[Celiac disease and dementia of rapidly fatal outcome].
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Celiac Disease↗
Biomedical subjects
J Cosnes
Publications and source records attributed to J Cosnes.
Enteral nutrition in malnutrition following gastric resection and cephalic pancreaticoduodenectomy.
Nutritional recovery was studied during continuous enteral nutrition in 29 patients who had developed malnutrition after gastric surgery. Patients were divided into three groups according to the type of surgery involved: total gastrectomy (n = 10), partial gastrectomy (n = 12), or cephalic pancreaticoduodenectomy (n = 7). The evolution of anthropometric and biological nutritional parameters in each group was compared with that observed in a control group of 10 nonoperated anorectic patients. Significant gains in body weight, arm muscle circumference, triceps skinfold, serum transferrin and global nutritional status were observed after 3 to 4 weeks of enteral nutrition in each group, while serum albumin, serum cholesterol, hemoglobin, and total lymphocyte count did not change significantly. No significant difference was observed between the groups. However, weight gain tended to be slower in patients with cephalic pancreaticoduodenectomy. This study confirms that enteral nutrition is an effective method of nutritional repletion after gastrectomy. Enteral nutrition can be used in undernourished gastrectomized patients when dietary measures alone have proven inadequate.
Adult↗
[Psoas abscess complicating Crohn's disease].
Psoas abscess were found in 6 cases among 166 patients with Crohn's disease between 1985 and 1989; in one case, it was the first sign of Crohn's disease. Diagnosis was usually difficult and should be suspected on the following signs: lower abdominal quadrant pain, psoitis, abdominal mass, sciatica or pain along the course of the femoral nerve. Diagnosis was confirmed in nearly all cases by computerized axial tomography. Effective therapy combines drainage and bowel resection.
Adolescent↗
[Elemental, semi-elemental, polymeric diets. Choice, indications, rational use].
In this review paper the main properties of elemental, semi-elemental and polymeric diets utilized in enteral nutrition are compared. The theoretical value of elemental diets (they do not require digestion) is upset by their effects on secretion. Semi-elemental diets are not hyperosmolar and are easily absorbed. Polymeric formulas acan be given in almost all indications of enteral nutrition, and in view of the high cost of elemental and semi-elemental diets, the latter should be reserved to elective indications, notably antigenic arrest of the digestive tract and major nitrogen malabsorption.
Digestive System Diseases↗
Isotonic high-sodium oral rehydration solution for increasing sodium absorption in patients with short-bowel syndrome.
We compared the effect of a standard oral rehydration solution and a high-sodium polymeric-glucose solution on sodium absorption in short-bowel syndrome. Six patients with high jejunostomy were tested in a random order with the standard solution or a solution containing maltodextrins (18 g Glucidex 12/L) enriched with 2.5 g NaCl/L. Solutions were administered via a nasogastric tube at a rate of 2 mL/min. Jejunal effluent was collected during an 8-h period. The net 8-h fluid absorption was not significantly different in the two periods. Glucose absorption was greater than 90% of the administered amount for both solutions. Net sodium absorption was greater for the maltodextrin solution than for the standard solution (56 +/- 12 vs 24 +/- 20 mmol, P less than 0.05). We conclude that replacement of glucose with maltodextrins and addition of sodium in the standard oral rehydration solution results in improved sodium absorption in short-bowel syndrome.
Absorption↗
Controlled trial comparing two types of enteral nutrition in treatment of active Crohn's disease: elemental versus polymeric diet.
To determine whether an elemental diet or a polymeric defined formula diet would be more effective for treating active Crohn's disease, we conducted a prospective randomised clinical trial in 30 patients with active Crohn's disease unresponsive to steroids and/or complicated by malnutrition. They received a four to six week enteral nutrition course with either an elemental diet or a polymeric diet. Clinical remission occurred in 10 of the 15 patients on elemental diet compared with 11 of the 15 patients assigned to polymeric diet. Both groups showed similar improvements in nutritional status, biological inflammation, alpha 1 antitrypsin clearance, and colonoscopic lesions (diminished in 17 out of 24 patients). Most patients relapsed during the year after discharge. We conclude that enteral nutrition, whatever the diet, is an efficient primary therapy for active Crohn's disease but does not influence the long term outcome.
Adult↗
[Crohn's disease and pregnancy].
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Crohn Disease↗
Adaptive hyperphagia in patients with postsurgical malabsorption.
The specific nutritional consequences of malabsorption after small-bowel surgery were studied in a consecutive series of 48 ambulatory patients who had had small-bowel resection (n = 43) or bypass (n = 5) and in 10 patients who had an ileal pouch (n = 10). The patients received a 3-day standardized oral regimen providing daily 30 kcal/kg of ideal body weight (IBW). Throughout the study, 41 patients had malabsorption (fecal fat greater than 5%); 17 had fecal fat less than 5% and served as controls. The malabsorption patients absorbed 70% of protein and 71% of fat. Twenty-one were normonourished and 20 had features of mild energy malnutrition, vs. 15 and 2 controls, respectively. Compared with controls, malabsorption patients had decreased body weight and triceps skin-fold but no features of protein malnutrition. their mean daily food intake at home was significantly enhanced (39.6 +/- 13.1 kcal/IBW kg) vs. controls (28.8 +/- 5.8 kcal/IBW kg, P less than 0.001). In the malabsorption group, caloric intake was higher in the normonourished patients than in those with mild malnutrition. This study shows that a chronic malabsorption has limited nutritional consequences. The patients compensate for their absorptive handicap by increasing their oral intake.
Absorption↗
[Elemental feeding into the distal segment of a temporary small bowel].
Patients who have an interruption of the small bowel with a high enterostomy usually need parenteral supply or reinfusion of chyme to maintain nutritional and electrolytic balances before restoring intestinal continuity. Ten patients (aged 28-76 years) with a terminal jejunostomy located within the first meter of jejunum were treated by infusion of an elemental diet into the distal small bowel (IEDDSB). In addition, five of these patients had an extensive small bowel resection. IEDDSB was started 32 days after operation and lasted 4 to 8 weeks. Mean daily caloric infusion was 1,732 +/- 666 kcal diluted in 2,860 +/- 808 ml; mean associated oral intake was 1,187 +/- 480 kcal/24 hr, and jejunal fecal losses averaged 3 kg per day. IEDDSB was well tolerated in 4 patients; 5 experienced transient abdominal pain or diarrhea; 1 developed severe and protracted diarrhea. Biological cholestasis was seen before IEDDSB and persisted in most patients; 1 patient developed biliary sludge. Through IEDDSB, nutritional status improved or remained satisfactory in 9 patients, and worsened in 1 patient with sepsis and a short lower intestine. Mean body weight, triceps skin fold, muscle circumference, serum albumin, serum transferrin did not change significantly. Digestive nitrogen balance performed in 6 patients showed a net absorption between 5 and 15 g/24 hr. Fluid and electrolyte balance was maintained in 9 patients and 1 received iterative intravenous saline. Digestive sodium balance showed a net absorption rate greater than 60 mmol/24 hr. in all patients, except the one who required intravenous supply. Postoperative recovery was uneventful in all patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[A prospective study of liver test anomalies during continuous enteral nutrition].
In 119 gastrointestinal patients, serum transaminases (ASAT) and alkalines phosphatases (AP) were prospectively measured on the first and the twenty first days of a continuous enteral nutrition (CEN) regimen. The exclusion criteria were: recent surgical procedure, transfusion or total parenteral nutrition (TPN), or a cancer during the previous five years. Of the 119 patients, 71 patients were included in the study. The patients received: (a) an exclusive elemental CEN (n = 25, all with Crohn's disease) or non elemental CEN (n = 9), providing 40 kCal/kg of ideal body weight (IBW)/day; (b) a non exclusive non elemental CEN providing a minimum of 30 kCal/kg IBW/day. Of the 56 patients having normal hepatic function tests (HFT) on the first day, only 2 developed mild abnormalities (incidence of 3.6%). Of the 15 remaining patients having abnormal HFT on the first day, HFT improved or returned to normal in 8 cases. During CEN: the appearance of abnormal HFT seems rare, pre-existing abnormalities can improve and there is no associated morbidity. These results suggest that there is no hepatic side effects of CEN, in contrast to TPN, and that CEN must be preferred over TPN whenever the choice is possible.
Adolescent↗
[Ischemic and inflammatory colitis in elderly subjects over 70].
Twenty-five cases of non-infectious, macroscopic colitis, observed consecutively in patients over 70, were studied. The final diagnosis was, in 12 instances, ischemic colitis, in 10 instances cryptogenetic colitis (6 ulcerative colitis and 4 Crohn's diseases), and in 3 instances, non-classified colitis. The clinical manifestations consisted of rectal bleeding (92%), abdominal pain (76%) and diarrhea (56%). In 3 cases, the ano-perineal lesions observed in Crohn's diseases were noted and, in one case, a pyoderma gangrenosum was present. Endoscopy and/or barium enema showed a lesion of the left colon in 92% of the cases and of the sigmoid colon in 80% of the cases. The prognosis was severe, requiring surgery in 32% of the cases (5 ischemic colitis, 3 cryptogenetic colitis), and a 24% mortality (3 ischemic colitis, 3 ulcerative colitis), secondary to the condition and the extent of the colic involvement. The best factors of the etiological diagnosis of colitis were: the type of onset of the symptoms, the presence of anal or cutaneous lesions, the information provided by endoscopy and histology, which were specific in 11 out of 20 cases. In 5 cases, the diagnosis was only made by examination of the surgical specimen; in 3 cases, the diagnosis remained uncertain. These results suggest that the clinical data combined with an early, minimally traumatizing left endoscopy in elderly patients, should allow a quick, positive and etiological diagnosis of colitis, in order to initiate a suitable treatment in most cases.
Aged↗
Continuous enteral nutrition during the early adaptive stage of the short bowel syndrome.
Sixty-two patients with the short bowel syndrome (30-150 cm) were managed by continuous enteral nutrition (CEN) in the early adaptive phase. In all, 82 per cent were referrals from other units and 85 per cent of referrals had failure of one or more organ systems on admission. There were intra-abdominal abscesses in 41 per cent of patients and 37 per cent had an enterocutaneous fistula. The diet included polysaccharides, medium chain triglycerides and protein hydrolysates, mixed with a high-viscosity tapioca suspension. An elemental diet was used initially in 15 per cent of patients. Thirty-three patients had an interruption of the gastrointestinal tract by a temporary enterostomy. Chyme was re-infused into the distal intestine in 20 cases. 'Zero-time' was taken as the time of operation or, for referred patients treated conservatively, the date of admission. CEN was commenced at a mean of 14 days from zero-time. Total parenteral nutrition could be discontinued at a mean of 36 days and exclusive oral alimentation was resumed at a mean of 87 days. Patients with small bowel longer than 80 cm attained enteral autonomy earlier than patients with a shorter length. Mean faecal volume did not increase following institution of CEN, suggesting tolerance to the high-viscosity diet. In cases with re-infusion of enteric content, the distal circuit (length of distal small intestine 46 cm) was able to absorb 70 per cent of the volume re-infused (mean volume 2700 ml). Body weight and nutritional markers increased significantly during the course of CEN. This study suggests that enteral autonomy can be attained early in the short bowel syndrome, even under challenging conditions. Elemental formulae do not appear to offer a benefit over polymeric diets.
Adolescent↗
[The overwhelmed intestine syndrome].
We studied 54 patients who, after small intestinal resection, developed a massive protracted diarrhea with a daily fecal loss greater than 2 kg, status we defined as the "overwhelmed intestine syndrome" (OIS). Median length of residual small bowel was 120 cm, 19 patients had a definitive stoma (jejunostomy, n = 9; colostomy, n = 10), 26 patients had a provisional jejunostomy. Fecal weight greater than 2 kg was related to enteral hyperalimentation (greater than 3,500 Kcal) in 19 patients (induced OIS) and was clearly independent in 16 others who had fecal weight over 3 kg while receiving approximately 2,000 Kcal (obligatory OIS); the last 19 patients had fecal weight between 2 and 3 kg during normoalimentation. Hypocalcemia and hypomagnesemia were common in the three groups. The other complications were seen mostly in patients with obligatory OIS: in those patients, parenteral nutrition was maintained in 9 cases out of 16 (vs. 0 in other groups), nutritional gain was scanty, sodium equilibrium was difficult to obtain in spite of a large sodium intake (380 mmol/day), hospitalization lasted several months and autonomy via the enteral route could not be achieved in 7 out of the 9 patients with definitive short bowel (vs. 0 in other groups). This study shows that the OIS is an unique functional entity. Complications and prognosis are dependent on the obligatory or induced pattern of the syndrome. Only patients with obligatory OIS require definitive home parenteral nutrition.
Adult↗
[Crohn's disease and enteral feeding: comparative nutritional efficacy of elemental and polymeric nutritive mixtures].
The nutritional development with three types of enteral diets during 28 days, was compared in 45 patients with malnutrition presenting an active Crohn's disease. Enteral feeding consisted of a polymeric mixture (Realmentyl) administered in addition to a normal oral diet in 11 patients; the same mixture was administered alone exclusively to 9 patients, and an elemental diet (Vivonex HN) administered exclusively to 25 patients. The total caloric intake reached, in the three groups, the mean values of 60.2, 36.9 and 33.8 kcal/kg of ideal weight/day, respectively. 33 patients also received steroids. At the end of 28 days of enteral diet, the improvement in the weight and the anthropometric measurements (muscle circumference, triceps skinfold) was significantly more marked (gain of 6.5 kg) with the supplemental polymeric mixture than with exclusive enteral diet, polymeric diet (+/- 2.0 kg) or basic (+1.2 kg). Transferrin and albumin plasma levels increased in all 3 groups, but much faster with the exclusive elemental feeding, in spite of a higher urinary urea excretion in these patients. The overall nutritional development was significantly better with supplemental polymeric feeding, and was identical in the two other groups. These results confirm that the supplemental polymeric enteral feeding is more effective, from the nutrition standpoint. With an exclusive enteral feeding, the nutritional result is appreciably the same, whether the mixture consists of polymers or basic elements.
Adult↗
[Continuous enteral nutrition and short bowel syndrome].
In the short bowel syndrome, enteral nutrition makes it possible to ensure adequate caloric intake, increases absorption, and facilitates intestinal adaptation. In a series of 98 patients with short bowel syndrome, enteral nutrition proved to be well tolerated, effective from a nutritional standpoint and made it possible to maintain digestive feeding alone in 88 cases. The quality of the result is determined by strictly observing the practical applications of this method (slow continuous flow rate, a cautious increase, and administration of electrolyte and mineral supplements).
Adult↗
[Continuous enteral feeding at a digestive intensive care unit].
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Digestive System Diseases↗
[Aid to decision for nutritional support in chronic digestive diseases].
In patients with chronic gastro-intestinal disease, deciding whether or not to provide nutritional support is difficult. The aim of the present study was to develop an objective index to help clinicians to decide which patients should be treated with nutritional support. Two hundred and two patients were studied prospectively. Seventy-one had an inflammatory bowel disease, 51, a malabsorption syndrome, 59, an esophagogastric disorder, and 21, a pancreatic disease. On admission, nutritional status was assessed by anthropometric and biological measurements, and spontaneous oral caloric intake. Clinical assessment of the nutritional condition was performed by an independent observer. Using discriminant analysis, collected data were correlated to the therapeutic outcome of the patient during the 15 days after admission, i. e. whether or not they received nutritional support. Clinical global assessment proved to be the most discriminant variable: 83 p. 100 of the patients were correctly classified. This variable was deleted from further analysis to obtain an objective index, calculated with four variables: mid-arm muscle circumference, body weight, serum albumin, and caloric oral intake expressed as kcal X IBW kg-1 X day-1. The index classified correctly 84 p. 100 of the patients. This study demonstrates that subjective clinical assessment is the best variable to decide whether or not a gastrointestinal patient should receive nutritional support. We suggest that this index might be of help in these situations.
Chronic Disease↗
[Ultrasonic study of gallbladder motility during exclusive continuous enteral feeding].
Total parenteral nutrition may be responsible for gallbladder sludge and lithiasis which might possibly be related to gallbladder bile stasis. Gallbladder motility has not yet been studied during constant-rate enteral nutrition. We performed serial ultrasonographic studies of gallbladder volume and contents in ten patients receiving constant-rate enteral nutrition during 35 +/- 17 days. Each patient had two weekly examinations at 9 AM and 2 PM on the same day. None of the patients developed gallbladder sludge or lithiasis. The gallbladder was frequently seen to be contracted. Mean gallbladder volume during constant-rate enteral nutrition was not significantly different from mean gallbladder volume after Bladex. Individual gallbladder volume changed significantly from one measurement to another. This study showed that gallbladder motility is preserved during constant-rate enteral nutrition. The persistence of gallbladder contractions may prevent the development of biliary sludge ad lithiasis.
Adolescent↗