Nutrition Management in Patients With Chronic Gastrointestinal Motility Disorders: A Systematic Literature Review

Abstract

Background The aim of this study was to systematically review effects of nutrition interventions on outcomes in patients with chronic gastrointestinal (GI) motility disorders. There is currently a lack of evidence‐based guidelines for nutrition management in this group, likely a result of the rarity of the conditions. Methods A systematic review of all study types to evaluate current evidence‐based nutrition interventions was performed using Medline, Embase, and CINAHL databases. Two independent reviewers participated in the process of this systematic review. A total of 15 studies and a total of 524 subjects were included. Results Best treatment of this population group was found to include a stepwise process, progressing from oral nutrition to jejunal nutrition and lastly to parenteral nutrition. Small particle, low‐fat diets were significantly better tolerated than the converse, with jejunal nutrition prior to consuming oral food significantly improving oral intake and motility. In more progressive cases, percutaneous endoscopic gastrostomy with jejunal extension nutrition had lower reported symptoms than other enteral routes. Exclusive long‐term parenteral nutrition is a feasible option for advanced cases, with a 68% survival rate at 15 years duration, though oral intake with parenteral nutrition is associated with higher survival rates. Conclusion Treatment of patients with GI motility disorders should first trial oral nutrition. For patients who progress to jejunal or parenteral feeds, the primary aim should be to maintain or reinstate oral intake to reduce morbidity and mortality risk. Higher‐quality studies are still required in this area, particularly in the areas of chronic intestinal pseudo‐obstruction and systemic sclerosis.

ACG Clinical Guideline: Gastroparesis

“…After the pioneering randomized, controlled trial by Olausson et al (55) demonstrated efficacy of small particle diet compared with normal diet for relief of symptoms, improving GE and enhancing glycemic control (56) in patients with diabetes, a systematic review (57) of all study types evaluated current evidence-based nutrition interventions involving a total of 15 studies and of 524 subjects, using a stepwise process, progressing from oral nutrition to jejunal nutrition and lastly to parenteral nutrition. Small particle, low-fat diets were significantly better tolerated than the converse, with jejunal nutrition before consuming oral food significantly improving oral intake and motility.…”

Patients With Severe Gastrointestinal Dysmotility Disorders Receiving Home Parenteral Nutrition Have Similar Survival As Those With Short‐Bowel Syndrome: A Prospective Cohort Study

“…Information regarding radiology, manometry, and pathology for diagnosing GID and its variant is not part of the registry. However, the participating programs are academic centers, where it is expected that diagnoses and management of GID follow recommended pathways and guidelines 6,7,15 . We did not look into intravenous fluid supplement types or volume, which may have a prognostic factor in patients with chronic intestinal failure 25 .…”

“…It encompasses enteric dysmotility, chronic intestinal pseudo‐obstruction (CIPO), GI neuromuscular disease, and other secondary causes such as diabetes, scleroderma, and autonomic failure 6 . Infrequently, the affected patients with severe GID are unable to tolerate oral or enteral nutrition, and thus, the use of HPN for life is inevitable 7 . Complications and survival of GID patients may be different depending on the underlying disease.…”

Peptide‐based formula: Clinical applications and benefits

“…These included use of EN for GI and non‐GI disorders as well as in a range of clinical scenarios, including patients with malignancy, especially head and neck cancer, 20,21 as well as neurodegenerative, 22 hepatic‐biliary/pancreatic, 23,24 or renal 25 disorders. EN can also be beneficial in challenging cases such as intestinal failure involving severe GI dysmotility 26 or in special groups, such as in patients who underwent bariatric surgery 27 . Unfortunately, despite these benefits, long‐term EN can be a challenging and overwhelming experience for patients and caregivers alike 28 .…”