Gastric versus Jejunal Feeding: Evidence or Emotion?

INTRODUCTION In patients that require nutrition support, enteral nutrition (EN) results in reduced infectious complications, and is more cost effective compared to parenteral nutrition (PN) (1). The knowledge of the benefits of EN has led to increasing acceptance and use of enteral feeding, especially in critically ill patients. However, there remains a substantial reluctance to utilize enteral feedings in some clinical situations due to concerns of feeding intolerance and aspiration risk. It is clear that some of these concerns are perceptions of feeding intolerance that have been challenged in recent investigations. For example, research demonstrating successful EN in severe pancreatitis, hypotension with pressors, and immediately after bowel anastomosis, all highlight the feasibility of EN in settings that may have previously been considered a contraindication to EN (2–6). It is true, however, that many critically ill patients exhibit delayed gastric emptying and have multiple risk factors for aspiration pneumonia (7). The acquisition of nosocomial pneumonia portends a more complicated hospitalization with increased length of stay, hospital costs, and mortality (8). Clinicians have searched for a means to retain the advantage of EN while reducing the risks of feeding intolerance and aspiration. Strategies such as the use of prokinetic medications, elevation of NUTRITION ISSUES IN GASTROENTEROLOGY, SERIES #42