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2015, Number 2

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RCAN 2015; 25 (2)

On enteral nutrition and the gastrointestinal physiologism

Nin ALA, Santana PS

Language: Spanish
References: 70
Page: 390-404
PDF size: 507.78 Kb.


ABSTRACT

For quite some time the physiological “superiority” of enteral nutrition (EN) over parenteral nutrition has been taken for granted. EN (meaning the administration of nutrients with a defined chemical composition through an access placed in the gastrointestinal tract) should be the first nutritional intervention in a patient with no counterindication for using the digestive tract. However, the supposedly higher physiologism of EN might obscure the fact that this therapy obviates the cephalic phase of intestinal digestion and absorption. The important contribution of the cephalic phase to a better acceptance and digestion of foods, and nutrients therein contained, has been recognized in recent years. The food phenomenon starts from the very moment the subject anticipates the arrival of food. Complex neurohormonal signals simultaneously connect brain, stomach, small bowel and accessory glands of the gastrointestinal tract in order to secure, not only a correct intestinal absorption, but also enjoying the act of eating. Exclusion of the cephalic phase of the intestinal physiologism could explain failure in thriving of patients subjected to prolonged EN schemes using an enteral device. Measures to rehabilitate the oral function as soon as possible should be prescribed in every patient with an EN scheme. In selected cases, the patient should be encouraged to taste sips of the nutrient before its infusion. In addition, cyclic EN schemes should be recommended in order to simulate the alternance between pre- and postpandrial periods. Hence, a higher therapeutic effectiveness and a long-term superior tolerance to non-volitional EN should be expected.


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