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Enteral nutrition by tube.

Summary When p.o. intake is unsatisfactory or contraindicated, maintenance of nutrition by tube feeding is an alternative to the i.v. route. A number of factors will enter into the decision as to which alternative is better. In general, it is desirable to utilize the alimentary tract if it is functioning adequately. The potential hazard of aspiration and problems in inserting the tube into the appropriate part of the tract may offset advantages of tube feeding. The composition of the formula to be administered will depend upon the functional state of the gastrointestinal tract and the metabolic needs of the patient. Defined-formula diets have become commercially available for p.o. and tube feeding. These are both a boon and a problem to patient, physician, and dietitian. They simplify ordering, storage, preparation, and administration, but they have drawbacks related to their fixed composition. The large number of diverse formulations require expertise for their proper use. Entry of food into the alimentary tract is a stimulus to maintenance of structure and function of that tract and to hyperplasia when resection of bowel has occurred. Special formulations and modifications in route and rate of feeding may be beneficial in meeting the needs of patients with pancreatic insufficiency, malabsorption of various etiology, fistulas, and organ failures that modify nutritional requirements. Consideration should be given to adjunctive chemotherapy during nutritional rehabilitation of patients with known or suspected tumor.