Why is enteral nutrition not used more in the U.S?

Because it's not used here often, many doctors aren't very familiar with it (didn't see it during their training) and don't realize how well it works. They're also worried that patients won't comply with the treatment. Most will prescribe it if the patient insists, but they usually won't think to offer it otherwise. Insurance coverage is an issue because enteral nutrition is both food and medical treatment, and health insurers don't cover food so they use that as an excuse to refuse coverage. That said, in some states insurers are required to cover it for patients with Crohn's, and many people are able to obtain coverage in other states by going through the appeals process with their insurer.

I asked my gastro about TPN and he said it's a last resort because the GI tract atrophies and there are nutrition/infection problems.

I don't know what the deal is in the US but I believe there are some similarities in the UK. I say this because the consultant my son had on diagnosis had only just moved to our local hospital from another across the other side of the country. He had good results with enteral nutrition at his previous hospital and so was keen to use it on son. However, coming under a different Primary Care Trust he wasn't sure whether it was permitted, fortunately it was and son was on total enteral nutrition for 7 1/2 weeks, and some 7 months later continues on a bottle a day to supplement his diet/put some weight on.
So I do think it is down to whether the consultant is familiar with it, and although here we do not have to worry about insurance coverage I guess there are similar isues regarding whether the Primary Care Trust will allow it.
Unfortunately son still did need the drugs as well.

The sad thing is that not only is it not covered by health insurance, including medicare and medicaid, but it is not covered by food stamps. I know because I have all 3 and I had to pay so much money out of pocket, when all ready on a severely bad budget. The sad thing was I am unable to digest that. I think it is crazy that neither one of them cover it, especially when people like myself can only depend on that for nutrition needs. Yet, they can cover bad junk foods.

What kind of stuff do doctors prescribe for enteral nutrition -- is it pretty much Ensure or something like that?

Ensure isn't really enteral nutrition. In Ensure, and Boost, and similar products, there are fats, carbs (complex and simple) and proteins, along with some vitamins and minerals, all mixed in water. These are relatively easy to digest - but some digestion is still required to break down the fats, the sugars and carbs, and the proteins.

In a true enteral nutrition supplement, the fats are broken down already; the sugars are broken down already (no complex carbs); and the proteins are broken down to amino acids. No digestion is required - just absorption. The drawback is that when the fats, sugars, and proteins are broken down like this, the taste can be pretty bad, if not downright intolerable, so sometimes these formulations have to be given through a nasogastric tube (straight into the stomach without having to drink them) if the patient can't drink them normally.

By the way, as a side note, enteral nutrition is often confused with parenteral nutrition, as in the posts above. To remedy this confusion, think of it this way: Enteral refers to the small bowel, an example being enteritis (inflammation of small bowel). The prefix par- usually means "around", so in this case, enteral nutrition means using the small bowel, while parenteral nutrition means going around (or bypassing) the small bowel.

beave said...
Ensure isn't really enteral nutrition. In Ensure, and Boost, and similar products, there are fats, carbs (complex and simple) and proteins, along with some vitamins and minerals, all mixed in water. These are relatively easy to digest - but some digestion is still required to break down the fats, the sugars and carbs, and the proteins.

In a true enteral nutrition supplement, the fats are broken down already; the sugars are broken down already (no complex carbs); and the proteins are broken down to amino acids. No digestion is required - just absorption. The drawback is that when the fats, sugars, and proteins are broken down like this, the taste can be pretty bad, if not downright intolerable, so sometimes these formulations have to be given through a nasogastric tube (straight into the stomach without having to drink them) if the patient can't drink them normally.

By the way, as a side note, enteral nutrition is often confused with parenteral nutrition, as in the posts above. To remedy this confusion, think of it this way: Enteral refers to the small bowel, an example being enteritis (inflammation of small bowel). The prefix par- usually means "around", so in this case, enteral nutrition means using the small bowel, while parenteral nutrition means going around (or bypassing) the small bowel.

Thank you beave for clarifying this. Parenteral is nutrition through an IV, for further clarification.

And GDen

I would think that would only last a couple days. I'm guessing you'd need about 6 cans a day, depending on height and weight. I'm not positive though. So you can see why it's pretty much impossible to afford a product like that. If anyone could clarify that would be great.

I think I saw that each bottle or whatever has about 300 calories, so, yep, probably at least 6 per day. Ouch!

Ivy6 -- thanks, lots of good reading.

Oh, or did you mean "ouch" financially?

ivy6 said...
Oh, or did you mean "ouch" financially?

Yes, that! I imagine enteral nutrition is pretty easy on the system physically.

Quick question...

So there's elemental, semi elemental, and polymeric formulas...

Would Ensure and boost be considered a "polymeric" formula? Can't seem to find the answer anywhere.

EDIT- nevermind, Ensure is a polymeric formula...Thanx again Writer/Margaret

Post Edited (Poppysocks) : 8/6/2010 1:29:42 AM (GMT-6)

No, Randy, you were right, Ensure IS an enteral nutrition product. There are even a handful of case reports and studies of its use in patients with Crohn's, but published so long ago that few people remember.