The role of the gastroenterologist in the provision of artificial nutrition support

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Abstract

Background:

Nutrition support is required for the prevention or treatment of malnutrition in patients with intestinal failure and those who are unable to eat.

Aims:

To determine the demands upon gastroenterologists for nutrition support, the available resources, and compliance with the British Society of Gastroenterology (BSG) guidelines.

Method:

A questionnaire was circulated to all 483 consultant physician members of the BSG.

Results:

There were 336 (70%) replies. Fifty-three per cent of respondents reported malnutrition in 20% or more of their patients. Seventy-nine per cent of consultants supervised patients on enteral feeding, and 64% supervised parenteral feeding. Feeding jejunostomy was used by 61% of Teaching Hospital (TH) consultants but only 38% of District General Hospital (DGH) consultants (P < 0.001). Twenty-seven per cent of respondents headed, or were members of, a nutrition support team (NST). Forty-five and 38% of respondents did not follow written protocols for peripheral and central parenteral nutrition, respectively. Fifty-five per cent monitored catheter complications, of whom 44% reported catheter infections in 5% or more of their patients. Weights of inpatients were obtained by 76% of DGH consultants and 91% of TH consultants (P < 0.001). Fifty-eight per cent of respondents did not arrange for nutritional screening. Ninety-six per cent of consultants could access a dietitian, 55% had access to an NST and 36% had a nutrition nurse specialist (NNS). An NNS was available to 57% of TH consultants but only 23% of DGH consultants (P < 0.001).

Conclusions:

Gastroenterologists have a major role in nutrition support. Facilities are suboptimal. Observing guidelines may improve nutritional care. These findings have implications for resources and training.

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