[Enteral tube feeding--an alternative to parenteral infusion therapy]

Nasoenteral alimentation is less hazardous, cheaper and more physiological than parenteral nutrition. Serious complications of tube feeding such as bleeding from esophageal lesions or aspiration pneumonia have become rare since soft silicone-rubber or polyurethane tubes are used and the diets are delivered into the jejunum rather than into the stomach. The costs of full enteral alimentation are 25 to 50% of that caused by total parenteral nutrition. For intraduodenal or intrajejunal feeding continuous infusion of an elemental or oligopeptide diet is necessary. At the beginning of the feeding program infusion rate must be slowly increased over four to five days to avoid diarrhea, abdominal cramping and vomiting. The caloric requirements depend on the extent of protein energy malnutrition and hypercatabolism of the individual patient. Although follow-up of the patient's nutritional status and water- and electrolyte balance in the hospital must be extremely close at the beginning, tube feeding can be continued--if necessary--by home enteral nutrition later on.