Early enteral nutrition: overcoming the fear of feeding

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This article is sponsored content brought to you by DLC Australia.

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The practice of fasting patients with gastrointestinal disease is still commonplace in many veterinary hospitals and clinics.

Furthermore, the use of supplements—including probiotics, prebiotics and adsorbents—is heavily used despite limited or no evidence of efficacy.

However, evidence supports that the gastrointestinal tract is highly dependent on readily available luminal energy to re-establish gastrointestinal function.

Withholding food increases the risks of breakdown of vital enterocyte tight junctions, and the potential translocation of bacterial or inflammatory mediators from the gut lumen.

Atrophy of the high-energy-consuming enterocytes commences within hours of having no direct luminal nutrient supply.

The guidelines for successful management of acute gastrointestinal disease in dogs and cats are:

1. Nutritional support should be initiated as early as possible.

2. Enteral alimentation should be chosen whenever possible.

3. The condition of the patients must be considered when choosing diet.

Feed Don’t Fast: the evidence

Veterinary studies support the proactive feeding of patients with gastrointestinal disease. Significantly lower mortality rates were observed in parvovirus puppies fed early and enterally, compared to those on a ‘wait until they stop vomiting’ regime (Mohr et al, 2003). Patients receiving only parenteral (intravenous) nutrition did not fare as well as those also fed enterally in another study (Chan et al, 2002).

The benefits of early enteral feeding are clear: reduced severity of disease, decreased complications, shorter hospital stays and better patient outcomes (McClave et al, 2009). Veterinary nutritional and critical care experts now advocate this approach.

What to feed and when?

Early feeding in acute gastrointestinal disease should preferably be readily consumed AND not place additional stress on the damaged intestinal mucosa. Oral rehydration therapy that combines microenteral nutrition and peroral rehydration support is in these cases the optimal choice. Oralade is the only product that supplies enterocyte specific nutrients, including key amino acids (glutamate and glutamine) as well as sodium and glucose for the GI-tract without stressing the already damaged mucosa. The high palatability of Oralade also stimulates oral food consumption in anorectic patients. Oralade is therefore the ideal bridge for use in gastroenteritis and pancreatitis before the introduction of commercial easily-digestible diets.

Oralade is supporting the Feed Don’t Fast campaign to help drive awareness of the need to feed patients proactively and early. Further information and a free CPD webinar on early enteral nutrition and gastrointestinal disease by Dr Ava Firth is available at www.feeddontfast.co.uk

Web: www.dlc.com.au

Phone: 03 9360 9700

Toll Free: 1300 785 405

References
Mohr AJ et al. (2003) Effect of early enteral nutrition on intestinal permeability, intestinal protein loss, and outcome in dogs with severe parvoviral enteritis. J Vet Intern Med 17(6): 791-8
Chan DL et al. (2002) Retrospective evaluation of partial parenteral nutrition in dogs and cats. J Vet Intern Med 16(4): 440-5
McClave SA et al. (2009) Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Journal of Parenteral and Enteral Nutrition 33(3): 277-316 

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