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

Divisions of Gastroenterology and Dietetics, Mayo Clinic and Mayo Foundation, Jacksonville, Florida and Rochester, Minnesota

Michael Camilleri, MD

Divisions of Gastroenterology and Dietetics, Mayo Clinic and Mayo Foundation, Jacksonville, Florida and Rochester, Minnesota

Jody A. Weckwerth, RD, LD, CNSD

Divisions of Gastroenterology and Dietetics, Mayo Clinic and Mayo Foundation, Jacksonville, Florida and Rochester, Minnesota

Michelle Romano, RD, LD, CNSD

Divisions of Gastroenterology and Dietetics, Mayo Clinic and Mayo Foundation, Jacksonville, Florida and Rochester, Minnesota

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.

Nutrition in Clinical Practice, Vol. 14, No. 1, 29-32 (1999)
DOI: 10.1177/088453369901400106


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