Gi Intolerance Can Affect Patient Outcomes
Feeding patients who are malnourished or at risk of malnutrition, whether by oral or enteral routes, can be
a challenge since not all formulas are well tolerated. This can result in elevated gastric residuals,
vomiting, diarrhoea, malab- sorption and/or abdominal pain.
The side effects resulting from GI intolerance have an impact on patient care.
GI INTOLERANCE CAN AFFECT PATIENT OUTCOMES
GI intolerance is a state in which one or more of the GI tract’s functions (digestion,
absorption, motility, and barrier) is affected. Therefore, GI intolerance is a complex
problem which presents itself as diarrhoea, vomiting and high gastric residuals.8
GI intolerance can lead to poor clinical outcomes, potentially increasing care costs, due to
the utilisation of more expensive therapies and extended lengths of stay in ICU.
ENTERAL NUTRITION AND USING THE GUT CAN HELP IMPROVE GI TOLERANCE
It is important to use the patient's gut if it works. Enteral nutrition (EN) is preferred
over parenteral nutrition (PN) because it helps to maintain normal intestinal structure and
ENTERAL NUTRITION IS PREFERRED FOR THE GUT
The following image shows intestinal mucosa in the ‘fed’ state. EN delivers nutrients and
attracts blood flow to the gut; this stimulates the growth of the intestinal mucosal cells
and maintains gut integrity. Gut integrity prevents bacterial translocation (when bacteria
move from the GI tract into the bloodstream because the mucosal barrier is not functional or
is weak), and reduces the risk of sepsis.
The bottom image shows the consequences of not using the gut. The intestinal villi have
atrophied and their surface area for digestion and absorption is reduced. The junctions in
the mucosal barrier have become less ‘tight’ and bacteria can pass through them, i.e.
translocate through the gut wall.8,9
ENTERAL NUTRITION IS BETTER FOR PATIENTS THAN PARENTERAL NUTRITION
The use of EN promotes intestinal trophism, stimulates insulin secretion and the immune system, and reduces
the incidence of bacterial translocation and sepsis. Additional benefits of EN is reduced episode of
hyperglycemia and reduced risk of liver dysfunction.5, 9, 10
Furthermore, EN is associated with fewer complications and costs less than PN.
SOME ENTERAL FORMULAS ARE DESIGNED TO IMPROVE GI TOLERANCE
The type of enteral formula given during a nutritional intervention plays an important role in
feeding tolerance. In order to best meet nutritional needs, the formula selected for each
Deliver the appropriate nutrients in the appropriate amounts
Preserve lean body mass
Maintain immune function and favourably modulate the immune response
Avert metabolic complications and attenuate the metabolic response to stress
Be delivered as early as possible to maintain gut integrity, reduce complications, decrease
length of stay in the ICU, and have a positive effect in patients’ clinical outcomes
PATIENTS IN THE INTENSIVE CARE UNIT
The prevalence of both acute and chronic malnutrition in critically ill children and adults is well
documented. Early enteral nutrition is generally accepted as the standard of care for most hospitalised
patients; however, delayed feeding still occurs with relative frequency. Early enteral nutrition is
associated with decreased overall length of hospital stay in adult trauma, surgical and medical ICU
Barriers to optimal enteral nutrition to meet patients’ nutritional goals include lack of enteral access,
vasoactive medications, neuromuscular blocking medications, fluid restriction, feeding intolerance (such as
elevated gastric residuals, vomiting, constipation, diarrhoea and abdominal distension) and interruption of
feeds due to procedures.5,17,18
PATIENTS WITH CHRONIC DIARRHOEA
Diarrhoea associated with malabsorption is a major health problem affecting both children and
adults. A variety of terms have been used to describe this condition, including persistent
diarrhoea and chronic diarrhoea. Researchers have shown that peptide-based formulations may be
best absorbed by those with chronic diarrhoea.19-21
PATIENTS WITH CEREBRAL PALSY
Gastro-oesophageal reflux occurs in as many as 77% of patients with cerebral palsy.22
The rate of gastric emptying associated with any given formula is affected by the type of
protein the enteral formula contains. In 1992, researchers reported a significant reduction in
episodes of vomiting in patients fed a whey-based formula versus a casein-based formula. Gastric
emptying times were significantly shorter with whey-based formulas compared to casein-based
formulas. The authors of the study concluded that whey-based formulas reduce the frequency of
vomiting by improving the rate of gastric emptying.23
WE HAVE THE ATTRIBUTES
Feed the gut and feed the patient: The first and only enzymatically hydrolysed 100% whey protein
formula; high amount of MCT; balanced peptide profile. Designed for improved tolerance & absorption,
providing optimal nutritional support and supporting optimal growth and development in children.
Tried and tested: Feeds the gut to make even the most difficult patients thrive and grow, built on
evidence and experience (60 clinical studies, 23+ years of successful clinical experience, preferred
by dieticians in the US).
Practical tools and services: Offering tools like ‘optimising the ICU ecosystem’s performance with
Nx’ training sessions and new healthcare protocols, like PEP UP.
Proven return on investment: Reducing the cost of care associated with GI intolerance.
Use at home: For exclusive enteral nutrition to manage certain GI conditions, or to help patients
adapt to solid food
again during recovery.