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PubMed2000

Poult enteritis complex.

Poult enteritis complex (PEC) is a general term that encompasses the infectious intestinal diseases of young turkeys. Some diseases, such as coronaviral enteritis and stunting syndrome, are relatively well characterised, while others, such as transmissible viral enteritis, poult growth depression and poult enteritis mortality syndrome, remain ill-defined. All forms of PEC are multifactorial, transmissible and infectious. Salient clinical features include stunting and poor feed utilisation that result from enteritis. In the more severe forms, runting, immune dysfunction and mortality are reported. Gross and microscopic lesions of enteritis are present in all forms but tend to be non-specific. Other lesions may be present, depending on the agents involved. The basic pathogenesis involves the following: a) alteration of the intestinal mucosa, generally by one or more viruses infecting enterocytes; b) inflammation; c) proliferation of secondary agents, usually bacteria. Non-infectious factors interplay with infectious agents to modulate the course and severity of disease. Diarrhoea is believed to be primarily osmotic because of maldigestion and malabsorption, but may also have a secretory component. Transmission is primarily faecal-oral. No public health significance is recognised or suspected. Prevention is based on eliminating the infectious agents from contaminated premises and preventing introduction into flocks. This is accomplished by an effective cleaning, disinfection and biosecurity programme. All-in/all-out production or separate brooding and finishing units are helpful. Control may require regional co-ordination among all companies producing turkeys, especially if the production is highly concentrated, and a quarantine programme for more severe forms of PEC. No vaccines or specific measures for controlling the organisms involved in PEC are available. Treatment is supportive for the viral component, while antibiotics, especially those with efficacy against Gram positive bacteria, may help to reduce the impact to bacterial infections. Evidence suggests that PEC occurs wherever turkeys are raised commercially, but this is not well documented and distribution of the various organisms that have been associated with PEC is largely unknown. The disease causes enormous economic loss, mostly from failure of the turkey to reach its genetic potential.

Animals↗
PubMed1994

Gallbladder motility and cholecystokinin release during long-term enteral nutrition in patients with Crohn's disease.

BACKGROUND: Gallbladder bile stasis during long-term continuous enteral feeding may contribute to the high prevalence of gallstones in patients with Crohn's disease. We therefore examined the effects of continuous enteral nutrition on gallbladder motility and cholecystokinin (CCK) release in six patients. METHODS: Gallbladder volume was measured ultrasonographically for 12 h on days 1 (start), 8, 22 (6-h interruption of enteral feeding), 36, and 43 (end) of enteral feeding. Plasma CCK was assessed at several time points. RESULTS: Initial fasting gallbladder volume was 19.3 +/- 4.5 (mean +/- SEM) ml, which decreased to 4.9 +/- 3.6 ml after start of feeding. CCK increased from 1.5 +/- 0.3 to 3.9 +/- 1.1 pmol/l. On days 8 and 36 the gallbladder was almost completely contracted, and CCK increased to 7.5 +/- 2.7 and 8.3 +/- 2.6 pmol/l, respectively. On days 22 and 43 gallbladder volume increased, and CCK decreased rapidly to fasting concentrations after interruption of feeding. CONCLUSIONS: During continuous enteral nutrition the gallbladder is completely contracted, and CCK concentrations remain elevated. It is therefore unlikely that long-term enteral nutrition contributes to the increased prevalence of gallstones in patients with Crohn's disease.

Adolescent↗
PubMed2006

Absorption characteristics of EC-MPS--an enteric-coated formulation of mycophenolic sodium.

UNLABELLED: Enteric-coated mycophenolate sodium is an advanced formulation delivering mycophenolic acid (MPA), designed to improve MPA-related upper gastrointestinal adverse events by delaying MPA release until the small intestine. OBJECTIVE: Two studies were undertaken to identify the absolute bioavailability and dose-proportionality of enteric-coated mycophenolate sodium in stable renal transplant patients receiving cyclosporine. METHODS: Study 1: The mean MPA AUC(0-t) was shown to be greater after MPA infusion than after oral enteric-coated mycophenolate sodium (42.1 vs. 28.9 microg x h/ml). Mean absolute bioavailability was 0.71 +/- 0.21 (SD). Study 2: The AUC(0-t) and C(max) for MPA were proportional to the dose of enteric-coated mycophenolate sodium, similarly mean AUC(0-infinity) and C(max) for MPA glucuronide were proportional to dose administered. RESULTS AND CONCLUSIONS: In patients receiving cyclosporine the absolute bioavailability of MPA provided by enteric-coated mycophenolate sodium is equivalent to that provided by mycophenolate mofetil when administered in combination with cyclosporine, and exhibits dose-proportionality. Enteric-coated mycophenolate sodium was well tolerated from 180 - 2,160 mg with no serious adverse events reported.

Administration, Oral↗
PubMed1987

Dietitians' development of an enteral nutrition management package.

Several dietitians at the Royal Victoria Hospital, Montreal, examined current hospital practices in enteral feeding and defined three major areas of concern that are known to influence the management of enterally-fed patients. These concerns deal with physicians' perceptions, nursing management and cost. In order to address these concerns and consequently improve the management of enterally-fed patients, an Enteral Nutrition Management Package consisting of an order form, flow sheet and monitoring record was developed. The package provides standardized guidelines for enterally-fed patients and emphasizes the need for monitoring patients' clinical progress. The usefulness of the package is dependent upon the participation of every member of the health care team including the physician, nurse and dietitian. The development of the package is the result of initiative taken by clinical dietitians in addressing patient care concerns in enteral nutrition within a multidisciplinary system.

Dietary Services↗
PubMed1999

Neurotransmission at the interface of sympathetic and enteric divisions of the autonomic nervous system.

The sympathetic and enteric divisions of the autonomic nervous system are interactive in the determination of the functional state of the digestive tract. Activation of the sympathetic input suppresses digestive function primarily through release of norepinephrine at its synaptic interface with the enteric nervous system. The enteric nervous system functions like an independent minibrain in the initiation of the various programmed patterns of digestive tract behavior and moment-to-moment control as the neural microcircuits carry-out the behavioral patterns. Most of the postganglionic projections from sympathetic prevertebral ganglia terminate as synapses in myenteric and submucous ganglia of the enteric nervous system. Two primary actions of the sympathetic input are responsible for suppression of motility and secretion. First is presynaptic inhibitory action of norepinephrine to suppress release of neurotransmitters at fast and slow excitatory synapses in the enteric neural microcircuits and this effectively shuts-down the circuit. Second is inhibitory synaptic input to submucosal secretomotor neurons to the intestinal crypts. The alpha, adrenergic receptor subtype mediates both actions. Axons of secretomotor neurons to the crypts bifurcate to innervate and dilate the submucosal vasculature. Dilitation of the vasculature increases blood flow in support of increased secretion. Sympathetic inhibitory input to the secretomotor neurons therefore suppresses both secretion and blood flow. Activation of the sympathetic nervous system cannot explain the symptoms of secretory diarrhea and abdominal discomfort associated with psychologic and other forms of stress. Current evidence suggests that brain to mast cell connections account for stress-induced gastrointestinal symptoms. Degranulation of enteric mast cells by neural inputs releases inflammatory mediators that enhance excitability of intestinal secretomotor neurons while suppressing the release of norepinephrine from postganglionic sympathetic axons. This is postulated to underlie the secretory diarrhea and abdominal discomfort associated with stress.

Animals↗
PubMed2000

[Enteral nutrition: techniques and indications].

Enteral nutrition must be preferred to parenteral nutrition if case of intact digestive tract. Naso-gastric tubes are frequently used, particularly in enteral feeding. However, the use of naso-enteral tubes, i.e. naso-duodenal and naso-jejunal tubes, is expected to increase in the future. Their efficacy has been demonstrated in two specific cases: intensive care (post-operative or post-traumatic states), acute pancreatitis. A third potential use is in the replacement of a naso-gastric tube by a naso-jejunal tube in cases of frequent aspiration pneumonia related to a gastro-esophageal reflux. Gastro- and jejunostomies have to be indicated when enteral nutrition is thought to be used for more than one month. The insertion of a naso-gastric tube is generally performed by the nurse following medical guidelines and the insertion of a naso-jejunal tube is often done during an endoscopy by the physician. The verification of the correct position of the tube should preferably be done with an X-ray confirmation. However, this is difficult to perform at home and the most frequent method for control is the clinical method by auscultation. Enteral nutrients are generally polymeric and infused with gravity without a peristatic pump excepted in children. In conclusion, technical improvements in enteral nutrition have led to a simple, cost-effective and low risk methods of treatment.

Enteral Nutrition↗
PubMed2000

[Effects of early enteral feeding and L-arginine supplementation on liver albumin synthesis in burned rats].

OBJECTIVE: To evaluate the effect of early enteral feeding and L-arginine supplementation on mRNA expression of albumin, and some cytokines. METHODS: Twenty Wistar rats prepared with gastrostomy 7 days before the experiment were inflicted with 30% TBSA flame and were divided into early enteral feeding group (EF) and L-arginine enriched early enteral feeding group (AEF). All rats in two group starts enteral feeding two hours after burn. Capillary electrophoresis and reverse transcription-polymerase chain reaction (RT-PCR) were used to measure the mRNA of albumin, TNFa, IL-1a, IL-6R and iNOS respectively on 1st, 3rd, 6th and 9th day post burn (PBD). Serum albumin was observed at the same time. RESULTS: The mRNA expression of albumin on PBD1 was reduced in both group and improved on PBD3, 6, 9. The gene expression of albumin was significantly higher in AEF group than in EF group onPBD3, 9 [(1812 +/- 41) vs (1417 plus minus 43), P < 0.01]. Similarly, serum albumin were very low in two groups on PBD1 and improved on PBD3, 6, 9. Serum albumin in AEF group was significantly higher than in EF group on PBD9 [(31.9 plus minus 2.1) g/L vs (28.1 plus minus 1.3) g/L, P < 0.01]. The mRNA of TNFalpha, IL-1alpha, IL-6R and iNOS were increased on PBD1 and reduced on PBD3, 6, 9. The gene expression of TNFalpha, IL-1alpha in AEF group were significantly lower than EF group on PBD6, while IL-6R differed significantly between AEF group and EF group [(972 +/- 87) vs (2570 +/- 90), P < 0.01] on PBD9. There were no significant difference in iNOS mRNA production after burn in two group. CONCLUSION: Early enteral feeding could improve albumin biosynthesis and reduce the gene expression of TNFalpha, IL-1alpha, IL-6R and iNOS. L-arginine-supplemented early enteral feeding could further increase the gene expression of albumin possibly by reducing the expression of TNFalpha, IL-1alpha and IL-6R and did not increase the expression of iNOS.

Albumins↗
PubMed2000

Perioperative enteric nutritional supplementation in pediatric patients with neuromuscular scoliosis.

Perioperative nutritional status has been shown to be important in minimizing complications after extensive spinal procedures. Traditionally, total parenteral nutrition has been used to supplement oral nutrition intake. Little information exists regarding the risks and benefits of enteric supplementation in pediatric patients. To assess use and safety of enteric nutritional supplementation after extensive pediatric spine surgery, a retrospective review was done of 21 consecutive pediatric cerebral palsy patients receiving enteric nutritional supplementation via nasal or gastric feeding tubes after, and/or between stages of, anterior and posterior spinal fusions. Enteric supplementation was maintained for an average of 9.1 days, and the lowest albumin and total protein levels were seen the third postoperative day. Enteric nutritional supplementation was found to be a safe alternative to total parenteral nutrition in pediatric cerebral palsy patients after spinal stabilization procedures. In addition, enteric feedings may be less costly than central hyperalimentation and do not carry the inherent risk of central venous access.

Adolescent↗
PubMedDate not supplied

[Current trends of artificial enteral nutrition in acute pancreatitis].

During recent years, there has been considerable debate as to the nutritional supply that needs to be established for a patient with acute pancreatitis. The main problem is still infection of the pancreatic necrosis, which has a decisive bearing on the indication for surgery and is the main cause of mortality. Infection stems from bacterial translocation from the patient's gut. Enteral nutrition with its known potential for reducing this type of infection constitutes an attempt to prevent it by preserving the enteric mucosal barrier. Today, the concept of pancreatic rest is no longer considered mandatory in the guidelines of many Surgical and Nutritional Societies, whilst enteral nutrition is the gold standard for acute pancreatitis. Assuring an integrated parenteral and enteral supply before reaching the full regimen of enteral nutrition is the most reliable policy during the early days of the disease. Moreover, outcomes being equal, enteral nutrition is cheaper than parenteral nutrition, as has been extensively demonstrated in many clinical trials in severe acute pancreatitis.

Acute Disease↗
PubMed2004

[A patient with lessened sensitivity to acenocoumarol during a period of enteral feeding].

A 69-year-old man was operated on for a subdural haematoma which had developed during the use of acenocoumarol. Directly after the operation the patient was started on enteral feeding. The acenocoumarol was restarted at a later stage. The dose of acenocoumarol needed for an appropriate level of blood-dilution was twice as high during the period of enteral feeding than it had been preoperatively. After the transition from enteral feeding to oral feeding it was possible to lower the dose of acenocoumarol. The need for a higher dose was probably due to enhanced binding of the proteins in the enteral feeding. The patient was admitted to a nursing home. The combination of acenocoumarol and enteral feeding occurs frequently in patients being rehabilitated. It is important to monitor the blood-dilution when starting and stopping enteral feeding.

Acenocoumarol↗
PubMed2004

Influence of enteral nutrition on the frequency of complications in case of major burns.

UNLABELLED: The objective of the study was to assess if enteral nutrition reduces the rate of severe complications and complication-related mortality in case of major burns. MATERIAL AND METHODS: Two groups were included in the study. Group A was assessed prospectively and included 67 patients treated in Kaunas University of Medicine Hospital in 2000-2003. These patients received 30-40 kcal/kg/day in enteral way over the period of wound surgery. Group A was compared with Group B, which was assessed retrospectively and included 71 patients without enteral nutrition treated in 1997-1998. Groups were homogeneous by patients' age; extent of general and deep burn area; Baux and Burn indexes. RESULTS: 10 patients (15%) in Group A had pneumonia, 3 (30%) of them died; 11 (16%) had lung edema, 3 (27%) of them died; 24 (36%) had sepsis, 3 (12.5%) of them died; renal insufficiency was diagnosed to 4 patients (6%) in Group A, 2 (50%) of them died. In Group B (without enteral nutrition) pneumonia was diagnosed to 27 patients (38%) of 71, 18 (63%) of them died; lung edema--to 20 (28%), 18 (90%) of them died, 19 patients (27%) had sepsis, 12 (63%) of them died; renal insufficiency was diagnosed to 10 patients (14%), all of them (100%) died. CONCLUSIONS: Enteral nutrition statistically significantly diminished frequency of pneumonia and lung edema for burned patients. Pneumonia, lung edema, sepsis and renal insufficiency were less hazardous for life of patients with enteral nutrition (p<0.05).

Adolescent↗
PubMed2005

Early enteral and parenteral nutritional support in patients with cirrhotic portal hypertension after pericardial devascularization.

BACKGROUND: The abnormal metabolism caused by cirrhosis always results in a complex problem about nutritional support, which will be more intricate while patients with portal hypertension are treated with pericardial devascularization. Comparing the effects of early enteral and parenteral nutritional support in patients with cirrhotic portal hypertension after pericardial devascularization, we try to realize the advantages and disadvantages of the two nutritional therapies and to guide our clinical practice. METHODS: After pericardial devascularization, 40 patients with cirrhotic portal hypertension were divided randomly into 2 groups: enteral and parenteral nutritional support, respectively. The general nutritional condition, capability of producing protein, liver function, blood velocity of the portal vein, gut function, bowel bacterial translocation, mortality, complication rate, stay in ICU, duration of hospitalization and costs of treatment were determined in all the patients and compared between the 2 groups. RESULTS: Both enteral and parenteral nutritional supports could improve the general nutrition condition of the patients; but patients receiving enteral nutritional support had fewer complications. Enteral nutrition was more effective than parenteral nutrition in increasing the blood velocity of the portal vein, stimulating gut motion, preventing bowel bacterial translocation, shortening the stay in ICU and the duration of hospitalization, and saving costs of treatment. CONCLUSION: After pericardial devascularization, patients with cirrhotic portal hypertension should be treated with enteral nutritional support as early as possible.

Adult↗
PubMedDate not supplied

[Early enteral nutrition in the critically-ill patient].

Enteral nutrition has demonstrated to be a useful and safe method to nourish critically ill patients admitted to the Intensive Care Unit. Although the time a severely ill patient can stand without nutrition is unknown, accelerated catabolism and fasting may be deleterious in those patients, and the more common recommendation is to start on artificial nutrition when a fasting period longer than seven days is foreseen. At an experimental level, advantages of enteral nutrition over parenteral nutrition are evident since the use of nutritional substrates via the gastrointestinal tract improves the local and systemic immune response and maintains the barrier functions of the gut. Clinical studies have demonstrated that early enteral nutrition administered within the first 48 hours of admission decreases the incidence of nosocomial infections in these patients, but not the mortality, with the exception of special groups of patients, particularly surgical ones. The major inconvenience of enteral nutrition is its digestive intolerance and the transpyloric approach, necessary when there is gastroparesia. Its efficacy is also questioned when the patient has tissue ischemia. For early enteral nutrition to be effective, a treatment strategy must be implemented that includes from simple measures, such as uprising the bed headrest, to more sophisticated ones, such as the transpyloric approach or the use of nutrients with immunomodulatory capabilities. To date, the use of early enteral nutrition is the best method for nutritional support in this kind of patients provided that it is individualized according to each patient clinical status and that is done following an adequate therapeutic strategy.

Critical Illness↗
PubMed2005

Nutritional adequacy in patients receiving mechanical ventilation who are fed enterally.

BACKGROUND: Inadequate nutritional intake in critically ill patients can lead to complications resulting in increased mortality and healthcare costs. Several factors limit adequate nutritional intake in intensive care unit patients given enteral feedings. OBJECTIVE: To examine the adequacy of enteral nutritional intake and the factors that affect its delivery in patients receiving mechanical ventilation. METHODS: A prospective, descriptive design was used to study 60 patients receiving enteral feedings at target or goal rate. Energy requirements were determined for the entire sample by using the Harris-Benedict equation; energy requirements for a subset of 25 patients were also determined by using indirect calorimetry. Energy received via enteral feeding and reason and duration of interruptions in feedings were recorded for 3 consecutive days. RESULTS: Mean estimated energy requirements (8996 kJ, SD 1326 kJ) and mean energy intake received (5899 kJ, SD 3058 kJ) differed significantly (95% CI 3297-3787; P < .001). A total of 41 patients (68.3%) received less than 90% of their required energy intake, 18 (30.0%) received within +/-10%, and 1 (1.7%) received more than 110%. Episodes of diarrhea, emesis, large residual volumes, feeding tube replacements, and interruptions for procedures accounted for 70% of the variance in energy received (P<.001). Procedural interruptions alone accounted for 45% of the total variance. Estimated energy requirements determined via indirect calorimetry and mean energy received did not differ. CONCLUSIONS: Most critically ill patients receiving mechanical ventilation who are fed enterally do not receive their energy requirements, primarily because of frequent interruptions in enteral feedings.

Adult↗
PubMedDate not supplied

Systemic responses to different enteral feeding schedules in rats.

The purpose of this study was to describe selected temporal systemic responses to different enteral feeding schedules using an animal model, as one prerequisite for determining optimal delivery times for human enteral feedings. The effect of feeding schedules and time of day were examined relative to body weight and plasma glucose, insulin, glucagon, and corticosterone levels. Adult male Sprague-Dawley rats (N = 80) were used in a 4 x 4 randomized block design. Rats started the feeding schedules on Day 11 post-gastrostomy tube placement. The following feeding schedules, often used by humans, were tested: 24-hour enteral; 24-hour oral; 12-hour (rest time) enteral; and 12-hour (rest time) oral. Plasma was collected on Day 20. Despite very different feeding schedules, there were no statistical differences in weight gain, or plasma glucose and glucagon levels. Levels of insulin and corticosterone were significantly influenced by time of day and/or feeding group. Temporal pattern disruption was greatest in the rest-time fed enteral group. Both route and timing of enteral delivery modified metabolic hormone patterns.

Analysis of Variance↗
PubMed1986

[Enteral feeding at home].

Enteral nutrition was used for the purpose of providing an adequate alimentary support to patients who had been discharged from the hospital. Ten of them received the enteral diet in their own homes by means of a Dobbhoff tube. Six patients, however, had been receiving it during their hospitalization period, and four had started the treatment in their own houses, thus avoiding need for hospitalization. Enteral feeding was the only nutritional support used in the case of six patients. For the others, an oral diet was free to be used, even though the enteral diet provided all the required calories and proteins. All patients did very well and improvement of their nutritional condition was observed, without any intercurrence due to the enteral nutrition. Development of this procedure allows provision of adequate nutritional support to patients in their own homes, even in more complex situations. The low-cost enteral diet is easy to prepare and administer, thus enabling low-income patients to receive it in their own homes. Furthermore, it shortens the hospitalization period, and avoids the risk of discontinuing adequate nourishment of ill persons after their discharge from the hospital.

Adult↗
PubMed1988

Interference of oral phenytoin absorption by enteral tube feedings.

The medical records of 11 brain-injured patients, simultaneously on enteral tube feeding and phenytoin, were retrospectively reviewed for evidence of interference of phenytoin absorption. One case demonstrated no interference. Three cases suggested depression of serum phenytoin levels by enteral formula, but the contribution of other factors could not be ruled out. Seven cases did appear to reflect a direct alteration of phenytoin levels by enteral formula. To achieve adequate serum phenytoin levels, patients may need (1) large oral phenytoin doses above that recommended while on continuous enteral feedings, (2) administration of oral phenytoin between intermittent enteral feedings, or (3) a choice of alternative anticonvulsants which have been shown to be unaffected by enteral formula.

Absorption↗
PubMed1988

[Crohn's disease and enteral feeding: comparative nutritional efficacy of elemental and polymeric nutritive mixtures].

The nutritional development with three types of enteral diets during 28 days, was compared in 45 patients with malnutrition presenting an active Crohn's disease. Enteral feeding consisted of a polymeric mixture (Realmentyl) administered in addition to a normal oral diet in 11 patients; the same mixture was administered alone exclusively to 9 patients, and an elemental diet (Vivonex HN) administered exclusively to 25 patients. The total caloric intake reached, in the three groups, the mean values of 60.2, 36.9 and 33.8 kcal/kg of ideal weight/day, respectively. 33 patients also received steroids. At the end of 28 days of enteral diet, the improvement in the weight and the anthropometric measurements (muscle circumference, triceps skinfold) was significantly more marked (gain of 6.5 kg) with the supplemental polymeric mixture than with exclusive enteral diet, polymeric diet (+/- 2.0 kg) or basic (+1.2 kg). Transferrin and albumin plasma levels increased in all 3 groups, but much faster with the exclusive elemental feeding, in spite of a higher urinary urea excretion in these patients. The overall nutritional development was significantly better with supplemental polymeric feeding, and was identical in the two other groups. These results confirm that the supplemental polymeric enteral feeding is more effective, from the nutrition standpoint. With an exclusive enteral feeding, the nutritional result is appreciably the same, whether the mixture consists of polymers or basic elements.

Adult↗