In patients unable to tolerate oral intake, multiple options of nutrient delivery are available to the clinician. Administration of enteral nutrition (EN) has long been considered the standard of care for nutrition support among patients unable to meet energy and protein requirements orally. Healthcare practitioners must make careful decisions related to ordering, administering, and monitoring EN therapy. In the hospital setting, the registered dietitian is a key resource in enteral formula selection and method of administration, monitoring for and troubleshooting EN-related complications, and transitioning to oral feeding. The hospital setting also presents many unique challenges in providing optimal nutrition to the enterally fed patient.

p<0.001) for PUD. There was a decrease in rate of vagotomy (0.8% vs 0.4%; p<0.001), Bilroth I and II (1% vs 0.8%; p<0.001), and pyloroplasty (0.6% vs 0.4%; p<0.001). The rate of endoscopic intervention has increased (10.4% vs 11.5%; p<0.001).The rate of mortality has decreased (3.0% vs 2.8%; p<0.001). H.pylori infection declined from 5.3% in 2005 to 4.1% in 2012 (p <0.001). Demonstrates time trend of interventional therapy. CONCLUSIONS: Despite the increase in peptic ulcer complications and the incidence of emergency admissions there has been a significant decrease in the use of definitive surgical interventions and an increase in the use of therapeutic endoscopy. Considering future advances the role of anti-ulcer surgery will continue to decline. Training the next generation of surgeon may be impacted, novel training methods should be developed.

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