Nutritional considerations in severe primary chronic small intestinal dysmotility. Issue 5 (September 2021)

• Record Type: Journal Article
• Authors: Conley, Thomas Edward; Lal, Simon
• Is Part Of: Current opinion in clinical nutrition and metabolic care. Volume 24:Issue 5(2021)
• Publication Date: 2021-09
• Subjects: chronic intestinal pseudo-obstruction -- nutrition -- parenteral nutrition -- quality of life; Diet therapy -- Periodicals; Metabolism -- Periodicals; Nutrition -- Periodicals; Nutrition disorders -- Periodicals; Clinical medicine -- Periodicals; Clinical Medicine -- Periodicals; Metabolism -- Periodicals; Nutrition -- Periodicals; Nutrition Disorders -- Periodicals; Nutritional Support -- Periodicals; 613.2
• DOI: 10.1097/MCO.0000000000000775
• Languages: English
• ISSNs: 1363-1950

Abstract

Abstract : Purpose of review: To provide an update on the recent evidence underpinning the approach to nutritional care in patients with severe primary chronic small bowel dysmotility. Recent findings: Patients with severe chronic small intestinal dysmotility suffer nutritional and nonnutritional morbidity, both as a result of their underlying polysymptomatic, poorly understood condition and the interventions required. A proportion require artificial nutrition support; however, this is associated with impaired quality of life and associated complications. The approach to nutritional support must therefore engage a multidisciplinary team (MDT) to ensure that decisions to escalate beyond oral nutrition reflect individualised risk-benefit discussions while adopting a holistic approach to symptom management. Since nutritional outcomes are worse in those with the chronic intestinal pseudo-obstruction (CIPO) phenotype, differentiation into CIPO and non-CIPO subgroups, using a pragmatic diagnostic approach rather than invasive/poorly tolerated investigations, can be an important step in achieving nutritional care tailored to the individual. Summary: Malnutrition in patients with severe chronic small intestinal dysmotility is multifactorial. Early engagement of a broad team that includes dietitians, psychologists and pain management experts is crucial to achieving the most beneficial and least harmful patient-centred nutritional care outcomes.