Intérêt de la nutrition entérale par sonde nasogastrique dans la boulimie

The use of enteral nutrition in the treatment of eating disorders: a systematic review

PURPOSE

Enteral nutrition (EN) is frequently used in the treatment of anorexia nervosa (AN), and less commonly, bulimia nervosa (BN); yet, no standardized guidelines for treatment exist at this time. The aim of this review is to investigate the efficacy of EN in the treatment of eating disorders and make recommendations for clinical practice and future research.

METHODS

An exhaustive literature search of 7 databases was completed. The search strategy combined key terms anorexia nervosa, bulimia, and eating disorders with terms associated with EN. There were no restrictions on publication date or language. Studies that assessed the effect of EN on weight restoration, refeeding syndrome, and binge/purge behaviors in the treatment of AN and BN were included.

RESULTS

Of 73 full-text articles reviewed, 22 met inclusion criteria. Nineteen studies reported that significant short-term weight gain was achieved when EN was used for refeeding malnourished AN patients; however, results varied for the six studies reporting on long-term weight gain, maintenance, and recovery. In studies with a comparator, no significant differences were found between the EN and oral refeeding cohorts regarding gastrointestinal disturbance, refeeding syndrome, or electrolyte abnormalities. Five studies examined the effect of EN on binge/purge behaviors, suggesting that temporary exclusive EN decreases the frequency and severity of binge/purge episodes.

CONCLUSION

Although EN is an essential life-saving treatment in severe cases of AN, it does not guarantee long-term success or recovery. The results of this systematic review highlight the need for prospective controlled trials with adequate sample sizes to make comparisons between specific feeding methods, formulations, and defined short and long-term outcomes. Evidence-based standards for clinical practice are needed with specific guidelines for best results for AN and BN treatment.

LEVEL OF EVIDENCE

I, systematic review.

[Treating the somatic complications of anorexia]

Anorexia can cause serious somatic complications, linked to undernutrition or associated pathological behaviours. The care pathway drawn up by a multi-discipline team is a real therapeutic challenge. Oral nutritional supplements, enteral nutrition and parenteral nutrition are three possible forms of nutritional assistance.

A 3-month at-home tube feeding in 118 bulimia nervosa patients: a one-year prospective survey in adult patients

BACKGROUND & AIMS

To study the 1-yr follow-up of 118 bulimia nervosa (BN) patients after a 3-month at-home tube feeding (TF) in a prospective study.

METHODS

At-home TF lasted 3 months, including one month of exclusive TF (no food). All patients fulfilled 4 questionnaires (score of binge/purging episodes (BP), eating disorder inventory, anxiety, depression), before, at the 3-month TF point, and 6 and 12 months latter.

RESULTS

The score of BP episodes dramatically decreased from 28.8 ± 15 (before TF) to 7.3 ± 5.4 at 3 months, as well as at 1 yr (15.1 ± 6.2). We also obtained a 50% decrease in Beck score (depression) and Hamilton score (anxiety). Curiously, there was no difference between the BP scores of the patients following psychotherapy and those who did not, despite lower scores for anxiety and depression.

CONCLUSION

In conclusion, in bulimia nervosa patients having normal BMI and purging behavior, home-TF allow to obtain total withdrawal from bingeing/purging in at least 75% of the cases at short term (3 months) and in 25% of the patients at one year, whatever the patients have or have not psychotherapy.

Efficacy of tube feeding in binge-eating/vomiting patients: a 2-month randomized trial with 1-year follow-up

BACKGROUND

In many binge-eating/vomiting patients, abstinence could not be obtained from classical treatments. Since the authors showed that tube feeding (TF) reduced such episodes in anorexia nervosa (AN)-hospitalized patients, they carried out a randomized trial on the efficacy of TF plus cognitive behavioral therapy (CBT) vs CBT alone in AN and bulimia nervosa adult outpatients.

METHODS

The authors randomly assigned 103 ambulatory patients to receive 16 sessions of CBT alone (n = 51) or CBT plus 2 months of TF (n = 52). The main goal was abstinence of binge-eating/vomiting episodes. Other criteria were gains in fat-free mass and muscle mass improvements in nutrition markers, and quality of life (SF-36 Health Survey), depression (Beck Depression Inventory), and anxiety (Hamilton Anxiety Rating Scale) scores. Evaluations were performed at 1, 2 (end of treatment), 5, 8, and 14 months (analysis of variance).

RESULTS

TF patients were rapidly and more frequently abstinent at the end of treatment (2 months) than the CBT patients: 81% vs 29% (P < .001). Fat-free mass, biological markers, depressive state (-58% vs -26%), anxiety (-48% vs -15%), and quality of life (+42% vs +13%) were more improved in the TF group than in the CBT group (P < .05). One year later, more TF patients remained abstinent (68% vs 27%, P = .02); they were less anxious, were less depressed, and had better quality of life than the CBT patients (P < .05).

CONCLUSION

TF combined with CBT offered better results than CBT alone.

[Tube feeding at home in anorexia nervosa patients]

INTRODUCTION

In the aim to explore the efficacy of tube feeding (TF) in ambulatory anorexia nervosa (AN) patients, we prospectively treated 60 AN patients by tube feeding (TF) at home, using a nasogastric tube.

METHODS

Nutritional (clinical, biological) and psychological (Hamilton and Beck scores) markers were assessed before and after 2 months of NEAD.

RESULTS

While the patient's body weight was decreasing during the previous 2 months, it significantly increased (P<0.001) during the 2-month TF, both in the restrictive and the binge/purging form: +3,42 +/- 2,39 kg in the restrictive ones and +2,82 +/- 2,17 kg in the binge/purging ones. Patients were rapidly (48 h) and frequently abstinent from binge/purging during TF: 90% had no more binge/purging episodes (P<0.0001). TF did not worse the eating behavior, and did increase neither anxiety nor depressive levels (Hamilton and Beck scores). Biological nutritional markers were normal before TF and remained so (2nd month), except haptoglobin which was low before and reached normal range during TF (P<0,01).

CONCLUSION

Ambulatory TF seems to be useful in AN patients at home. This could permit to avoid hospitalization, but needs to be confirmed by a randomized trial.