These patients are prime candidates for NG or NI feeding if the gastrointestinal tract is normal, as in the case of critical care, anorexia (usually secondary
to disease and malnutrition), neurological impairment preventing oral feeding, substantially increased requirements with relative anorexia (e.g., in burn cases), or chronic obstructive lung disease with severe dyspnea. However, for diseases of the pharynx, esophagus, or stomach or in cases of surgery of the esophagus, stomach, or pancreas, patients usually require intubation of the stomach or intestine by percutaneous gastrostomy or operative jeju-nostomy to allow feeding beyond the site of obstruction. If there is an abnormality of the intestinal tract, such as short bowel with more than 60 cm of available small intestine, IBD, or chronic partial bowel obstruction, diets must be delivered carefully with the aid of a pump to avoid surges of delivered fluid diets and consequent distension of the bowel. Despite careful selection, a proportion of patients expectantly fed via the nasogastric or nasoenteral route will show intolerance, complications, or inability to meet target nutrient intake without clinically unacceptable side effects. For example, in trials of patients with Crohn's disease, approximately 20% of patients could not tolerate nasogastric feeding. When EN fails or cannot be used for reasons given previously, then parenteral nutrition (PN) must be used.
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