Nutritional support in gastrointestinal disease

Nutritional support is capable of spontaneously healing many gastrointestinal fistulas, particularly if the fistula arises from bowel that is not involved with inflammatory bowel disease or a malignant growth. The choice of either enteral or parenteral nutrition can be used in the treatment of any fistula, the use of enteral nutrition should be more selective. It is recommended that enteral therapy for an upper gastrointestinal fistula be carried out by distal infusion of the diet by either tube or operative jejunostomy. Infusion of the diet distal to the site of the fistula should not increase drainage of the fistula. If drainage does increase in response to enteral feeding, then enteral therapy should be discontinued, and parenteral therapy should be started. Similarly, a fistula of the ileum or colon may also be treated with enteral therapy into the proximal bowel as long as sufficient length of normal bowel exists to absorb the diet proximal to the fistula.