Malnutrition and cystic fibrosis

Question

I am a 45 year-old adult with cystic fibrosis since birth. My weight has always fluctuated between 39 and 42 kg since my teens. Since 1993 I am diabetic and treated with insulin; I have been losing weight for 2 years. With bags of Clinomel® [parenteral feeding soultion] for 1 year, I have gained weight (39 kgs) but I have been offered gastrostomy, which should be more efficient, because I lose weight again. What is gastrostomy?
Thank you in advance for your time.

Answer

Hello,
Enteral nutrition is a liquid diet delivered directly into the stomach, either by a nasogastric tube or by gastrostomy.
Gastrostomy is a small hole in the abdominal wall for inserting a tube directly into the stomach. It is placed during gastroscopy with a short general anesthesia (15-20 minutes).
For 1 to 3 months, the gastric catheter is left in place. It is flexible and rolls up easily to be hidden under clothing (30-60 cm).
Then, a "button" is placed during a new gastroscopy. It closes the gastrostomy hole when not used for nutrition and allows not to keep permanent gastric catheter. This button should be changed every six months.
The nutrition is availabel in form of 500 ml and 1 liter bags and reaches directly the stomach through a catheter connected to the gastrostomy ("button" is opened). A pump is used to regulate the flow.
It is also important to maintain as much as possible the oral intakes, gastrostomy being only a support to help regaining weight.
You must not forget your pancreatic enzymes at time of nutrition.
Finally, you will have to closely monitor your diabetes in the beginning, because your insulin requirements are expected to increase during enteral nutrition, and diabetes treatment should be adapted with your diabetologist.
Best regards
Deborah Grunewald (nutritionist) et Dr Dominique Hubert

20.10.2014