Late dumping syndrome in an infant on feeding jejunostomy

Jain, Agam; Gupta, Aditya; Jat, Kana Ram; Kabra, S. K.

doi:10.1136/bcr-2018-228471

Cited by 6 publications

(4 citation statements)

References 9 publications

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“…The use of feeds based on hydrolyzed protein or amino acids, those with added modular supplements or concentrating feeds, increases the osmolality, creating an osmotic gradient, which draws water into the gastrointestinal tract lumen and may cause symptoms of nausea, cramping, vomiting, or diarrhea. Bolus feeds into the jejunum can be associated with dumping syndrome causing hypoglycemia 46 . Children receiving JT feeding should be fed continuously given the limited reservoir of the jejunum compared with the stomach and monitored for signs of intolerance; particularly if hydrolyzed, modular or concentrated feeds are used or in the context of intestinal dysmotility.…”

Section: Recommendations and Discussionmentioning

confidence: 99%

A clinical consensus paper on jejunal tube feeding in children

McGrath,

Collins,

Comerford

et al. 2024

J Parenter Enteral Nutr

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BackgroundFeeding problems are common in children with complex medical problems or acute critical illness and enteral nutrition may be required. In certain situations, gastric tube feeding is poorly tolerated or may not be feasible. When feed intolerance persists despite appropriate adjustments to oral and gastric enteral regimens, jejunal tube feeding can be considered as an option for nutrition support.MethodsA multidisciplinary expert working group of the Australasian Society of Parenteral and Enteral Nutrition was convened. They identified topic questions and five key areas of jejunal tube feeding in children. Literatures searches were undertaken on Pubmed, Embase, and Medline for all relevant studies, between January 2000 and September 2022 (n = 103). Studies were assessed using National Health and Medical Research Council guidelines to generate statements, which were discussed as a group, followed by voting on statements using a modified Delphi process to determine consensus.ResultsA total of 24 consensus statements were created for five key areas: patient selection, type and selection of feeding tube, complications, clinical use of jejunal tubes, follow‐up, and reassessment.ConclusionJejunal tube feeding is a safe and effective means of providing nutrition in a select group of pediatric patients with complex medical needs, who are unable to be fed by gastric tube feeding. Appropriate patient selection is important as complications associated with jejunal tube feeding are not uncommon, and although mostly minor, can be significant or require tube reinsertion. All children receiving jejunal tube feeding should have multidisciplinary team assessment and follow‐up.

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Section: Recommendations and Discussionmentioning

confidence: 99%

A clinical consensus paper on jejunal tube feeding in children

McGrath,

Collins,

Comerford

et al. 2024

J Parenter Enteral Nutr

View full text Add to dashboard Cite

show abstract

“…Direct administration of food into the jejunum causes rapid absorption of glucose, leading to prominent hyperglycemia, hyperinsulinemia, and reactive hypoglycemia. 27 Glycemic control is more difficult in patients with diabetes than in those without diabetes after DPEJ. A recent study revealed that extended glycemic fluctuation is a risk factor for macrovascular and microvascular events and mortality.…”

Section: Discussionmentioning

confidence: 99%

Prognostic outcomes after direct percutaneous endoscopic jejunostomy in elderly patients: comparison with percutaneous endoscopic gastrostomy

Nishiwaki¹,

Kurobe²,

Baba³

et al. 2021

Gastrointestinal Endoscopy

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Background and Aims: Direct percutaneous endoscopic jejunostomy (DPEJ) is an alternative method of enteral feeding to percutaneous endoscopic gastrostomy (PEG). Although long-term outcomes of PEG have been reported, little is known regarding the outcomes of DPEJ.Methods: A retrospective cohort study was conducted including 115 and 651 consecutive attempts of DPEJ and PEG, respectively, in a total of 766 elderly patients between April 2004 and March 2019. Patients' clinical background, procedural and long-term outcomes, survival analysis, and cause of death were analyzed.Results: Successful placement rates were 93.9% and 97.1% for DPEJ and PEG, respectively. There was no significant difference in procedure-related adverse events (AEs) between the DPEJ and PEG groups. Rates of pneumonia, vomiting, and upper GI bleeding were significantly lower, whereas those of fistula enlargement and ileus were significantly higher in the DPEJ group as long-term AEs. The median survival periods were 694 and 734 days for DPEJ and PEG, respectively, with no significant differences between the 2 groups. Multivariate analysis revealed that age 80 years old or older, C-reactive protein level of 1.0 mg/dL or higher, and the presence of diabetes were independent risk factors for mortality after DPEJ. Respiratory tract infection was the primary cause of death in both groups.Conclusions: DPEJ is considered a safe and feasible method of access for enteral feeding as well as PEG. Although the survival period after DPEJ may be expected to be as long as that with PEG, DPEJ-specific AEs should be kept in mind on long-term feeding.

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“…Reactive hypoglycemia followed by postprandial hyperglycemia and hyperinsulinemia, known as late dumping syndrome, is the major symptom following rapid inflow into the jejunum. In patients who undergo jejunostomy, rapid or bolus feeding causes hyperinsulinemia, and induced reactive hypoglycemia may result in late dumping syndrome ( 21 ). Hyperplasia of islet β-cells in gastric-bypass surgery is considered to induce hyperinsulinemia and consequent hypoglycemia ( 22 ).…”

Section: Discussionmentioning

confidence: 99%

Use of a Low-carbohydrate Enteral Nutrition Formula with Effective Inhibition of Hypoglycemia and Post-infusion Hyperglycemia in Non-diabetic Patients Fed via a Jejunostomy Tube

Nishiwaki¹,

Fujimoto

Kurobe³

et al. 2020

Intern. Med.

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Objective As direct jejunal feeding often causes great fluctuation in glucose levels, continuous or slow infusion is recommended for jejunal tube-fed patients. However, continuous feeding results in prolonged immobility and the loss of activities of daily living. We investigated whether or not intermittent feeding of a low-carbohydrate high-monounsaturated fatty acid (LC/HM) nutrient formula reduces glucose fluctuation in patients who have undergone jejunotomy. Methods Ten bed-ridden non-diabetic patients receiving enteral feeding via a jejunostomy tube were enrolled in this study. LC/HM formula and standard control formula were infused in cross-over order for each patient at a speed of 160 kcal/h. Blood glucose levels were monitored by a continuous glucose monitoring system during the investigation period. Results The mean and standard deviation of the glucose concentrations and mean amplitude of glucose excursion (MAGE) were markedly lower while receiving LC/HM formula than while receiving control standard formula (104 vs. 136 mg/dL, 18.1 vs. 58.1 mg/dL, 50.8 vs. 160 mg/dL, respectively). The post-infusion hyperglycemia [area under the curve (AUC) ＞140 mg/dL] and peak value of the glucose level were also significantly lower in patients fed LC/HM than the control (25.7 vs. 880 mg・h/dL and 153 vs. 272 mg/dL, respectively). Reactive hypoglycemia (AUC ＜70 mg/dL) was also significantly lower (0.63 vs. 16.7 mg・h/dL) and the minimum value of the glucose level higher (78.4 vs. 61.8 mg/dL) in patients fed LC/HM than the control. Conclusion The LC/HM formula is considered to markedly inhibit glycemic spikes and prevent rebound hypoglycemia in patients who receive enteral feeding after jejunostomy.

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Late dumping syndrome in an infant on feeding jejunostomy

Cited by 6 publications

References 9 publications

A clinical consensus paper on jejunal tube feeding in children

A clinical consensus paper on jejunal tube feeding in children

Prognostic outcomes after direct percutaneous endoscopic jejunostomy in elderly patients: comparison with percutaneous endoscopic gastrostomy

Use of a Low-carbohydrate Enteral Nutrition Formula with Effective Inhibition of Hypoglycemia and Post-infusion Hyperglycemia in Non-diabetic Patients Fed via a Jejunostomy Tube

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