How to feed patients with small intestinal dysmotility

Area of Science:

• Gastroenterology
• Nutritional Science
• Clinical Medicine

Background:

• Chronic small intestinal dysmotility presents a spectrum of malnutrition, from mild compromise to intestinal failure.
• Feeding these patients is a significant clinical challenge, exacerbated by diagnostic uncertainty and increasing parenteral nutrition referrals.
• Awareness is growing for overlapping disorders with high symptom burden but without intestinal failure.

Purpose of the Study:

• To review current approaches to feeding patients with chronic small intestinal dysmotility.
• To discuss the complexities of nutritional management in this patient population.
• To highlight the importance of tailored strategies and multidisciplinary care.

Main Methods:

• Literature review of recent findings in chronic small intestinal dysmotility and nutritional support.
• Analysis of pragmatic classifications and diagnostic challenges.
• Synthesis of evidence regarding enteral and parenteral nutrition strategies.

Main Results:

• A classification into chronic intestinal pseudo-obstruction (CIPO) and non-CIPO subtypes aids in guiding nutritional trajectory.
• A diagnostic grey zone exists, including disorders of gut-brain interaction, disordered eating, and opioid-related bowel dysfunction.
• Feeding strategies must be phenotype and symptom-burden tailored, prioritizing enteral support and reserving parenteral nutrition for intestinal failure or life-threatening risk.

Conclusions:

• Individualized feeding plans are essential, balancing malnutrition risks with parenteral support risks.
• Symptom severity and psychosocial factors must be considered in management.
• Early multidisciplinary team engagement, considered therapies, and nuanced clinical reasoning are vital for effective management.