Nutrition Support And Crohn's Disease

If there is risk of developing malnutrition or progression of malnutrition, sometimes a more intensive and defined form of nutrition, called nutrition support, is required. There are two types of nutrition support, total enteral nutrition (tube feeding) and total parenteral nutrition (intravenous feeding).

 

 

By itself, total enteral nutrition (TEN) can reduce the amount of inflammation in the intestine and thereby avoid the need for medications, such as steroids, that may have numerous undesirable side effects. It also has the added benefit of enhancing growth.

 

A relatively soft small tube is passed through the nose and through the esophagus, ending up in the stomach or upper part of the small intestine. Tube feeding can be delivered by using gravity drip or a pump to deliver a precise volume per hour. Tube feeding does not preclude taking other fluids by mouth, so you can continue to drink even while you have the tube inserted.

 

Children often learn how to place this tube themselves. They insert the tube every evening before going to bed, administer the feeds overnight while they sleep, and take the tube out in the morning before going about their usual activities during the day.

The procedure should to be supervised by your health-care team to ensure that possible side effects of tube feeding (bloating, cramping, diarrhea) are monitored and properly addressed. There is also a cost associated with tube feeding, which is not always covered by governments or third parties, such as insurance companies.

 

 

Total parenteral nutrition (TPN) is a specialized form of nutrition delivered via an intravenous line. A PICC line (peripherally inserted central catheter) is an example of a type of line that is commonly placed in order to deliver the concentrated nutrients to a large blood vessel, which rapidly dilutes the solution. In this kind of nutrition support, the gut can rest because no absorption is required while nutrients are delivered directly into the bloodstream.

 

TPN may be required before surgery if you are very ill and cannot consume enough nutrition by mouth or by tube feeding. Sometimes after surgery the bowel is slow to work; TPN can be provided until this resolves and you are eating well again. With multiple surgeries for Crohn's disease, some individuals don't have enough intestines left to absorb adequate nutrients and maintain stable weight, fluid balance, and electrolyte balance. These people may need TPN permanently, in which case there are home TPN programs available in many communities to prescribe and monitor the administration of TPN.

 

This may seem like a perfect solution to avoid the discomfort of gastrointestinal intolerance symptoms from eating. Beside the high cost, there are, however, risks that need to be taken into account before making a decision to use TPN. These include a higher risk of infection, blood clots (deep vein thrombosis), and metabolic intolerance. Because this is an artificial way to provide nutrition, your body often has difficulty processing the nutrients, and you could develop problems with your liver or gallbladder or abnormalities of cholesterol, triglycerides, and sugar levels in the blood as a result. Some people do not feel hungry while on TPN because the intravenous solution is giving them enough calories, but they sometimes do psychologically miss eating food and want to eat.

 

A specialized nutrition support team can help to avoid these complications while monitoring and adjusting the TPN to account for blood values that are unstable or abnormal.