Artificial nutrition in italian gastroenterology departments: Correct use and limits

Background: Nutritional status affects the course, ensuing complications and prognosis of virtually all diseases. Aims: The present study was designed to define the role of nutrition in gastroenterology departments by means of two investigations analyzing: a) the availability of devices for assessing nutritional status; b) nutritional treatment in clinical practice: the incidence and frequency of indications for its use, together with the type of treatment adopted. Patients and Methods: Two questionnaires were sent to Italian Academic and Hospital gastroenterology Departments, all with clinical wards. Results: The results obtained refer to 27 Departments, 22 of which took part in both parts of the analysis, enrolling 547 patients during the two weeks of the study. The first analysis shows that clinical nutrition and outpatients nutritional treatment are carried out in 73% of University hospitals and 46% of State hospitals. There are areas devoted specifically to nutritional treatment in 35% of the total departments, while 42% have an operative multidisciplinary nutritional team". The use of artificial nutrition is confirmed in 81% of the departments, preparation of the parenteral nutrition bags being carried out autonomously in 50% of them, by the hospital pharmacy in 39%, by other wards in by other wards in 12% and by private pharmaceutical companies in 12%. Finally, our data show that scales and the statiometer are available everywhere, while more specific tools, such as skinfold calipers are available in 54% of the departments, and calorie intake can be assessed in 22-41%. The second analysis revealed that nutritional treatment was necessary in 50% of patients in the case series examined and that this was taken into account and given in almost all cases (91%). In detail, 69% of the patients treated received dietetic supplementation and 31% artificial nutrition, (12% enteral; 88% parenteral), although supportive parenteral nutrition is often contraindicated in conditions where good bowel function provides the conditions for enteral nutrition. Conclusion: It could be stated that: i) artificial nutrition is commonly used in gastroenterology departments in Italy; ii) the indications for enteral and parenteral nutrition are not always properly respected: There is excessive use of parenteral nutrition and an unjustified resistance to the use of enteral nutrition; iii) nutritional treatment is often given without adequate nutritional assessment confirmed by the relative technological tools. A better awareness of correct practices for nutritional support should be promoted, encouraging both greater use of diagnostic and monitoring techniques and a more discerning choice of the most suitable type of artificial nutrition to be administered in gastroenterology.