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2015, Número 2

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RCAN 2015; 25 (2)


Sobre la nutrición enteral y el fisiologismo gastrointestinal

Nin ALA, Santana PS

Idioma: Español
Referencias bibliográficas: 70
Paginas: 390-404
Archivo PDF: 507.78 Kb.


RESUMEN

Durante mucho tiempo se ha tenido por descontada la “superioridad” fisiológica de la nutrición enteral (NE) sobre la nutrición parenteral. La NE (entendida como la administración de nutrientes con una composición química definida a través de un acceso colocado en el tracto gastrointestinal) debe ser la primera intervención nutricional en un paciente en el que no concurre contraindicación alguna para el uso del tracto digestivo. Sin embargo, el supuesto superior fisiologismo de la NE puede oscurecer el hecho que esta terapia obvia la fase cefálica de la digestión y la absorción intestinales. En años recientes se ha reconocido la importante contribución de la fase cefálica a la mejor recepción y digestión de los alimentos, y la absorción de los nutrientes en ellos contenidos. El fenómeno alimentario se inicia desde el mismo momento en que el sujeto anticipa la llegada del alimento. Complejas señales neurohormonales conectan simultáneamente el encéfalo, el estómago, el intestino delgado y las glándulas accesorias del tracto gastrointestinal para asegurar no solo una correcta absorción intestinal sino además el disfrute del acto de comer. La exclusión de la fase cefálica del fisiologismo intestinal pudiera explicar la falla en renutrirse de pacientes con esquemas prolongados de NE no volitiva. En todo paciente sujeto a NE no volitiva se deben prescribir medidas para la rehabilitación de la vía oral tan pronto como sea posible. En casos seleccionados, se debe estimular al enfermo a degustar sorbos del nutriente antes de la infusión del mismo. Igualmente, se debe recomendar la administración de esquemas cíclicos de NE para simular la alternancia entre los períodos pre- y post-pandriales. De esta manera, cabe esperar una mayor efectividad terapéutica de la NE no volitiva y una superior tolerancia a largo plazo.


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