Clinical nutrition in gastroenterology

Abstract

Due to the undesirable effects of malnutrition on the course of a disease, clinical nutrition has become an important issue in gastroenterology and general internal medicine. Where possible, nutritional support should be started before malnutrition has developed, especially in high-risk patients. Both enteral and parenteral nutrition can meet nutritional requirements of the majority of patients. Nowadays, it is generally believed that enteral nutrition should be the therapy of choice, while parenteral nutrition should be reserved for patients where the adequate intake of nutritive ingredients cannot be achieved by the enteral route or where enteral nutrition is contraindicated. The main advantages of enteral nutrition over parenteral nutrition include physiologic superiority, adequate maintenance of both intestinal structure and function, protection against sepsis and multiple organ failure, gastric acid buffering effect, lower complication rate and lower costs. However, we use enteral and parenteral nutrition simultaneously in many clinical conditions in gastroenterology (IBD, acute pancreatitis, short-bowel syndrome, hepatic failure). Minimal enteral nutrition is a well-known term, and most gastroenterologists are familiar with it. An adequate nutritional support team is the cornerstone of any activity regarding nutritional support in internal medicine.