Reduction in Healthcare Utilization With Transition to Peptide‐Based Diets in Intolerant Home Enteral Nutrition Patients

Abstract

Background: Since the introduction of percutaneous endoscopic gastrostomy in the 1980s, the prevalence of home enteral nutrition (HEN) support has increased significantly. Despite these increases, many patients are unable to tolerate standard polymeric formulas (SPFs), resulting in significant healthcare resource utilization. Peptide-based diets (PBDs) have emerged as a viable option in SPF-intolerant patients; however, data in the HEN population are lacking. Methods: Retrospective review of our prospectively maintained HEN database was conducted to assess tolerance, efficacy, and impact on healthcare utilization in patients on PBDs. Results: From January 1, 2016, to May 1, 2018, 95 patients were placed on PBDs, with 53 patients being started directly and 42 patients being transitioned from SPFs. In patients transitioned to PBDs, symptoms of nausea and vomiting, diarrhea, abdominal pain, and distention improved significantly. Healthcare utilization also declined significantly, including mean number of phone calls

Real‐World Evidence of Treatment, Tolerance, Healthcare Utilization, and Costs Among Postacute Care Adult Patients Receiving Enteral Peptide‐Based Diets in the United States

“…w-PB ETF formulas have previously been shown to be more effica- cious and better tolerated than whole-protein formulas in patients with acute and chronic medical conditions in both the acute and postacute care settings. [22][23][24][25][26]28,29 The data indicate that utilization of w-PB ETF leads to a statistically significant improvement in GI tolerance compared with standard ETF in clinical practice in patients in the postacute care setting. More than half of the adult patients in the study experienced no intolerance events after w-PB diets were used.…”

“…[22][23][24] PB ETF formulas have also been shown to be more efficacious and better tolerated by patients in the postacute setting compared with standard whole-protein formulas. 29 Despite the need for well-tolerated ETF formulas for use in the postacute setting, limited data are available in relation to the use of PB diets for HEN. 19 The objective of this study was to describe the demographic, clinical, and treatment characteristics of 100% wheyprotein peptide-based (w-PB) ETF in adults in a postacute care setting and assess the real-world tolerance and frequency of GI tolerancerelated adverse events, before and after initiation of PB ETF.…”

Gastrointestinal Tolerance and Protein Absorption Markers with a New Peptide Enteral Formula Compared to a Standard Intact Protein Enteral Formula in Critically Ill Patients

“…This suggests that the new peptide feed is suitable to initiate tube feeding in critically ill patients upon ICU entry, but does not seem to offer benefits compared tube feeding initiation with a standard tube feed on tolerance or protein absorption. Potential advantages in patients with proven malabsorption or persistent intolerance to standard feeds remains to be investigated [ 36 ]. For example, a well-designed and adequately powered trial to investigate the effect of PF on diarrhea in patients who do not tolerate standard tube feeds would be of interest.…”

Complex Enterally Tube-Fed Community Patients Display Stable Tolerance, Improved Compliance and Better Achieve Energy and Protein Targets with a High-Energy, High-Protein Peptide-Based Enteral Tube Feed: Results from a Multi-Centre Pilot Study

“…Furthermore, patients with a short bowel had enhanced nitrogen absorption when a peptide-based formula was used compared with a polymeric whole protein formula [17,26]. In addition, as fat malabsorption is a frequent problem in patients with impaired gastrointestinal function, the use of MCTs in peptide-based enteral tube feeds has been shown to decrease steatorrhea, decrease dyspepsia and improve nutritional status [27,28]. Therefore, peptide-based, MCT-containing enteral feeds offer nutritional, functional and clinical benefits among various patient groups; however, much of the existing evidence is in adults in critical care or other acute hospital settings.…”

“…Therefore, peptide-based, MCT-containing enteral feeds offer nutritional, functional and clinical benefits among various patient groups; however, much of the existing evidence is in adults in critical care or other acute hospital settings. Evidence in patients receiving peptide-based HEN in the community is sparse in adult patients [28], and there are only a few studies in infant and paediatric populations [29,30], so more work is necessary.…”