Enteral Nutrition

What is enteral feeding?

Enteral feeding refers to intake of food via the gastrointestinal (GI) tract. The GI tract is composed of the mouth, esophagus, stomach, and intestines.

Enteral feeding may mean nutrition taken through the mouth or through a tube that goes directly to the stomach or small intestine. In the medical setting, the term enteral feeding is most often used to mean tube feeding.

A person on enteral feeds usually has a condition or injury that prevents eating a regular diet by mouth, but their GI tract is still able to function.

Being fed through a tube allows them to receive nutrition and keep their GI tract working. Enteral feeding may make up their entire caloric intake or may be used as a supplement.

When is enteral feeding used?

Tube feedings may become necessary when you can’t eat enough calories to meet your nutritional needs. This may occur if you physically can’t eat, can’t eat safely, or if your caloric requirements are increased beyond your ability to eat.

If you can’t eat enough, you’re at risk for malnourishment, weight loss, and very serious health issues. This may happen for a variety of reasons. Some of the more common underlying reasons for enteral feeding include:

  • a stroke, which may impair ability to swallow
  • cancer, which may cause fatigue, nausea, and vomiting that make it difficult to eat
  • critical illness or injury, which reduces energy or ability to eat
  • failure to thrive or inability to eat in young children or infants
  • serious illness, which places the body in a state of stress, making it difficult to take in enough nutrients
  • neurological or movement disorders that increase caloric requirements while making it more difficult to eat
  • GI dysfunction or disease, although this may require intravenous (IV) nutrition instead

Types of enteral feeding

According to the American College of Gastroenterology, there are six main types of feeding tubes. These tubes may have further subtypes depending on exactly where they end in the stomach or intestines.

The placement of the tube will be chosen by a doctor based on what size tube is needed, how long enteral feeds will be required, and your digestive abilities.

A medical professional will also choose an enteral formula to be used based on tube placement, digestive abilities, and nutritional needs.

The main types of enteral feeding tubes include:

  • Nasogastric tube (NGT) starts in the nose and ends in the stomach.
  • Nasoenteric tube starts in the nose and ends in the intestines (subtypes include nasojejunal and nasoduodenal tubes).
  • Gastrostomy tube is placed through the skin of the abdomen straight to the stomach (subtypes include PEG, PRG, and button tubes).
  • Jejunostomy tube is placed through the skin of the abdomen straight into the intestines (subtypes include PEJ and PRJ tubes).


Possible complications of enteral feeding

There are some complications that can occur as a result of enteral feeding. Some of the most common include:

  • aspiration, which is food going into the lungs
  • refeeding syndrome, dangerous electrolyte imbalances that may occur in people who are very malnourished and start receiving enteral feeds
  • infection of the tube or insertion site
  • nausea and vomiting that may result from feeds that are too large or fast, or from slowed emptying of the stomach
  • skin irritation at the tube insertion site
  • diarrhea due to a liquid diet or possibly medications
  • tube dislodgement
  • tube blockage, which may occur if not flushed properly

There are not typically long-term complications of enteral feeding.


Who shouldn’t have enteral feeding?

The main reason a person wouldn’t be able to have enteral feeds is if their stomach or intestines aren’t working properly.

Someone with a bowel obstruction, decreased blood flow to their intestines (ischemic bowel), or severe intestinal disease such as Crohn’s disease would likely not benefit from enteral feedings.

The outlook

Enteral feeding is often used as a short-term solution while someone recovers from an illness, injury, or surgery. Most people receiving enteral feeds return to regular eating.

There are some situations where enteral feeding is used as a long-term solution, such as for people with movement disorders or children with physical disabilities.

In some cases, enteral nutrition can be used to prolong life in someone who is critically ill or an older person who can’t maintain their nutritional needs. The ethics of using enteral feeding to prolong life have to be evaluated in each individual case.

Enteral feeding can seem like a challenging adjustment for you or a loved one. Your doctor, nurses, a nutritionist, and home health care providers can help make this adjustment a successful one.