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When to feed the patient with gastrointestinal bleeding.
Stephen A McClave1, Wei-Kuo Chang
1Division of Gastroenterology/Hepatology, 550 S. Jackson St., Louisville, Kentucky 40202, USA. samcclave@louisville.edu
Summary
Artificial enteral nutrition therapy in patients with gastrointestinal bleeding (GIB) is complex. Enteral feeding may be beneficial or harmful depending on the GIB cause, requiring careful clinical assessment.
Area of Science:
- Clinical Nutrition
- Gastroenterology
- Critical Care Medicine
Background:
- Artificial enteral nutrition (AEN) is often withheld in patients with gastrointestinal bleeding (GIB) due to concerns of increased morbidity.
- This practice creates a clinical dilemma, as AEN may not always exacerbate GIB and could potentially be beneficial.
Purpose of the Study:
- To explore the complex relationship between AEN and GIB.
- To guide clinicians on the appropriate management of AEN in the context of GIB.
Main Methods:
- Review of current evidence and clinical considerations regarding AEN in GIB.
- Discussion of the differential etiologies of GIB and their impact on AEN decisions.
- Emphasis on the role of endoscopic evaluation in determining GIB cause.
Main Results:
- Evidence of GIB is not an absolute contraindication for AEN.
- The impact of AEN on GIB varies significantly based on the underlying cause of bleeding.
- AEN can protect gut mucosa, increase rebleeding risk, or have no effect, depending on GIB etiology.
Conclusions:
- Nutrition support specialists require a thorough understanding of GIB pathophysiology to make informed decisions about AEN.
- Decisions on initiating or continuing AEN should be individualized, considering the specific GIB diagnosis and potential risks.
- Temporary withholding of AEN (48-72 hours) may be necessary in select cases to minimize rebleeding risk.