Oral and enteral nutrition management and drug treatment of short bowel syndrome

ESPEN Guidelines on Enteral Nutrition: Gastroenterology

Undernutrition as well as specific nutrient deficiencies have been described in patients with Crohn's disease (CD), ulcerative colitis (UC) and short bowel syndrome (SBS). The present guideline gives evidence-based recommendations for the indication, application and type of formula of enteral nutrition (EN) (oral nutritional supplements (ONS) or tube feeding (TF)) in these patients. It was developed in an interdisciplinary consensus-based process in accordance with officially accepted standards and is based on all relevant publications since 1985. ONS and/or TF in addition to normal food is indicated in undernourished patients with CD or CU to improve nutritional status. In active CD EN is the first line therapy in children and should be used as sole therapy in adults mainly when treatment with corticosteroids is not feasible. No significant differences have been shown in the effects of free amino acid, peptide-based and whole protein formulae for TF. In remission ONS is recommended only in steroid dependent patients in CD. In patients with SBS TF should be introduced in the adaptation phase and should be changed with progressing adaptation to ONS in addition to normal food.

Composition of enteral diets and meals providing optimal absorption rates of nutrients in mini pigs

BACKGROUND

Commercial enteral diets differ widely in nutrient composition. It is unknown whether the nutrient composition of the diets influences intestinal absorption.

OBJECTIVE

The objective of this study was to investigate the effects of different enteral diets providing 60% of energy as carbohydrate, protein, or fat or 33.3% of energy from each nutrient on intestinal absorption in mini pigs.

DESIGN

Kinetics of nutrient absorption were determined by perfusing a 150-cm jejunal segment. The kinetics of absorption were used to determine optimal relations between the absorption and recovery of each nutrient. From these data, the optimal nutrient composition of the diets providing complete absorption of the macronutrients in the shortest intestinal length was evaluated. Absorption of nutrients was further determined after oral administration of 4 corresponding meals.

RESULTS

With all enteral diets, the absorption of nutrients displayed saturation kinetics. Absorption rates of carbohydrate were significantly larger than those of fat and protein. Consequently, the amounts of nutrients remaining unabsorbed per unit length of jejunum differed among the macronutrients. After administration of various test meals, the length of the small intestine required for complete absorption of the nutrients depended on the composition of the meals. The shortest intestinal length for complete absorption was needed for a diet providing 48% of energy as carbohydrate, 23% as protein, and 29% as fat. This composition closely matched the nutritional requirements.

CONCLUSION

The nutrient composition of diets can optimize intestinal absorption. This may be especially important in patients with malabsorption or short-bowel syndrome.