Malabsorption: What to Do When Enteral Tube Nutrition Has Not Maintained Nutritional Status
When malabsorption is severe enough that enteral tube feeding — whether short-term nasogastric support or long-term feeding via ostomy — has been tried and has not achieved the required nutritional goals, the clinical situation escalates to intestinal failure. This protocol addresses the next step.
Enteral (tube) nutrition was used — including nasogastric or nasojejunal feeding for short-term support, or a feeding ostomy for longer-term support — but did not maintain or improve nutritional status. In adults, weight loss was not prevented or BMI and muscle mass did not improve; in children, normal growth and development was not achieved.
For patients with intestinal failure who cannot maintain adequate nutritional status through the oral or enteral route, a form of parenteral support is indicated. The specific approach is tailored to the degree of malabsorption and the patient's nutritional state — the complete structured protocol specifies the criteria and the form of support that applies.
Maintain or improve nutritional status. In adults: prevent weight loss, improve BMI and/or increase muscle mass. In children: support normal growth and development.
References
- Parenteral nutrition should be reserved for patients with intestinal failure.
- Parenteral nutrition should be reserved for patients with intestinal failure, who cannot maintain the nutritional status or growth via the oral/enteral route.
- The type of parenteral support should be tailored, and may include intravenous fluids and/or electrolytes, complementary parenteral nutrition or total parenteral nutrition, depending on the degree of malabsorption and malnutrition.
- Nutritional status should be monitored regularly in patients with malabsorptive diseases, as one of the goals of treatment is to maintain or improve nutritional status.
- Therefore, the goals of therapy in adults will be to prevent weight loss, improve BMI and/or increase muscle mass.
- In children, the main goal is normal growth and development.