ABSTRACT
Malnutrition and weight loss are clinically significant complications of both human immunodeficiency virus (HIV) infection and cancer. Over the last two decades, multiple abnormalities in energy and protein metabolism have been documented in patients with cancer and, more recently, in HIV infection. In HIV infection, studies of the components of energy balance have demonstrated that weight loss results primarily from decreased energy intake, coupled with a failure to consistently reduce resting energy expenditure. Although several studies have shown that resting energy expenditure is elevated in many patients with HIV infection, other studies have shown that not all patients with HIV infection are hypermetabolic. Likewise, protein turnover is increased, decreased, or unchanged in patients with HIV infection and varies with the physiologic state of the patient. In cancer patients, studies of resting energy expenditure have produced similarly varying results, depending in part on tumor type and dietary intake. Protein turnover studies in patients with cancer suggest that support of the tumor may occur at the expense of host skeletal muscle. Abnormalities of glucose and lipid metabolism have been noted as well. Thus, pharmacologic intervention may be needed to restore weight and lean tissue in patients with weight loss associated with either HIV infection or cancer.
Subject(s)
Energy Metabolism , HIV Infections/metabolism , Neoplasms/metabolism , Wasting Syndrome/metabolism , Cachexia/etiology , Cachexia/metabolism , Humans , Neoplasms/complications , Proteins/metabolismABSTRACT
BACKGROUND: Enteral feeding through percutaneous endoscopic gastrostomy (PEG) is increasingly utilized in hospitals, homes, and institutions. However, PEGs have two major limitations: (1) risk for aspiration, which occurs in up to 30% of patients, and (2) it does not allow enteral feeding in patients with gastric outlet obstruction, gastroparesis, or gastric resection. METHODS: A new endoscopic method for placement of direct percutaneous endoscopic jejunostomy (DPEJ) was attempted in 150 patients with or without a history of major abdominal surgery. Patients were followed-up until tube utilization ceased because of death or resumption of oral feeding. RESULTS: There were 129 (86%) successful procedures and 21 (14%) unsuccessful attempts. Procedure-related complications included nine (6%) incisional infections. Bleeding, abscess, and colonic perforation each occurred in one patient (.6%), and all required surgical intervention. On long-term follow-up (n = 97), tube malfunction occurred in 3 patients (3%) and aspiration in 3 (3%). Duration of tube use in this population was 113 +/- 173 days. CONCLUSIONS: DPEJs can be performed successfully with a low complication rate. Enteral feeding through DPEJs drastically reduces aspiration, which commonly occurs with PEG feeding. DPEJs allow feeding and hydration of patients with gastric outlet obstruction due to cancer who are not surgical candidates, eliminate the need for intravenous hydration and feeding, and can cut costs of hospitalization and treatment.
Subject(s)
Endoscopy/methods , Enteral Nutrition/methods , Jejunostomy/methods , Enteral Nutrition/adverse effects , Female , Follow-Up Studies , Humans , Jejunostomy/adverse effects , Male , Middle AgedABSTRACT
Recent advances in nutrition support methods now offer home patients the possibility of maintaining nutritional adequacy when intake is compromised. Using either enteral or parenteral feeding when appropriate allows patients to achieve an improved quality of life at home. Options for management offer a wide variety of choices in feeding methods, formulations, delivery systems, rates and scheduling as well as services provided for a given need. Team management of these patients is necessary to assure proper medical care and support.
