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Aggressive nutrition intervention reduces ascites and frequency of paracentesis in malnourished patients with cirrhosis and ascites
Background and Aim Alterations in nutrient metabolism, nutritional requirements, and reduced dietary intakes are common in chronic liver disease (CLD). These result in malnutrition, sarcopenia, and exacerbate progression to decompensation and ascites. We aimed to investigate the effects of continuou...
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| Published in: | JGH open 2017-11, Vol.1 (3), p.92-97 |
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| creator | Vidot, Helen Bowen, David G Carey, Sharon McCaughan, Geoffrey W Allman‐Farinelli, Margaret Shackel, Nicholas A |
| description | Background and Aim
Alterations in nutrient metabolism, nutritional requirements, and reduced dietary intakes are common in chronic liver disease (CLD). These result in malnutrition, sarcopenia, and exacerbate progression to decompensation and ascites. We aimed to investigate the effects of continuous tube feeding (TF) on nutritional status and levels of ascites in malnourished individuals with decompensated cirrhosis.
Methods
Fourteen malnourished patients with decompensated cirrhosis and ascites who failed to respond to standard oral nutritional interventions received supplementary continuous nasogastric TF for 7 ± 1 weeks. Liver disease severity was assessed by model for end‐stage liver disease (MELD) and Child–Turcotte–Pugh (CTP) scores.
Results
Continuous TF occurred at home for 7 weeks (1.5–12 weeks). Prior to feeding, 12 patients had severe ascites, 10 required paracentesis, and 13 were severely malnourished. At completion of TF, five patients did not have ascites, four had mild ascites, four had moderate ascites, and only one had severe ascites and 10 no longer required paracentesis (P |
| doi_str_mv | 10.1002/jgh3.12016 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6206992</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2290723948</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4766-8247550779bfdf485aaac4dc22b7395a3f4a82fb50fda13b177d65727b6ae5dc3</originalsourceid><addsrcrecordid>eNp9kc1LHDEYh0OxVNl68Q-QgBcprM3HJJm5CCJVW4Re6jlk8rGTZTZZk5mVPfcfb8ZdRT309Ca8Tx7eNz8ATjC6wAiR78tFRy8wQZh_AkeENmLeIIEO3pwPwXHOS4QQrkXDKP8CDimqasoqegT-Xi0WyebsNxaGcUh-8DFAHwabNjY8X5I1o7YZqqz9MNVgoEv2cbRBb2F0cK2S0gW22efyFK5UH-KYfO6sKc3Bl16GT37ooPYpdXHiJsve-BV8dqrP9nhfZ-Dh5sef67v5_e_bn9dX93NdCc7nNakEY0iIpnXGVTVTSunKaEJaQRumqKtUTVzLkDMK0xYLYTgTRLRcWWY0nYHLnXc9titrppGT6uU6-ZVKWxmVl-87wXdyETeSE8SbhhTB-V6QYlk_D3Lls7Z9r4KNY5YE05pTQaumoGcf0GX5klDWk4SUVEo6JYIZ-LajdIo5J-teh8FITvHKKV75HG-BT9-O_4q-hFkAvAOefG-3_1HJX7d3dCf9B1WIs3Y</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2290723948</pqid></control><display><type>article</type><title>Aggressive nutrition intervention reduces ascites and frequency of paracentesis in malnourished patients with cirrhosis and ascites</title><source>Wiley Online Library Open Access</source><source>Publicly Available Content Database</source><source>PubMed Central</source><creator>Vidot, Helen ; Bowen, David G ; Carey, Sharon ; McCaughan, Geoffrey W ; Allman‐Farinelli, Margaret ; Shackel, Nicholas A</creator><creatorcontrib>Vidot, Helen ; Bowen, David G ; Carey, Sharon ; McCaughan, Geoffrey W ; Allman‐Farinelli, Margaret ; Shackel, Nicholas A</creatorcontrib><description>Background and Aim
Alterations in nutrient metabolism, nutritional requirements, and reduced dietary intakes are common in chronic liver disease (CLD). These result in malnutrition, sarcopenia, and exacerbate progression to decompensation and ascites. We aimed to investigate the effects of continuous tube feeding (TF) on nutritional status and levels of ascites in malnourished individuals with decompensated cirrhosis.
Methods
Fourteen malnourished patients with decompensated cirrhosis and ascites who failed to respond to standard oral nutritional interventions received supplementary continuous nasogastric TF for 7 ± 1 weeks. Liver disease severity was assessed by model for end‐stage liver disease (MELD) and Child–Turcotte–Pugh (CTP) scores.
Results
Continuous TF occurred at home for 7 weeks (1.5–12 weeks). Prior to feeding, 12 patients had severe ascites, 10 required paracentesis, and 13 were severely malnourished. At completion of TF, five patients did not have ascites, four had mild ascites, four had moderate ascites, and only one had severe ascites and 10 no longer required paracentesis (P < 0.001). Median patient survival was 26 ± 7 months. Five survived to transplantation and three remained transplant‐free at 8, 1.9, and 1.7 years. Seven patients were moderately malnourished at completion of TF with an overall improvement in hand grip strength from 51% to 65% of predicted (P = 0.02).
Conclusion
Supplementary continuous TF may help to reduce ascites and paracentesis requirements and improve nutritional status. Supplementary continuous TF should be considered as a treatment for malnourished patients with decompensated cirrhosis and refractory ascites.
Continuous tube feeding, in addition to oral intake as tolerated, reduces levels of ascites, paracentesis requirements, and improves grip strength in malnourished individuals with decompensated cirrhosis. Three individuals did not require liver transplantation. It is well tolerated and safe and a viable treatment option in malnourished individuals with decompensated cirrhosis.</description><identifier>ISSN: 2397-9070</identifier><identifier>EISSN: 2397-9070</identifier><identifier>DOI: 10.1002/jgh3.12016</identifier><identifier>PMID: 30483543</identifier><language>eng</language><publisher>Melbourne: Wiley Publishing Asia Pty Ltd</publisher><subject>ascites ; Caregivers ; cirrhosis ; continuous tube feeding ; Endoscopy ; Enteral nutrition ; Esophagus ; Hypertension ; Intervention ; Liver cirrhosis ; Liver diseases ; Malnutrition ; Nausea ; Nutrition ; Original ; paracentesis ; Parenteral nutrition ; Patients ; Proteins ; Quality of life ; Sarcopenia ; Transplants & implants</subject><ispartof>JGH open, 2017-11, Vol.1 (3), p.92-97</ispartof><rights>2017 The Authors. published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.</rights><rights>2017. This work is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4766-8247550779bfdf485aaac4dc22b7395a3f4a82fb50fda13b177d65727b6ae5dc3</citedby><cites>FETCH-LOGICAL-c4766-8247550779bfdf485aaac4dc22b7395a3f4a82fb50fda13b177d65727b6ae5dc3</cites><orcidid>0000-0001-8084-9968</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2290723948/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2290723948?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,11561,25752,27923,27924,37011,37012,44589,46051,46475,53790,53792,74997</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30483543$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vidot, Helen</creatorcontrib><creatorcontrib>Bowen, David G</creatorcontrib><creatorcontrib>Carey, Sharon</creatorcontrib><creatorcontrib>McCaughan, Geoffrey W</creatorcontrib><creatorcontrib>Allman‐Farinelli, Margaret</creatorcontrib><creatorcontrib>Shackel, Nicholas A</creatorcontrib><title>Aggressive nutrition intervention reduces ascites and frequency of paracentesis in malnourished patients with cirrhosis and ascites</title><title>JGH open</title><addtitle>JGH Open</addtitle><description>Background and Aim
Alterations in nutrient metabolism, nutritional requirements, and reduced dietary intakes are common in chronic liver disease (CLD). These result in malnutrition, sarcopenia, and exacerbate progression to decompensation and ascites. We aimed to investigate the effects of continuous tube feeding (TF) on nutritional status and levels of ascites in malnourished individuals with decompensated cirrhosis.
Methods
Fourteen malnourished patients with decompensated cirrhosis and ascites who failed to respond to standard oral nutritional interventions received supplementary continuous nasogastric TF for 7 ± 1 weeks. Liver disease severity was assessed by model for end‐stage liver disease (MELD) and Child–Turcotte–Pugh (CTP) scores.
Results
Continuous TF occurred at home for 7 weeks (1.5–12 weeks). Prior to feeding, 12 patients had severe ascites, 10 required paracentesis, and 13 were severely malnourished. At completion of TF, five patients did not have ascites, four had mild ascites, four had moderate ascites, and only one had severe ascites and 10 no longer required paracentesis (P < 0.001). Median patient survival was 26 ± 7 months. Five survived to transplantation and three remained transplant‐free at 8, 1.9, and 1.7 years. Seven patients were moderately malnourished at completion of TF with an overall improvement in hand grip strength from 51% to 65% of predicted (P = 0.02).
Conclusion
Supplementary continuous TF may help to reduce ascites and paracentesis requirements and improve nutritional status. Supplementary continuous TF should be considered as a treatment for malnourished patients with decompensated cirrhosis and refractory ascites.
Continuous tube feeding, in addition to oral intake as tolerated, reduces levels of ascites, paracentesis requirements, and improves grip strength in malnourished individuals with decompensated cirrhosis. Three individuals did not require liver transplantation. It is well tolerated and safe and a viable treatment option in malnourished individuals with decompensated cirrhosis.</description><subject>ascites</subject><subject>Caregivers</subject><subject>cirrhosis</subject><subject>continuous tube feeding</subject><subject>Endoscopy</subject><subject>Enteral nutrition</subject><subject>Esophagus</subject><subject>Hypertension</subject><subject>Intervention</subject><subject>Liver cirrhosis</subject><subject>Liver diseases</subject><subject>Malnutrition</subject><subject>Nausea</subject><subject>Nutrition</subject><subject>Original</subject><subject>paracentesis</subject><subject>Parenteral nutrition</subject><subject>Patients</subject><subject>Proteins</subject><subject>Quality of life</subject><subject>Sarcopenia</subject><subject>Transplants & implants</subject><issn>2397-9070</issn><issn>2397-9070</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>PIMPY</sourceid><recordid>eNp9kc1LHDEYh0OxVNl68Q-QgBcprM3HJJm5CCJVW4Re6jlk8rGTZTZZk5mVPfcfb8ZdRT309Ca8Tx7eNz8ATjC6wAiR78tFRy8wQZh_AkeENmLeIIEO3pwPwXHOS4QQrkXDKP8CDimqasoqegT-Xi0WyebsNxaGcUh-8DFAHwabNjY8X5I1o7YZqqz9MNVgoEv2cbRBb2F0cK2S0gW22efyFK5UH-KYfO6sKc3Bl16GT37ooPYpdXHiJsve-BV8dqrP9nhfZ-Dh5sef67v5_e_bn9dX93NdCc7nNakEY0iIpnXGVTVTSunKaEJaQRumqKtUTVzLkDMK0xYLYTgTRLRcWWY0nYHLnXc9titrppGT6uU6-ZVKWxmVl-87wXdyETeSE8SbhhTB-V6QYlk_D3Lls7Z9r4KNY5YE05pTQaumoGcf0GX5klDWk4SUVEo6JYIZ-LajdIo5J-teh8FITvHKKV75HG-BT9-O_4q-hFkAvAOefG-3_1HJX7d3dCf9B1WIs3Y</recordid><startdate>201711</startdate><enddate>201711</enddate><creator>Vidot, Helen</creator><creator>Bowen, David G</creator><creator>Carey, Sharon</creator><creator>McCaughan, Geoffrey W</creator><creator>Allman‐Farinelli, Margaret</creator><creator>Shackel, Nicholas A</creator><general>Wiley Publishing Asia Pty Ltd</general><general>John Wiley & Sons, Inc</general><scope>24P</scope><scope>WIN</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-8084-9968</orcidid></search><sort><creationdate>201711</creationdate><title>Aggressive nutrition intervention reduces ascites and frequency of paracentesis in malnourished patients with cirrhosis and ascites</title><author>Vidot, Helen ; Bowen, David G ; Carey, Sharon ; McCaughan, Geoffrey W ; Allman‐Farinelli, Margaret ; Shackel, Nicholas A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4766-8247550779bfdf485aaac4dc22b7395a3f4a82fb50fda13b177d65727b6ae5dc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>ascites</topic><topic>Caregivers</topic><topic>cirrhosis</topic><topic>continuous tube feeding</topic><topic>Endoscopy</topic><topic>Enteral nutrition</topic><topic>Esophagus</topic><topic>Hypertension</topic><topic>Intervention</topic><topic>Liver cirrhosis</topic><topic>Liver diseases</topic><topic>Malnutrition</topic><topic>Nausea</topic><topic>Nutrition</topic><topic>Original</topic><topic>paracentesis</topic><topic>Parenteral nutrition</topic><topic>Patients</topic><topic>Proteins</topic><topic>Quality of life</topic><topic>Sarcopenia</topic><topic>Transplants & implants</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vidot, Helen</creatorcontrib><creatorcontrib>Bowen, David G</creatorcontrib><creatorcontrib>Carey, Sharon</creatorcontrib><creatorcontrib>McCaughan, Geoffrey W</creatorcontrib><creatorcontrib>Allman‐Farinelli, Margaret</creatorcontrib><creatorcontrib>Shackel, Nicholas A</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Wiley Online Library Free Content</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>JGH open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vidot, Helen</au><au>Bowen, David G</au><au>Carey, Sharon</au><au>McCaughan, Geoffrey W</au><au>Allman‐Farinelli, Margaret</au><au>Shackel, Nicholas A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Aggressive nutrition intervention reduces ascites and frequency of paracentesis in malnourished patients with cirrhosis and ascites</atitle><jtitle>JGH open</jtitle><addtitle>JGH Open</addtitle><date>2017-11</date><risdate>2017</risdate><volume>1</volume><issue>3</issue><spage>92</spage><epage>97</epage><pages>92-97</pages><issn>2397-9070</issn><eissn>2397-9070</eissn><abstract>Background and Aim
Alterations in nutrient metabolism, nutritional requirements, and reduced dietary intakes are common in chronic liver disease (CLD). These result in malnutrition, sarcopenia, and exacerbate progression to decompensation and ascites. We aimed to investigate the effects of continuous tube feeding (TF) on nutritional status and levels of ascites in malnourished individuals with decompensated cirrhosis.
Methods
Fourteen malnourished patients with decompensated cirrhosis and ascites who failed to respond to standard oral nutritional interventions received supplementary continuous nasogastric TF for 7 ± 1 weeks. Liver disease severity was assessed by model for end‐stage liver disease (MELD) and Child–Turcotte–Pugh (CTP) scores.
Results
Continuous TF occurred at home for 7 weeks (1.5–12 weeks). Prior to feeding, 12 patients had severe ascites, 10 required paracentesis, and 13 were severely malnourished. At completion of TF, five patients did not have ascites, four had mild ascites, four had moderate ascites, and only one had severe ascites and 10 no longer required paracentesis (P < 0.001). Median patient survival was 26 ± 7 months. Five survived to transplantation and three remained transplant‐free at 8, 1.9, and 1.7 years. Seven patients were moderately malnourished at completion of TF with an overall improvement in hand grip strength from 51% to 65% of predicted (P = 0.02).
Conclusion
Supplementary continuous TF may help to reduce ascites and paracentesis requirements and improve nutritional status. Supplementary continuous TF should be considered as a treatment for malnourished patients with decompensated cirrhosis and refractory ascites.
Continuous tube feeding, in addition to oral intake as tolerated, reduces levels of ascites, paracentesis requirements, and improves grip strength in malnourished individuals with decompensated cirrhosis. Three individuals did not require liver transplantation. It is well tolerated and safe and a viable treatment option in malnourished individuals with decompensated cirrhosis.</abstract><cop>Melbourne</cop><pub>Wiley Publishing Asia Pty Ltd</pub><pmid>30483543</pmid><doi>10.1002/jgh3.12016</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-8084-9968</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Wiley Online Library Open Access; Publicly Available Content Database; PubMed Central |
| subjects | ascites Caregivers cirrhosis continuous tube feeding Endoscopy Enteral nutrition Esophagus Hypertension Intervention Liver cirrhosis Liver diseases Malnutrition Nausea Nutrition Original paracentesis Parenteral nutrition Patients Proteins Quality of life Sarcopenia Transplants & implants |
| title | Aggressive nutrition intervention reduces ascites and frequency of paracentesis in malnourished patients with cirrhosis and ascites |
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