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JAMA Patient Page
May 28, 2019

Enteral Nutrition

Author Affiliations
  • 1Stanford Hospital, Stanford, California
  • 2Stanford University School of Medicine, Stanford, California
JAMA. 2019;321(20):2040. doi:10.1001/jama.2019.4407

Nutrition is essential to health and can be provided via feeding tube directly into the gut.

Nutrition

Good nutrition is essential to growth, healing, and vitality. The body requires specific amounts of carbohydrates, protein, fat, vitamins, and minerals depending on body weight and other considerations. For a variety of reasons, some patients are not able to eat. To receive essential nutrients, such patients require means that do not involve chewing or swallowing. Adequate hydration must be provided, but many patients can be without nutrition for up to 7 days. However, depending on the circumstances, nutrition might need to be started sooner. Inability to eat may be temporary, but in some patients it may be a permanent condition.

Short-term Nutrition

The preferred means of nutrition, enteral nutrition, is through the gut. It is the most natural way in which nutrients are absorbed, allowing the intestines to do their job, and is safer than intravenous nutrition, which is delivered into the bloodstream.

  • The preferred route for enteral nutrition is through the stomach. A very thin plastic tube (nasogastric or NG tube) can be inserted into a nostril and pushed all the way into the stomach. Liquid nutrition can be given this way at a continuous, set rate or intermittently.

  • Occasionally, a nasojejunal (NJ) tube is placed instead. This tube is inserted into the part of the small bowel called the jejunum. This can be done for a variety of reasons, including a condition called gastroparesis, in which the stomach is not working but the rest of the intestine is. The pylorus is the valve that separates the stomach from the rest of the small bowel. Therefore, nasojejunal tubes are also referred to as postpyloric tubes.

These types of tubes can be inserted at the bedside by a nurse or a doctor. Placement might be slightly uncomfortable, but most patients can ignore the tube once in place. There is a risk of the tube being pulled out unintentionally. If this occurs, the tube may need to be replaced by a health care practitioner.

Long-term Nutrition

If patients are expected to require enteral nutrition for longer than a couple of weeks, a long-term solution is needed. This may involve use of tubes that go directly through the abdominal wall into the gut. A gastrostomy (G) tube or a jejunostomy (J) tube can be placed into the stomach or the jejunum, respectively.

There are 3 main ways to place these tubes: (1) surgically (open or laparoscopic technique) by a surgeon using general anesthesia; (2) fluoroscopically via x-ray guidance by a radiologist using sedation; or (3) endoscopically (called a percutaneous endoscopic gastrostomy or PEG tube) by a gastroenterologist or a surgeon using sedation.

These types of tubes can be left in place for months to years. If these tubes become dislodged and come out, the patient, family members, or other caregivers can replace them at home once the tract that the tube has been in is well formed. If a patient regains the ability to eat and no longer needs the tube, it can be removed. The hole usually closes on its own.

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Article Information

Conflict of Interest Disclosures: None reported.

Source: Marik P, Zaloga G. Early enteral nutrition in acutely ill patients: a systematic review. Crit Care Med. 2001;29(12):2264-2270.

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