Indications for Enteral Nutrition

Enteral nutrition is the preferred way of feeding patients who cannot eat, absorb, or use a normal diet in the presence of a usable gastrointestinal tract. The following are indications for EN:

1. Critical care patients, including those with trauma and burns, and also after major surgery.

2. Anorexia in patients with malignant disease, sepsis, liver and renal failure, and inflammatory bowel disease (IBD).

3. Upper gastrointestinal obstruction or ulceration of the pharynx, esophagus, stomach, and duodenum may prevent the ingestion of normal food. Examples of these conditions are cancer, central nervous system disorders, and stenosis following ulceration.

4. Pancreatic disease: In patients with pancreatitis it may be possible to feed a low-fat enteral formula through a NI route beyond the duodenum without causing increased disease activity or pain.

5. Short bowel and severe malabsorption: In controlled trials enteral diets are not better absorbed than normal food. Therefore, the presence of a short bowel per se is not an indication for enteral feeding. On the other hand, some patients with severe malabsorption may benefit from the use of elemental diets.

6. Inflammatory bowel disease: In IBD, enteral feeding is useful under the following situations:

i. Profound anorexia preventing the ingestion of a normal diet.

ii. Abdominal discomfort due to partial bowel obstruction or intestinal inflammation.

iii. Growth retardation resulting from insufficient nutrient intake.

iv. In Crohn's disease some controlled trials have suggested that enteral feeding induces a remission comparable to that seen with steroids.

7. Dementia: Patients unable to feed themselves because of profound mental changes.

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