Enteral access options and management in the patient with intestinal failure

Nutritional consequences of chronic diarrhoea

There is an undeniable link between gastrointestinal disorders and malnutrition. Chronic diarrhoea is one of the most common gastrointestinal conditions that can impact a patient's nutritional status. The nutritional consequences will depend on the cause of the diarrhoea as well as the location and extent of gastrointestinal involvement. In general, malabsorption plays a central role in the interaction between malnutrition and chronic diarrhoea. Malabsorption can result in both nutritional deficits and diarrhoea. With severe malnutrition, chronic diarrhoea can persist due to impaired immune function and poor mucosal recovery. Food intolerance and an inappropriate diet in the setting of malabsorption may also contribute to chronic diarrhoea. Patients may attribute their gastrointestinal symptoms to specific dietary intake, which can lead to self-imposed indiscriminate dietary restrictions. Therefore, disease-specific treatment in conjunction with appropriate nutritional counselling and intervention is recommended in the prevention and treatment of malnutrition in patients with chronic diarrhoea. Specialized nutritional support through enteral or parenteral administration may be required to treat severe caloric and micronutrient deficiencies. In this review, we aim to summarize the mechanism, diagnosis, and treatment of the nutritional consequences of chronic diarrhoea.

Nutritional support in gastrointestinal surgery: an overview

Nutritional status is important in determining the outcome of surgical patients. This is particularly so in patients undergoing gastrointestinal (GI) surgical procedures. It is important for the GI surgeon to be always aware that he has to assess the nutritional status of his patient, provide supplementation when required and have the means to get enteral and/or parenteral access when required. He must have the knowledge to choose the right route and formula for nutritional support. This evidence-based review gives an overview of the subject with the purpose of increasing awareness about the science of surgical nutrition.