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
Atia A, Girard‐Pipau F, Hébuterne X, Spies WG, Guardiola A, Ahn CW, Fryer J,
Xue F, Rammohan M, Sumague M. 2011. Macronutrient absorption characteristics in
humans with short bowel syndrome and jejunocolonic anastomosis: starch is the
most important carbohydrate substrate, although pectin supplementation may
modestly enhance short-chain fatty acid production and fluid absorption.
Journal of Parenteral and Enteral Nutrition. 35(2): 229-240.
Channabasappa N,
Girouard S, Nguyen V, Piper H. 2020. Enteral Nutrition in Pediatric Short‐Bowel Syndrome. Nutrition in Clinical Practice. 35(5):
848-854.
Josyabhatla R,
Imseis EM editors. Seminars in Perinatology. 2021.
Sulkowski JP,
Minneci PC. 2014. Management of short bowel syndrome. Pathophysiology. 21(1):
111-118.
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