Nutrition support in gastroenterology has traditionally favored the use of the gastrointestinal tract when possible. The review summarizes the prevailing paradigm: enteral nutrition is historically preferred because of its physiologic advantages, while parenteral nutrition has been reserved for situations in which enteral feeding is contraindicated or unable to meet nutritional needs. The authors frame recent advances in nutrition support as prompting a reassessment of when and how parenteral strategies should be used alongside or instead of enteral feeding.
The article is an opinion-style synthesis of current literature across several gastrointestinal disease states, emphasizing evidence that has emerged regarding indications, timing, and outcomes associated with each route of nutrition support. The review highlights both population-specific findings and broader practice themes relevant to clinicians managing patients with digestive diseases.
The review discusses evidence supporting enteral feeding across multiple clinical contexts. When the gastrointestinal tract is usable, enteral feeding remains the recommended initial approach due to physiological benefits. In inflammatory bowel disease (IBD), the authors note that exclusive enteral nutrition has demonstrated effectiveness for inducing remission and promoting mucosal healing; this positions enteral strategies as disease-modifying in select IBD scenarios.
In oncologic settings and in perioperative care, enteral nutrition continues to be preferred when feasible, although the review acknowledges that primary disease- or treatment-related gastrointestinal dysfunction can limit the ability to use the enteral route. The review does not provide detailed protocols or dosing specifics for enteral feeds but underscores the ongoing value of enteral access when tolerated.
Parenteral nutrition is identified in the review as an important alternative or adjunct in specific patient populations. Recent findings summarized include evidence that, in gastric cancer, parenteral nutrition may improve nutritional status and clinical outcomes related to treatment-associated gastrointestinal dysfunction. The authors emphasize that parenteral nutrition remains the preferred option in settings of intestinal failure and in severe complications where enteral feeding is not possible.
The review refrains from prescribing uniform criteria for initiation but highlights that parenteral strategies should be considered when enteral routes are contraindicated or insufficient to meet needs. The publication cites broader literature supporting parenteral nutrition as a necessary component of care in certain disease-specific circumstances.
A recurring theme in the review is the role of early parenteral nutrition when enteral nutrition is contraindicated or insufficient. The authors summarize studies showing the value of initiating parenteral nutrition earlier in such situations, specifically noting improvements in nutrient delivery and reductions in complications among critically ill and surgical patients where enteral feeding could not be used or proved inadequate.
While the review highlights benefits observed with earlier parenteral support in these contexts, it does not provide granular timing thresholds or protocolized regimens; instead, it presents the evidence as supportive of a clinical approach that prioritizes adequate nutrient delivery and complication reduction when enteral feeding is not viable.
The review identifies several practical areas of ongoing interest and investigation. These include optimal caloric and protein dosing for diverse patient populations and the increasing attention given to physiologic measurement tools such as indirect calorimetry to individualize energy prescription.
The authors underscore that refinement of dosing strategies and use of objective metabolic assessment remain active areas for research and practice development. The review does not specify dosing algorithms but signals the importance of these considerations for tailoring nutrition support to individual patient needs.
Another area highlighted in the review is the interaction between nutrition support and the gut microbiome. The authors point to emerging interest in how enteral and parenteral modalities may differentially affect microbial communities and how these effects could, in turn, influence clinical outcomes.
Specific mechanistic details or study results are not detailed in the abstract, but the review lists microbiome effects among the topics warranting further study and consideration when designing nutrition interventions in gastrointestinal disease.
The central conclusion of the review is endorsement of a patient-centered approach to nutrition support. The authors maintain that enteral nutrition should remain the first-line preference when the gastrointestinal tract can be utilized, while recognizing parenteral nutrition as an important alternative or adjunct for select populations, including those with intestinal failure, severe complications, or treatment-related dysfunction that precludes enteral feeding.
Future research priorities highlighted by the authors include refinement of supplemental parenteral nutrition practices and development of evidence-based, disease-specific approaches. The review calls for additional studies to clarify optimal timing, dosing, and modalities across patient groups and to further elucidate the clinical implications of nutrition-related effects on the gut microbiome.
Source citation: Rianna Deringer, Camila Schmeil Silva, Daniel Klein. Nutrition support in gastroenterology: opinion on current literature. Curr Opin Gastroenterol. Online ahead of print. PMID 42681978. DOI 10.1097/MOG.0000000000001194.