Intragastric prepyloric enteral nutrition, bolus vs continuous in the adult patient: A systematic review and meta‐analysis

Abstract

Bolus and continuous nutrition are commonly used enteral nutrition (EN) administration methodologies. Currently, there is insufficient evidence to establish which is the most effective method for reducing gastrointestinal complications in adult patients. The aim of this review is to evaluate the impact of bolus/intermittent EN compared with continuous EN for the following outcomes: diarrhea, constipation, emesis/vomiting, gastric residual volume, aspiration, and glycemic control in adult patients receiving intragastric prepyloric EN in the hospital setting. Bibliographical research was performed on the following databases: PubMed, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials. The review included all randomized and nonrandomized controlled trials of patients aged ≥18 years with preserved gastrointestinal function. Meta-analysis was performed by Review Manager V.5.3. Seven studies including 551 patients were included in the meta-analysis. Five of these studies reported that the diarrhea rate was higher in the bolus feeding group (risk ratio[RR] = 2.50; 95% CI, 1.17-5.34; P = 0.02), and another five of these studies indicated that the aspiration rate was higher in the continuous feeding group (RR = 0.55; 95% CI, 0.35-0.87; P = 0.01). There were no significant differences for the other outcomes. In conclusion, intermittent EN appears to reduce the incidence of aspiration in the hospital setting; however, it may increase the risk of diarrhea.For future research, we hypothesize the joint use of continuous nutrition until the patient reaches tolerance and then passing to bolus nutrition, thus reducing the incidence of aspiration and enabling a physiological nutrition intake.

Analysis of characteristics of movement disorders in patients with anti-N-methyl-D-aspartate receptor encephalitis

“…In addition, we also observed that patients in the MDs group were prone to gastrointestinal dysfunction, possibly because they are prone to concomitant autonomic dysfunction, or perhaps because they may be treated with enteral nutrition in the presence of a reduced level of consciousness, OFLD, and other conditions that lead to restriction of autonomous eating, which increased the incidence of patients with diarrhea, constipation and other gastrointestinal dysfunction (28). Although other complications did not show significant differences in this study, overall, the incidence of each complication was slightly higher in the MDs group than in the non-MDs group.…”

The need for biomarkers to determine response to enteral nutrition during and after critical illness: an update

“…(1) absence of the cephalic and oral phase of digestion (2) usually applied as continuous administration of liquid feeds (a) absence of the normal circadian rhythm (b) absence of the difference between fasted and fed pattern of GI motility: the fasting pattern may persist in the fed state [11] (c) distinct gastric motility pattern with storage, mixing and churning not needed for liquid feeds (d) altered neurohumoral feedback and pancreatic response with the more continuous, low rate flow of nutrients arriving in the small bowel [8] (e) altered incretin effect [12] The use of a continuous or intermittent feeding strategy has been a matter of debate, several systematic reviews failing to identify relevant differences in studied outcomes [13][14][15]. However, recent findings suggest the importance of autophagy in critical illness, raising the hypothesis that mimicking starvation periods with intermittent feeding could be beneficial to avoid excessive suppression of autophagy [16].…”

“…The use of a continuous or intermittent feeding strategy has been a matter of debate, several systematic reviews failing to identify relevant differences in studied outcomes [13–15]. However, recent findings suggest the importance of autophagy in critical illness, raising the hypothesis that mimicking starvation periods with intermittent feeding could be beneficial to avoid excessive suppression of autophagy [16].…”