Early enteral nutrition — principles and practice
Abstract
This article has three major objectives: to review briefly the physiology and metabolism of the small intestinal mucosa; to summarise the evidence and recommendations regarding early enteral nutrition; and to discuss how to implement early enteral nutrition in small animal veterinary practice.
The gastrointestinal tract has a high metabolic rate and is composed mostly of cells that have a short life. Early enteral nutrition (EEN) contributes to improved gastrointestinal (GI) function, decreased GI permeability and improved patient outcomes. EEN can be delivered starting on day 1 for even critically ill patients. A transition from simple to more complex foods over time results in fewer complications.
In simplest terms, the major function of the gastrointestinal tract (GIT) is to transform ingested food into simple molecules that can be used for energy and metabolic function by all of the other cells in the body. To accomplish this, the stomach provides mixing and gross breakdown of food, the small intestine provides further breakdown of food and absorption of nutrients, and the large intestine acts as a waste compactor and water extractor. The intestinal mucosa contains the cells that actually accomplish these processes. More detail on the types of cells can be found in Figure 1.
Cells in the small intestine
A very important secondary function of the GIT is to keep the waste material, digestive enzymes and bacteria inside the intestinal lumen and away from the rest of the body. The GIT is actually the largest immune organ in the body, containing about 50% of the lymphoid cells in the body (Mellema, 2011). Failure of this barrier function can allow bacteria or other pro-inflammatory substances to enter the systemic circulation, leading to sepsis or a systemic inflammatory response.
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