = 0.00), dry body weight (64 ± 10 to 66 ± 11; p = 0.04 vs. 60.8 ± 9.2 to 63.2 ± 10.7; p = 0.009), and mid-upper arm circumference (MUAC) (24.7 ± 3.3 to 25.5 ± 3.3; p = 0.116 vs. 23.5 ± 2.7 to 24.1 ± 2.9; p = 0.015), with better ascites resolution in IG (53.3%; p = 0.008) vs. CG (44.4%; p = 0.227). Median 12-month survival was comparable in both the groups (p = 0.864). Irrespective of the intervention group, energy intake > 25 kcal and protein > 0.8 g/kg/day significantly improved 12-month survival. Aggressive nutritional therapy improves nutritional status and resolves ascites, however fails to show long-term survival benefit, though higher calorie and protein intake has the potential to impact survival. NCT02140294.

Metabolic and nutritional triggers associated with increased risk of liver complications in SARS-CoV-2.

Obesity, diabetes, cardiovascular and respiratory diseases, cancer and smoking are risk factors for negative outcomes in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which can quickly induce severe respiratory failure in 5% of cases. Coronavirus disease-associated liver injury may occur during progression of SARS-CoV-2 in patients with or without pre-existing liver disease, and damage to the liver parenchyma can be caused by infection of hepatocytes. Cirrhosis patients may be particularly vulnerable to SARS-CoV-2 if suffering with cirrhosis-associated immune dysfunction. Furthermore, pharmacotherapies including macrolide or quinolone antibiotics and steroids can also induce liver damage. In this review we addressed nutritional status and nutritional interventions in severe SARS-CoV-2 liver patients. As guidelines for SARS-CoV-2 in intensive care (IC) specifically are not yet available, strategies for management of sepsis and SARS are suggested in SARS-CoV-2. Early enteral nutrition (EN) should be started soon after IC admission, preferably employing iso-osmolar polymeric formula with initial protein content at 0.8 g/kg per day progressively increasing up to 1.3 g/kg per day and enriched with fish oil at 0.1 g/kg per day to 0.2 g/kg per day. Monitoring is necessary to identify signs of intolerance, hemodynamic instability and metabolic disorders, and transition to parenteral nutrition should not be delayed when energy and protein targets cannot be met via EN. Nutrients including vitamins A, C, D, E, B6, B12, folic acid, zinc, selenium and ω-3 fatty acids have in isolation or in combination shown beneficial effects upon immune function and inflammation modulation. Cautious and monitored supplementation up to upper limits may be beneficial in management strategies for SARS-CoV-2 liver patients.

Difficult to treat esophageal perforation after endoscopic balloon dilation for stenosis due to endoscopic submucosal dissection followed by chemoradiotherapy: A case report.

Introduction and importanceThere is no clear consensus on a specific treatment for esophageal perforation. The surgical approach is deemed necessary for local severe infection and pleural contamination requiring debridement.Presentations of caseWe have reported herein the case of a patient with esophageal perforation with severe mediastinal and thoracic abscess after endoscopic balloon dilation for stenosis due to endoscopic submucosal dissection and chemoradiotherapy. A surgical approach with primary closure was performed, but not found effective; while conservative treatment with mediastinal drainage via posterior neck and recovery of nutritional status was found to be effective. For the recovery of nutritional status, enteral nutrition was assessed using a polymeric formula through a percutaneous endoscopic gastrojejunostomy tube.DiscussionEsophageal perforation is a life-threatening condition. Iatrogenic injuries are the frequent cause of esophageal perforation. For esophageal perforation, not only surgical interventions but also conservative treatments including various endoscopic approaches have been performed. If the inflammation is not localized, surgical intervention is often needed; however, if the patient's general condition is stable, conservative treatment with drainage, antibiotics, and nutritional management may be considered, even in cases of esophageal perforation.ConclusionsEsophageal perforation with a large perforation site with widespread inflammation can be improved with proper thoracic and mediastinal drainage and adequate nutrition support if the patient's condition is mild.

Exclusive enteral nutrition with oral polymeric diet helps in inducing clinical and biochemical remission in adults with active Crohn's disease.

Exclusive enteral nutrition (EEN) is not routinely used as induction therapy for adults with active Crohn'sdisease(CD). The aim of this study was to assess the effectiveness of EEN with oral polymeric formula as an adjunct for inducing clinical and biochemical remission in adults with active CD. We performed a retrospective analysis of data from January 2018 to September 2019 on all patients with active CD who commenced EEN. The primary end point (PE) was clinical remission (Crohn's Disease Activity Index [CDAI] ≤150) or response (100-point decrease in CDAI) at 8 weeks. The secondary end point (SE) was biochemical remission (C-reactive protein level ≤5 mg/L or feces calprotectin level ≤150 mcg/g) at 8 weeks in those whose baseline values were elevated. We also aimed to identify predictors of response to EEN therapy. Sixty-six patients commenced EEN; 53 (of 66; 80.3%) completed the prescribed EEN course. At 8 weeks, 42 (of 66; 63.6%) patients achieved the PE, and 30 (of 53; 56.6%) patients achieved the SE. Patients receiving EEN for ≥6 weeks achieved the PE (72% vs 47.8%; odds ratio [OR], 2.8; P = 0.047; CI, 0.97-8.16) and SE (67.6% vs 36.8%; OR, 3.58; P = 0.035; CI, 1.1-11.63) more frequently compared with patients who received EEN for <6 weeks. Nine patients reported adverse effects. Polymeric EEN is well tolerated, safe, and effective in inducing clinical and biochemical remission in adults with active CD. EEN duration of ≥6 weeks has better outcomes.

Obesity in children with acute lymphoblastic leukemia in remission: the evaluation of causes, hidden nutritional deficiency and the experience of its correction by using artificial enteral nutrition

Background. Antineoplastic treatment can have late toxic manifestations that can often appear after end of treatment. Children after treatment for acute lymphoblastic leukemia (ALL) have a risk of developing both obesity and undernutrition, which may be concealed by increased fat mass.Objective: to explore the incidence of obesity and hidden undernutrition in children with ALL and to describe the effect of enteral feeding using in these children.Materials and methods. In a retrospective study the data of 62 children with obesity that was revealed by standard examination was analyzed. The criterion of obesity was increased value of fat mass received by bioimpedance analysis. For this evaluation Russian bioimpedance analysis standards were used. Additionally, the included data were following: presence of endocrine pathology, weight change during latter 6 months before admission, physical activity and alimentary characteristics (usual regimen and structure of daily feed).Results. Only 54.8 % of patients with an actual excess of fat body mass index detected obesity (Z‑score higher than +2.00) and another 29 % body mass index was within the normal range (Z‑score from –1.00 to +1.00). This was the result of a tissue imbalance: reduce fat‑free mass. Some patients were diagnosed with insulin resistance and hyperinsulinemia. 83.7 % have a completely passive lifestyle. 49.0 % almost do not eat fruits and berries, 79.6 % – vegetables and 91.8 % – fish and seafood. Frequent intake of sweet dishes – 22.4 %, sausage products – 49.0 %, bakery products – 42.9 %, dishes from fast food restaurants – 42.9 %. 55.1 % of patients had more than 5 meals a day, while 18.4 % – less than 3. In or‑ der to correct hidden nutritional deficiencies, 22 patients received artificial nutritional formulas. They had a significant increase in fat‑free mass and a decrease in fat, in comparison with those who did not receive enteral feeding.Conclusion. Treatment‑associated factors, physical activity and alimentary causes play an important role in formation of not only obesity, but also hidden nutritional insufficiency in children with ALL after treatment. Enteral feeding using artificial polymeric formulas showed its effectiveness. An integrated and multidisciplinary approach to solving the problem is appropriate of prevention and treatment of obesity.

Раннее энтеральное питание с расширенным белково-калорийным обеспечением в комплексе интенсивной терапии пациентов с тяжелой политравмой как средство профилактики полиорганной недостаточности

Актуальность. Необходимость идентифицировать, лечить, предупреждать тяжелые нарушения нутритивного баланса у пациентов с политравмой остается одним из основных компонентов интенсивной терапии. Правильный выбор времени и метода нутритивной терапии, состава и энергетической ценности пищевых смесей призван способствовать снижению частоты трудно корректируемых осложнений, в том числе синдрома полиорганной недостаточности. Цель: оценить эффективность раннего энтерального питания с расширенным белково-калорийным обеспечением согласно протоколу Enhanced Protein-Energy Provision via the Enteral Route Feeding Protocol in Critically III Patients (PEP uP) в комплексе интенсивной терапии пациентов с тяжелой политравмой. Материалы и методы. Обследованы 40 больных с тяжелой политравмой, доставленных в отделение анестезии и интенсивной терапии (ОАИТ) в среднем через 0,5 часа после травмы. Средний возраст пострадавших — 41,9 ± 2,4 года. Основная группа (группа А) — 15 пациентов, которым проводилась нутритивная терапия по протоколу PEP uP. Группу сравнения (группа Б) составили 25 больных, у которых нутритивная поддержка проводилась согласно Европейским рекомендациям по клиническому питанию пациентов в ОАИТ с применением стандартных полимерных смесей. С целью оценки риска полиорганной недостаточности применяли шкалу Sequential Organ Failure Assessment (SOFA) при поступлении, на 2-е, 3-и и 5-е сутки лечения. Определяли в динамике уровень общего белка и альбумина сыворотки крови. Результаты. Тяжесть органной дисфункции по шкале SOFA в обеих группах при поступлении была соизмеримой. В группе Б со вторых суток отмечено развитие устойчивой гипопротеинемии, чего в группе А не наблюдалось. На 5-е сутки лечения в группе А отмечен достоверно более высокий уровень альбумина, чем в группе Б. На третий день лечения в группе Б выросла доля пациентов с проявлениями повреждения почек: 31,8 % — 0 баллов, 54,5 % — 1 балл, 13,7 % — 2 балла по шкале SOFA. В группе А оценки в 2 балла по шкале SOFA не наблюдалось, 84,6 % имели 1 балл, 15,4 % — 0 баллов. В течение первых трех суток отмечено уменьшение проявлений повреждения легких в обеих группах. Влияние ранней нутритивной поддержки на динамику индекса оксигенации остается, по нашему мнению, неопределенным. Выводы. Достигнуто сокращение срока пребывания пациентов с тяжелой политравмой в ОАИТ в среднем на трое суток (в группе А — 16,9 ± 1,4 суток, в группе Б — 19,9 ± 1,2 суток). Первые 3–5 суток интенсивной терапии с использованием протокола PEP uP позволяют снизить риски развития полиорганной недостаточности, что следует из низшего в данный термин суммарного балла по шкале SOFA в группе А (1–4 балла) по сравнению с группой Б (4–7 баллов). Нутритивная терапия методом раннего энтерального питания с расширенным белково-калорийным обеспечением позволяет улучшить адекватность покрытия белково-энергетических потребностей у пациентов в остром периоде политравмы, что может положительно влиять на уменьшение частоты развития осложнений, продолжительность пребывания пациентов в ОАИТ.

Usefulness of semi-solid medical foods administered after percutaneous endoscopic gastrostomy

Background: Even if preoperative enteral nutrition is administered without any issues, some patients suffer from gastrointestinal symptoms (e.g., vomiting and diarrhea) after initiating gastrostomy feeding. Because of the amino acid composition and limited amount of lipids, elemental diets may reduce the risk of gastrointestinal symptoms. However, elemental diets are expensive. Semi-solid medical foods are inexpensive and more closely mimic normal physiology than elemental diets. The aim of the present study was to investigate the usefulness of semi-solid medical foods when administered after percutaneous endoscopic gastrostomy (PEG).Method: This retrospective study analyzed 91 patients who had PEG performed by the author who was the attending physician. All patients received preoperative enteral nutrition with liquid nutrients, and there were no instances of gastrointestinal symptoms before PEG tube placement. The types of nutrients administered after PEG were divided into three categories: semi-solid medical foods (n = 20), polymeric formulas (n = 26), and elemental diets (n = 45). The incidence of gastrointestinal symptoms was compared among the three groups.Results: No gastrointestinal symptoms occurred in the semi-solid medical foods group; the incidence of gastrointestinal symptoms in the semi-solid medical foods group was significantly lower than that of the polymeric formulas group [0% vs. 26.9% (7/26), p 0.05] and was similar to that of the elemental diets group [0% vs. 2.2% (1/45), p = 1].Conclusion: If preoperative enteral nutrition is administered without any issues, semi-solid medical foods are useful as nutrients administered after PEG tube placement.