Enteral nutrition for severe malnutrition in chronic intestinal pseudo-obstruction.

Abstract

OBJECTIVE:

Chronic intestinal pseudo-obstruction (CIPO) is a rare intestinal motility disorder. A prolonged avoidance of food due to fear of aggravation of postprandial symptoms leads to severe malnutrition. We report a case of a 21 y old man who was diagnosed as CIPO with a history of recurrent intestinal colic and obstructive symptoms, slow transit type of constipation, bilateral hydronephrosis (non-obstructive), motor dysphagia without any evidence of demonstrable mechanical obstruction. Our aim was to keep his post prandial symptoms to a minimum and nutritionally build him up with enteral nutrition (EN).

METHODS:

He had life threatening malnutrition (BMI of 11 kg/m(2)) and significant postprandial distension with an intake more than 100 ml, compromising the quality of life. In view of a normal absorptive function of the gut, TPN was ruled out and the patient was treated with enteral nutrition (oral & tube) only. The EN regimen followed was ad libitum oral intake along with nocturnal NG tube feeding. Initially a full strength semi-elemental formula at 50 ml/hour was given, later shifted to polymeric formula at 100 ml/hour. Serum levels of magnesium, phosphate and potassium were regularly monitored to prevent refeeding syndrome. He ws constantly motivated, counseled and monitored.

RESULT:

With a gradual increase in the intake from 300 Kcal to 1400 Kcal he was discharged. Eight months from discharge he had a weight of 58 kg (BMI = 22.3 kg/m(2)), with resumption of normal activities and marked improvement in the quality of life.

CONCLUSION:

Carefully planned EN along with motivation, psychological support and regular monitoring are the keys to nutritional management in CIPO.

• Authors: Jaya Benjamin, Namrata Singh, Govind K Makharia
• Journal: Nutrition (Burbank, Los Angeles County, Calif.) (Nutrition) Vol. 26 Issue 5 Pg. 502-5 (May 2010) ISSN: 1873-1244 [Electronic] United States
• PMID: 20018487 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright 2010 Elsevier Inc. All rights reserved.

Topics

• Adult
• Body Mass Index
• Chronic Disease
• Constipation (etiology)
• Deglutition Disorders (etiology)
• Energy Intake
• Enteral Nutrition
• Food
• Gastrointestinal Motility
• Humans
• Intestinal Pseudo-Obstruction (complications, physiopathology)
• Male
• Malnutrition (etiology, therapy)