Effect of enteral nutrition in children with Short Bowel Syndrome (A Conceptual Research Paper)

Author Name: Fizza Zahid

laureatefolks@gmail.com

Effect of enteral nutrition in children with Short Bowel Syndrome

Introduction

Short bowel syndrome is known as malabsorption disorder which occurs when a person is lacking in the functional small intestine. In this condition the small intestine is unable to absorb nutrients necessary for body functions, due to all the malabsorption the common symptoms like diarrhea, malnutrition, weight loss, dehydration, bloating, anemia occurs. There are several ways a person can suffer from short bowel syndrome including removal of a part of small intestine mainly due to Crohn's disease, some people are born with abnormally short, small intestine or the gut gets damaged due to other problems. Short bowel syndrome usually develops when a person has less than 2 meters of functional small intestine left out of 6 meters. In children SBS is common, it occurs when the resection of the small intestine occurs which occurs in many disorders like necrotizing enterocolitis, tumor, Crohn’s disease, injury, and radiation enteropathy.

Enteral nutrition is basically the process of administration of nutrients in gut by tube directly to the esophagus, stomach, and small intestine. Some common administration methods of enteral feeding include nasogastric tube and PEG (percutaneous endoscopic gastrostomy). In SBS, the EN is provided as in this method formula feed is given to patients according to their requirement in the body. Short bowel syndrome is the most important cause of intestinal failure and enteral nutrition helps to maintain proper growth. (Channabasappa et al. 2020)

Continues enteral nutrition is proven to be beneficial in patients with SBS. It is proven to help meet the maximum daily nutrient requirement of patients. (Gong et al. 2009). A study conducted to assess the most effective recommendations for enteral nutrition care in short bowel syndrome, reveals that enteral care must start as soon as a person or child's bowel resection occurs so that intestine may adapt to change. The standard polymeric formula must be given in standard continuous administration. (Olieman et al. 2010)

Objectives of the study

Keeping given above-mentioned facts the objectives of this study are

1. Assessment of the need for enteral nutrition for short bowel syndrome.

2. Assessment of the efficacy of enteral nutrition on short bowel syndrome in children.

3. To assess methods to prevent malnutrition in patients with SBS by enteral feeding.

Significance of the study

This study aims to find out the effect of enteral nutrition in patients suffering from short bowel syndrome. In this health condition the intestines are unable to absorb the required amount of macro and micronutrients from the food and in addition to the other complications like diarrhea also contribute to dehydration and malnutrition. Patients with SBS are mostly on TPN and they can be shifted to enteral nutrition which is less complicated and good for the patient's health with proper guidance and care.

Literature review

Background of the study:

Enteral nutrition therapy is proven to help wean out the patients from total parenteral nutrition. A study was conducted in which 37 patients who were previously on TPN received enteral nutrition support therapy which included a low-fat and high carb diet. This process improved the gut absorption and plasma levels and eventually it was proved that short bowel syndrome patients can wean from TPN to enteral nutrition. (Weiming et al. 2004)

After the surgery in which small intestines are partially removed to control the short bowl syndrome total parenteral nutrition is started in such patients and TPN helps to minimize liver diseases. Appropriate nutrition is required in the post-operative situation to avoid intestinal failure. (Cole and Kocoshis 2013).One of the major reasons for morbidity and mortality with SBS is due to the long-term dependence on TPN.(Sulkowski and Minneci 2014).

Diet must contain complex carbohydrates along with fats as simple carbohydrates are not suitable. Enteral feed that is rich in vitamins minerals and electrolytes is beneficial for SBS patients. Weaning from TPN to EN in SBS patients is considered a successful step towards recovery. (Matarese 2013).Macronutrient distribution in diets must be CHO 50%, PRO 30 %, and FATS < 40 %. Foods that are rich in soluble fibers promote intestinal adaptation. (Wall 2013).

It has been seen that patient with enteral formula feeding has more macro and micronutrient absorption as compared to the patients not receiving the enteral feed. Enteral nutrition avoids most common long-term complications e.g central line infection, nephrolithiasis, anemia, a liver disease that occurs with TPN. (Billiauws et al. 2018). Study done by Atia A and all in 2011 shows that dietary starch is an important energy-providing substance in patients with SBS. Short-chain fatty acid production is increased in patients receiving starch and soluble fibers. Soluble fibers help in making intestinal transit slow, thus the dose of antidiarrheal medicine is reduced in SBS. (Atia et al. 2011).In neonatal intestinal failure, parenteral nutrition is used for the long term and probiotics are largely used. The microbiome improved to be important in the adaptation of gut health in SBS patients.(Josyabhatla and Imseis 2021). The nutrient absorption takes place in first 1 m of small intestine. Protein absorption is majorly disturbed in SBS as proteins are absorbed in the first part of small intestine. (Qandeel et al. 2011)

Enteral polymeric formulas are very helpful in maintaining nutrient intake in SBS patients. (Carroll et al. 2016).Malnutrition assessment and nutrition needs are needed to start the enteral nutrition therapy. Enteral nutrition therapy focuses on delivering nutrition in the form of tube feeding. (Seron-Arbeloa et al. 2013) Enteral nutrition has the following benefits

· It is simpler and cost-effective as compared to TPN.

· Nutrients are efficiently delivered and used in enteral feeding.

· It increases the intestinal blood flow.

· Complications in enteral nutrition are less as compared to TPN.

· It decreases the muscle catabolism

· Enteral nutrition improves weaning.

Enteral nutrition has many disadvantages but these disadvantages are less harmful as compared to the disadvantages of enteral nutrition. (Seres et al. 2013)

Conclusion

The purpose is to assess the effect of enteral feeding in children with SBS. With all the benefits of enteral nutrition discussed above, it is recommended to shift to EN therapy in SBS as it has a smaller number of disadvantages and more advantages as compared to total parenteral nutrition like it are simpler and more cost-effective and the nutrient absorption is very good as compared to TPN. Complications like dehydration, hyperglycemia, hypoglycemia, liver failure, micronutrient deficiency, and infections are not common in patients receiving enteral nutrition. (Mikhailov et al. 2014)

References

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