Enteral feeding by gastrostomy

Question

Hello
My CF son, who is homozygous for delta F508, has a BMI of 14 and he seems unable to gain weight so he doesn't grow: he is 15 1/2 years old and has a length of 156 cm with a weight of 35.9 kg.
All attempts have failed with calory supplements (my son was disgusted or took a supplement instead of a meal => useless), his pulmonologist and we are considering enteral feeding.
I wondered if there is a risk that it could not work? Because it is still an irreversible surgery ..
Thank you

Answer

Hello,

It is important in CF to maintain or restore a satisfactory nutritional status, which is correlated with better respiratory status and a higher quality of life. Adolescence is a period at risk of malnutrition because the needs and expenditures are increased; enrichment of food and caloric oral supplements are not always enough to gain weight, as in the case of your son.

First, one should seek for and take into account other factors that may participate in the poor nutritional status: uncontrolled pancreatic insufficiency (insufficient pancreatic enzymes, or sometimes forgotten), pulmonary infection, gastroesophageal reflux disease, diabetes, etc.

Then considering, as your pulmonologist proposes, support by enteral nutrition (the term "feeding" is avoided) of bringing a balanced nutrient mixture directly into the stomach, in addition to regular meals. This nutrition can be done either by nasogastric tube or gastrostomy.

In the first case, a thin flexible tube is inserted through the nose, going to the stomach to administer nutrition, usually overnight. The patient and his parents are trained if they wish to be more independent. Many teenagers prefer to put the probe in in the evenings for nutrition and remove it in the mornings. For nutrition by nasogastric tube, so there is no surgery. This is the technique of choice for short nutritions few weeks to a few months, but it can be used longer if the patient tolerates it well.

The second technique is the placement of a gastrostomy usually endoscopically by general anesthesia. A button is placed directly into the stomach through the abdominal skin. The nutritional product is then administered by the button. It is closed by a cap outside the period of use.

Whatever the technique used, enteral nutrition helps to provide calories in addition to meals, and rapid weight gain, assumed of course that enough calories are provided for profit, and pancreatic enzymes are administered.

Please discuss with your doctor the terms of enteral nutrition to choose together the most suitable technique for your son, and enable him to quickly improve his nutritional status.

Sincerely
Dr Michèle Gérardin

16.01.2015