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Feeding tube
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{{NeedsImage}} A '''feeding tube''' or use of '''enteral nutrition''' is a way to manage certain severe gastrointestinal problems or to increase food intake in a small number of patients with [[severe and very severe ME|severe ME/CFS]].<ref name="NBK559044">{{Cite book | title = Feeding Tube | date = 2021-09-29| publisher = StatPearls Publishing|language=en | url =https://www.ncbi.nlm.nih.gov/books/NBK559044/ | last = Jamieson | first = Nicole C. | last2 = Tadi | first2 = Prasanna|pmid=32644470}}</ref> Feeding tubes typically refer to use of a catheter (narrow tube) to deliver liquid nutrition directly into part of the [[Gastrointestinal system|gastrointestinal tract]], eg the [[jejunum]] or stomach. ==Theory== Feeding can take place when severe [[gastroparesis]] patients prevents food being digested quickly enough by placing a tube lower in the [[digestive tract]].<ref name="mayo">{{Cite web | url = https://www.mayoclinic.org/tests-procedures/home-enteral-nutrition/about/pac-20384955 | title = Home enteral nutrition | last = | first = | authorlink = | date = | website = Mayo Clinic|language=en|archive-url=|archive-date=|url-status=|access-date=2022-01-16}}</ref> ==Types == ===NG tube=== A nasogastric tube is a tube from the nose through the esophagus and into the stomach.<ref name="aus">{{Cite web | url = https://www.gastroparesisaustralia.com/feeding/ | title = Tube Feeding | last = | first = | authorlink = | date = 2018-08-13 | website = Gastroparesis Australia|language=en|archive-url=|archive-date=|url-status=|access-date=2022-03-25}}</ref> ===NJ tube=== A nasojejunal tube goes from the nose through the esophagus and stomach, and then into the small intestine.<ref name="aus" /> ===PEG tube=== A percutaneous endoscopic gastrostomy (PEG) feeding tube goes directly into the stomach, bypassing the nose, mouth and esophagus. A gastrostomy (surgery) is needed to place it into the stomach.<ref name="PEG-PEJ">{{Cite web | url = https://www.mskcc.org/cancer-care/patient-education/peg-pej-tube-feeding | title = About the Placement of Your PEG or PEJ Tube for Feeding | last = | first = | authorlink = | date = | website = Memorial Sloan Kettering Cancer Center|language=en|archive-url=|archive-date=|url-status=|access-date=2022-03-25}}</ref> ===PEJ tube=== A jejunostomy surgery is needed to insert a percutaneous endoscopic jejunostomy (PEJ) or PEJ tube through the skin and directly into the small intestine, bypassing the nose, mouth, esophagus and stomach.<ref name="PEG-PEJ" /> ==Total parenteral nutrition== Parenteral nutrition refers to nutrition delivered intravenously through a central line near the top of the chest. '''Total parenteral nutrition''' or '''TPN''' is the use of patenteral nutritional to fulfill all dietary needs (without eating). TPN requires surgery to place an IV tube into a vein, bypassing the [[gastrointestinal tract]] entirely.<ref name="TPN">{{Cite web | url = https://medlineplus.gov/ency/patientinstructions/000177.htm | title = Total parenteral nutrition | last = | first = | authorlink = | date = | website = MedlinePlus Medical Encyclopedia|language=en|archive-url=|archive-date=|url-status=|access-date=2022-01-16}}</ref> ==Evidence== No studies have investigated the effects of the feeding, it is typically a last resort. Patients who have used feeding tubes for ME/CFS include: *[[Merryn Crofts]] *[[Lynn Gilderdale]] *[[Whitney Dafoe]] ==News and articles == * 2023, [https://www.bbc.co.uk/news/uk-england-devon-64830022 Exeter ME patient's hospital care changed after campaign] - BBC News Devon :Alice Barrett, a young British woman with [[severe_and_very_severe ME|very severe ME/CFS]] was initially denied feeding through her NG-tube while in hospital because she was unable to sit upright enough for her NG tube to be at a 30 degree angle. The hospital only changed its policy to allow parents went public with the risk of Alice dying from starvation caused by the hospital's policy. *2022, [https://www.mirror.co.uk/news/uk-news/girl-11-using-feeding-tube-26083404 Girl, 11, using feeding tube to eat a year after Covid left her too weak to move] - Daily Mirror ==Notable studies == *2021, Life-Threatening Malnutrition in Very Severe ME/CFS<ref name="malnutrition2021">{{Cite journal | last = Baxter | first = Helen | author-link = | last2 = Speight | first2 = Nigel | authorlink2 = Nigel Speight | last3 = Weir | first3 = William | authorlink3 = William Weir | date = Apr 2021 | title = Life-Threatening Malnutrition in Very Severe ME/CFS| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8070213|journal=Healthcare|language=en|volume=9|issue=4 | pages = 459|doi=10.3390/healthcare9040459|pmc=PMC8070213|pmid=33919671|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8070213 (Full text)] *2021, Extremely Severe ME/CFS—A Personal Account<ref name="Dafoe2021">{{Cite journal | last = Dafoe | first = Whitney | author-link = Whitney Dafoe | date = May 2021 | title = Extremely Severe ME/CFS—A Personal Account| url = https://www.mdpi.com/2227-9032/9/5/504|journal=Healthcare|language=en|volume=9|issue=5 | pages = 504|doi=10.3390/healthcare9050504|pmc=PMC8145314|pmid=33925566|access-date=|quote=|via=}}</ref> - [https://doi.org/10.3390/healthcare9050504 (Full text)] ==Clinicians== ==Risks and safety== Feeding tubes carry varying degrees of risk, including risks of surgery, complications from incorrect placement, risk of infection, and risk of nutritional deficiencies or complications from the feed used. Risks of not using a feeding tube are also expected to be taken into account, for example continuing severe and rapid weight loss, becoming too weak from lack of food to swallow food,<ref name="NG2022-LC">{{Cite news |url =https://www.mirror.co.uk/news/uk-news/girl-11-using-feeding-tube-26083404 | title = Girl, 11, using feeding tube to eat a year after Covid left her too weak to move| publisher = The Mirror | first = Dave | last = Burke | date = Jan 31, 2022}}</ref> and life-threatening malnutrition. Risks from a TPN are significantly more than from nasal feeding tubes. ==Costs and availability== Generally these require hospital treatment to insert or check. ==See also== *[[Anorexia]] (appetite loss) *[[Severe_and_very_severe_ME#verysevere|Very severe ME]] *[[Gastroparesis]] ==Learn more== *[https://www.mayoclinic.org/tests-procedures/home-enteral-nutrition/about/pac-20384955 Home enteral nutrition] - Mayo Clinic *[https://medlineplus.gov/ency/patientinstructions/000177.htm Total Parenteral Nutrition] - MedlinePlus *[https://www.mskcc.org/cancer-care/patient-education/peg-pej-tube-feeding About the Placement of Your PEG or PEJ Tube for Feeding] - Memorial Sloan Kettering Cancer Center ==References== {{reflist}} [[Category:Potential treatments]] [[Category:Management strategies]] [[Category:Nutrition]] [[Category:Nutritional deficiencies]]
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