References
Equal efficacy of gastric and jejunal tube feeding in liver cirrhosis and/or alcoholic hepatitis: a randomised controlled study
Abstract
Background and aim: Malnutrition and muscle mass loss are complications in liver cirrhosis and alcoholic hepatitis (AH). Hospitalised patients who do not meet nutritional requirements are recommended to be fed enterally or parenterally, but no guidelines recommend a specific type of tube. This study aimed to compare the efficacy of jejunal versus gastric feeding. Method: 40 inpatients with liver cirrhosis and/or AH, a nutritional risk score more than 2 and a reduced daily energy intake were included. Half were randomised to nasogastric (NG) and half to nasojejunal (NJ) tube feeding. All received Peptamen AF as a supplement to oral intake. Participants were followed up until discharge or death. Findings: The study evaluated the data for 33 patients for 7 days after tube insertion. Mean daily energy intake for 7 days was 6509 kJ (NG) vs 6605kJ (NJ) (
Malnutrition and muscle mass loss (sarcopenia) are frequent complications of liver cirrhosis and alcoholic hepatitis (AH) and have been reported in more than 50% of patients with decompensated liver cirrhosis and patients with AH (Palmer et al, 2019; Sehrawat et al, 2020). Furthermore, malnutrition and sarcopenia are associated with higher rates of complications, such as hepatic encephalopathy, spontaneous bacterial peritonitis and increased mortality (Gunsar et al, 2006; Huisman et al, 2011; Montano-Loza et al, 2012).
Patients with severe liver disease (Child-Pugh class C) (Table 1) are regarded to be at high risk of malnutrition (Merli et al, 2019). Recommended daily energy intake for a patient with liver cirrhosis is at least 35 kcal/kg, with daily protein intake no less than 1.2-1.5 g/kg (Plauth et al, 2006; Plauth et al, 2009; Merli et al, 2019). Inpatients with severe liver disease who are unable to achieve the recommended intake with oral nutrition and oral supplements could be candidates for enteral or parenteral nutrition. Single studies have shown the benefit of enteral nutrition for survival, but no systematic reviews or meta analyses have shown that enteral nutrition has an effect on mortality (Antar et al, 2012; Koretz et al, 2012). Patients with cirrhosis have a higher risk of gastroparesis (Verne et al, 2004). Furthermore, patients with liver disease are also characterised by having anorexia, early satiety and nausea (Cheung et al, 2012; Wang et al, 2018).
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