Publications (2)3.29 Total impact
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Article: Gastric versus post-pyloric feeding: Relationship to tolerance, pneumonia risk, and successful delivery of enteral nutrition
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ABSTRACT: Enteral nutrition has been shown to have clinical advantages over parenteral nutrition in critically ill patients. However, delivery of enteral nutrition can be challenging because of intolerance and potential adverse effects. Gastric feeding is more physiologic than post-pyloric feeding, but its use may be limited by intolerance due to gastric dysfunction and by inappropriately low gastric residual volumes. Post-pyloric feeding may help to overcome these disadvantages by making it possible to avoid feeding interruption and potentially reduce the risk of aspiration. Results from studies to date have not shown any advantage of post-pyloric over gastric feeding in regard to outcome. This article focuses on strategies for enteral nutrition delivery in critically ill patients. The selection of site for enteral feeding should be based on risks, patient tolerance, and availability of local expertise. Predetermined feeding protocols may help to optimize the delivery of enteral nutrition. Only sufficient and safe delivery of enteral nutrition will have a positive impact on patient outcome.Current Gastroenterology Reports 04/2012; 9(4):309-316. -
Article: Successful long-term jejunostomy feedings in relapsing pancreatitis: a case report.
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ABSTRACT: Relapsing pancreatitis is characterized by repeated episodes of acute inflammation of the pancreas, with either a localized or a systemic organic response that may progress to chronic pancreatitis. Enteral jejunal feedings have been shown to be effective in the management of acute pancreatitis, but long-term use of jejunal feedings as treatment of relapsing pancreatitis has not been reported. We describe the case of a young patient treated with long-term jejunal feedings to induce remission and prevent recurrence of acute relapsing pancreatitis. An 18-year-old Hispanic man had well-documented recurrent episodes of acute pancreatitis. Multiple studies were performed as part of the diagnostic workup of the patient's relapsing pancreatitis, including endoscopic ultrasound, endoscopic retrograde cholangiopancreatography with biliary sphincterotomy, and laparoscopic cholecystectomy. Despite medical therapy, endoscopic and surgical procedures, the patient continued having episodes of pancreatitis on a monthly basis, with over 13 distinct documented episodes of pancreatitis during a 15-month period. A jejunostomy tube was inserted surgically, and long-term jejunal feedings were instituted, with excellent control of the patient's symptoms. There was only 1 episode of pancreatitis in the ensuing 24 months associated with the resumption of oral feedings and a weight gain of 20 pounds during this time period. Chronic jejunal feedings seem to be an effective alternative for treatment and prevention of acute relapsing pancreatitis. To our knowledge, this is the first report of long-term enteral feedings in acute relapsing pancreatitis.Journal of Parenteral and Enteral Nutrition 30(3):251-3. · 3.29 Impact Factor
