Shelby Victory, RD
Monday, December 18, 2017
At ACUTE we have the ability to use enteral nutrition, also known as tube feeding, to help our patients meet their nutrition goals. Let’s start by explaining what tube feeding is and how it is utilized. We use several different types of complete formulas that include carbohydrates, proteins, and fats as well as vitamins and minerals. These formulas are administered from a pump or a syringe into a feeding tube that is placed usually into the nose and ending in the stomach or small intestine. These formulas can be administered continuously (running throughout the entire day), cyclic (running for a portion of the day), or via bolus (a single, larger amount over a short period of time) depending on the patients preferences or tolerance. Outlined below are some common diagnoses that patients with severe eating disorders may experience where the assistance of a feeding tube may be helpful.
Some patients we treat at ACUTE are diagnosed with the eating disorder ARFID which stands for avoidant restrictive food intake disorder. These patients may truly be driven to gain weight or be accepting of nutrition, but tend to be underweight due to past experiences that have caused trauma therefore making it more difficult to achieving their nutrition goals. Patients with ARFID may have a fear of choking, experience abdominal pain during or after eating, or have issues with textures, smells, and appearance of foods. A tube feeding can help alleviate some of the pressure of completing meals, while still allowing the patient to be successful with their meal plan. This allows a more flexible schedule for the patient to obtain nutrition orally at a more comfortable rate, without affecting their overall nutrition for the day.
At ACUTE some of our patients experience SMA syndrome. SMA syndrome is caused by to the loss of the mesenteric fat pad, resulting in the duodenum to be compressed between two arteries (the aorta and superior mesenteric artery.) This blockage of the duodenum can be complete or partial. Patients who develop SMA syndrome usually experience abdominal pain, fullness, nausea, and/or vomiting after meals. Patients who are diagnosed with SMA typically require a soft/liquid diet making their options very limited or repetitive. Depending on the degree of severity of the blockage, a feeding tube may be the most appropriate way for the patient to obtain adequate nutrition, while minimizing discomfort until this fat pad is able to restore. The restoration of the fat pad is directly correlated with the rate of total weight restoration. A tube feed or modified/liquid diet is usually only needed for a short duration until the patient is able to tolerate a more regular consistency diet. The Registered Dietitian will work with the patient to find a meal plan that works for them, keeping in mind this can be a combination of tube feeding and/or a liquid/softer diet.
Gastroparesis is a very common amongst patients with severe eating disorders. Gastroparesis is the delayed emptying of the stomach, causing the patient to feel extremely full for a prolonged period of time. Patients at ACUTE typically require a high level of calories to start weight restoring and will require frequent calorie increases to meet their body’s demand. This can be very challenging, especially for someone diagnosed with gastroparesis. A feeding tube can help break up the volume of meals by redistributing the calories throughout the day. The Registered Dietitian can modify the patient’s meal plan to consume smaller meals/snacks during the day, and receive the remaining calories via the feeding tube at night. These tubes can be placed past the stomach to reduce the feeling of fullness as well. The best way to treat gastroparesis is with weight restoration; therefore a feeding tube can be a good tool to consider using to assist in this process.
It is also not uncommon for patients with severe eating disorders to experience difficulty swallowing also known as dysphagia. When patients restrict their intake for a prolonged period of time the muscles utilized to swallow are weakened. This can cause choking with foods or beverages during consumption. In addition to restricting, patients who experience reflux from self-induced vomiting can also cause dysphagia, or make the current dysphagia worse. At ACUTE we have the ability to consult a speech language pathologist to help work and strengthen the muscles responsible for the swallowing process. With Dysphagia, some foods and beverages can be deemed medically unsafe due to the risk of aspiration. Due to this, variety and selection may be limited, which can make meeting your calorie goals more challenging. We may also encourage a feeding tube in this case to help meet nutrition goals, while working with speech therapy to advance the patient’s oral diet.
I hope this article has helped with the understanding of enteral nutrition and the many reasons it can be helpful in the treatment of severe eating disorders. To reiterate the scenarios above, a feeding tube can help provide nutrition in a safe and effective manner. At ACUTE, our first priority is nutrition. The Registered Dietitians at ACUTE will work individually with each patient to determine the best way to achieve their nutrition goals. Another thing to keep in mind is that these feeding tubes can come out just as easily as they can be placed; it is by no means a permanent solution. This promotes flexibility and empowers the patient to make appropriate choices regarding nutrition that may feel more comfortable without jeopardizing their recovery.