Nutrition support in gastroenterology: opinion on current literature

Historically, enteral nutrition has been the preferred therapy due to its physiologic benefits, with parenteral nutrition selected if enteral nutrition was contraindicated or insufficient; however, recent advances in nutrition support have prompted reevaluation of this process. This review summarizes the current evidence regarding enteral nutrition and parenteral nutrition in gastrointestinal oncology, inflammatory bowel disease (IBD), critical care, and gastrointestinal surgery.

In gastric cancer, parenteral nutrition may improve the nutritional status and clinical outcomes of treatment-related gastrointestinal dysfunction. In IBD, exclusive enteral nutrition may be effective for inducing remission and promoting mucosal healing, whereas parenteral nutrition is preferred in intestinal failure and severe complications. Studies have shown the value of early parenteral nutrition when enteral nutrition is contraindicated or insufficient, specifically for improving nutrient delivery and reducing complications in critically ill and surgical patients. Additional areas of interest include caloric and protein dosing, indirect calorimetry, and the effect of nutrition support on the gut microbiome.

Current evidence supports a patient-centered approach to nutrition support with enteral nutrition remaining as the preference when the gastrointestinal tract can be utilized and parenteral nutrition as an important alternative or adjunct in select populations. Future research should focus on the refinement of supplemental parenteral nutrition practices and the development of evidence-based approaches for specific disease states.