The Effect of Enteral Tube Feeding on Patients' Health-Related Quality of Life: A Systematic Review

Omorogieva Ojo, Edel Keaveney, Xiao-Hua Wang, Ping Feng, Omorogieva Ojo, Edel Keaveney, Xiao-Hua Wang, Ping Feng

Abstract

Patients with functional gastrointestinal tract who are unable to meet their nutritional requirements may benefit from the use of enteral nutrition via feeding tubes which could be nasogastric, percutaneous endoscopic gastrostomy and jejunostomy. Although enteral tube feeding has been shown to promote nutritional status, improve wound healing, and enhance patients' quality of life (QoL), evidence of tube and feed complications and reduced QoL has also been reported. Despite the increasing prevalence of patients on enteral tube feeding, no systematic review examining the role of enteral tube feeding on patients' QoL appears to have been published.

Aim: The aim of this systematic review is to evaluate the effect of enteral tube feeding on patients' QoL.

Method: Three databases (EMBASE, Pubmed, and PsycINFO) plus Google Scholar were searched for relevant articles based on the Population, Intervention, Comparator, Outcomes (PICO) framework. The review was in line with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines and involved the use of synonyms and medical subject headings. In addition, search terms were combined using Boolean operators (AND/OR) and all the articles retrieved were exported to EndNote for de-duplication.

Results: Fourteen articles which met the criteria were included and three distinct areas were identified: the effect of early versus late enteral tube feeding on QoL; the QoL of patients on gastrostomy versus standard care, and the effect of enteral tube feeding on QoL. Overall, nine studies reported improvement in the QoL of patients on enteral tube feeding, while five studies demonstrated either no significant difference or reduction in QoL. Some factors which may have influenced these outcomes are differences in types of gastrostomy tubes, enteral feeding methods (including time patients spent connected to enteral feed/pump), and patients' medical conditions, as well as the generic and/or type of QoL measuring instrument used.

Conclusion: Most reviewed studies suggest that enteral tube feeding is effective in improving patients' QoL. The use of enteral tube feeding-specific QoL measuring instruments is recommended for future research, and improved management strategies including use of mobile enteral feeding pumps should further enhance patients' QoL. More studies on the effect of delivery systems/enteral feeding pumps on QoL are needed as research in this area is limited.

Keywords: QoL; Quality of life; enteral feed; enteral nutrition; enteral tube feeding; home enteral nutrition; patients; systematic review.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Prisma flow chart.

References

    1. Ojo O. The challenges of home enteral tube feeding: A global perspective. Nutrients. 2015;7:2524–2538. doi: 10.3390/nu7042524.
    1. Best C., Hitchings H. Enteral tube feeding–From hospital to home. Br. J. Nurs. 2010;19:174. doi: 10.12968/bjon.2010.19.3.46540.
    1. Dennis M.S., Lewis S.C., Warlow C. Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): A multicentre randomised controlled trial. Lancet. 2005;365:764–772.
    1. Rowat A. Malnutrition and dehydration after stroke. Nursing Stand. 2011;26:42–46. doi: 10.7748/ns.26.14.42.s49.
    1. Rowat A. Enteral tube feeding for dysphagic stroke patients. Br. J. Nurs. 2015;24:138–144. doi: 10.12968/bjon.2015.24.3.138.
    1. Lim M.L., Yong B.Y.P., Mar M.Q.M., Ang S.Y., Chan M.M., Lam M., Lopez V. Caring for patients on home enteral nutrition: Reported complications by home carers and perspectives of community nurses. J. Clin. Nurs. 2018;27:2825–2835. doi: 10.1111/jocn.14347.
    1. Chen S., Xian W., Cheng S., Zhou C., Zhou H., Feng J., Chen L. Risk of regurgitation and aspiration in patients infused with different volumes of enteral nutrition. Asia Pac. J. Clin. Nutr. 2015;24:212–218. doi: 10.6133/apjcn.2015.24.2.12.
    1. Löser C., Aschl G., Hébuterne X., Mathus-Vliegen E.M.H., Muscaritoli M., Niv Y., Skelly R.H. ESPEN guidelines on artificial enteral nutrition-percutaneous endoscopic gastrostomy (PEG) Clin. Nutr. 2005;24:848–861.
    1. Bernstein O.A., Campbell J., Rajan D.K., Kachura J.R., Simons M.E., Beecroft J.R., Tan K.T. Randomized Trial Comparing Radiologic Pigtail Gastrostomy and Peroral Image-Guided Gastrostomy: Intra- and Postprocedural Pain, Radiation Exposure, Complications, and Quality of Life. J. Vasc. Interv. Radiol. 2015;26:1680–1686. doi: 10.1016/j.jvir.2015.07.012.
    1. Magné N., Marcy P.Y., Foa C., Falewee M.N., Schneider M., Demard F., Bensadoun R.J. Comparison between nasogastric tube feeding and percutaneous fluoroscopic gastrostomy in advanced head and neck cancer patients. Eur. Arch. Oto-Rhino-Laryngol. 2001;258:89–92. doi: 10.1007/s004050000311.
    1. Ojo O., Brooke J. Recent Advances in Enteral Nutrition. Nutrients. 2016;8:709. doi: 10.3390/nu8110709.
    1. Bourgault A.M., Ipe L., Weaver J., Swartz S., O’Dea P.J. Development of evidence-based guidelines and critical care nurses’ knowledge of enteral feeding. Crit. Care Nurse. 2007;27:17–29.
    1. Ojo O., Brooke J. Evaluation of the Role of Enteral Nutrition in Managing Patients with Diabetes: A Systematic Review. Nutrients. 2014;6:5142–5152. doi: 10.3390/nu6115142.
    1. Wang G., Chen H., Liu J., Ma Y., Jia H. A comparison of postoperative early enteral nutrition with delayed enteral nutrition in patients with esophageal cancer. Nutrients. 2015;7:4308–4317. doi: 10.3390/nu7064308.
    1. Altomare R., Damiano G., Abruzzo A., Palumbo V.D., Tomasello G., Buscemi S., Lo Monte A.I. Enteral Nutrition Support to Treat Malnutrition in Inflammatory Bowel Disease. Nutrients. 2015;7:2125–2133. doi: 10.3390/nu7042125.
    1. Wanden-Berghe C., Nolasco A., Sanz-Valero J., Planas M., Cuerda C. Health-related quality of life in patients with home nutritional support. J. Hum. Nutr. Diet. 2009;22:219–225. doi: 10.1111/j.1365-277X.2009.00957.x.
    1. Govindaraju T., Sahle B.W., McCaffrey T.A., McNeil J.J., Owen A.J. Dietary Patterns and Quality of Life in Older Adults: A Systematic Review. Nutrients. 2018;10:971. doi: 10.3390/nu10080971.
    1. EQ-5D Health Questionnaire. [(accessed on 31 December 2018)]; Available online: .
    1. Mandy van Reenen and Bas Janssen (2015) EQ-5D-5L User Guide Basic Information on How to Use the EQ-5D-5L Instrument Version 2.1. [(accessed on 31 December 2018)]; Available online: .
    1. World Health Organisation (1996) WHOQOL-BREF Introduction, Administration, Scoring and Generic Version of the Assessment. [(accessed on 20 December 2018)]; Available online: .
    1. Cuerda M.C., Apezetxea A., Carrillo L., Casanueva F., Cuesta F., Irles J.A., Lizan L. Development and validation of a specific questionnaire to assess health-related quality of life in patients with home enteral nutrition: NutriQoL(R) development. Patient Prefer. Adher. 2016;10:2289–2296. doi: 10.2147/PPA.S110188.
    1. Day T. Home enteral feeding and its impact on quality of life. Br. J. Community Nurs. 2017;22:S14–S16. doi: 10.12968/bjcn.2017.22.Sup7.S14.
    1. White H., King L. Enteral feeding pumps: Efficacy, safety, and patient acceptability. Med. Dev. Evid. Res. 2014;7:291–298. doi: 10.2147/MDER.S50050.
    1. Arevalo-Manso J.J., Martinez-Sanchez P., Juarez-Martin B., Fuentes B., Ruiz-Ares G., Sanz-Cuesta B.E., Parrilla-Novo P., Diez-Tejedor E. Enteral tube feeding of patients with acute stroke: When does the risk of diarrhoea increase? Int. Med. J. 2014;44:1199–1204. doi: 10.1111/imj.12586.
    1. Moher D., Liberati A., Tetzlaff J., Altman D.G., Prisma G. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. BMJ. 2009;339:b2535. doi: 10.1136/bmj.b2535.
    1. Baker J., Janda M., Graves N., Bauer J., Banks M., Garrett A., Nicklin J.L. Quality of life after early enteral feeding versus standard care for proven or suspected advanced epithelial ovarian cancer: Results from a randomised trial. Gynecol. Oncol. 2015;137:516–522. doi: 10.1016/j.ygyno.2015.03.048.
    1. Bannerman E., Pendlebury J., Phillips F., Ghosh S. A cross-sectional and longitudinal study of health-related quality of life after percutaneous gastrostomy. Eur. J. Gastroenterol. Hepatol. 2000;12:1101–1109. doi: 10.1097/00042737-200012100-00006.
    1. Critical Appraisal Skills Programme (CASP) CASP Checklists. [(accessed on 8 February 2019)];2018 Available online:
    1. Morton R.P., Crowder V.L., Mawdsley R., Ong E., Izzard M. Elective gastrostomy, nutritional status and quality of life in advanced head and neck cancer patients receiving chemoradiotherapy. ANZ J. Surg. 2009;79:713–718. doi: 10.1111/j.1445-2197.2009.05056.x.
    1. Hossein S.M., Leili M., Hossein A.M. Acceptability and outcomes of percutaneous endoscopic gastrostomy (PEG) tube placement and patient quality of life. Turk. J. Gastroenterol. 2011;22:128–133. doi: 10.4318/tjg.2011.0180.
    1. Kurien M., Andrews R.E., Tattersall R., McAlindon M.E., Wong E.F., Johnston A.J., Sanders D.S. Gastrostomies Preserve But Do Not Increase Quality of Life for Patients and Caregivers. Clin. Gastroenterol. Hepatol. 2017;15:1047–1054. doi: 10.1016/j.cgh.2016.10.032.
    1. Rogers S.N., Thomson R., O’Toole P., Lowe D. Patients experience with long-term percutaneous endoscopic gastrostomy feeding following primary surgery for oral and oropharyngeal cancer. Oral. Oncol. 2007;43:499–507. doi: 10.1016/j.oraloncology.2006.05.002.
    1. Salas S., Baumstarck-Barrau K., Alfonsi M., Digue L., Bagarry D., Feham N., Zanaret M. Impact of the prophylactic gastrostomy for unresectable squamous cell head and neck carcinomas treated with radio-chemotherapy on quality of life: Prospective randomized trial. Radiother. Oncol. 2009;93:503–509. doi: 10.1016/j.radonc.2009.05.016.
    1. Donohoe C.L., Healy L.A., Fanning M., Doyle S.L., Hugh A.M., Moore J., Reynolds J.V. Impact of supplemental home enteral feeding postesophagectomy on nutrition, body composition, quality of life, and patient satisfaction. Dis. Esophagus. 2017;30:1–9. doi: 10.1093/dote/dox063.
    1. Guo Z., Wu R., Zhu W., Gong J., Zhang W., Li Y., Li J. Effect of exclusive enteral nutrition on health-related quality of life for adults with active Crohn’s disease. Nutr. Clin. Pract. 2013;28:499–505. doi: 10.1177/0884533613487218.
    1. Loeser C., von Herz U., Kuchler T., Rzehak P., Muller M.J. Quality of life and nutritional state in patients on home enteral tube feeding. Nutrition. 2003;19:605–611. doi: 10.1016/S0899-9007(02)01072-9.
    1. Roberge C., Tran M., Massoud C., Poiree B., Duval N., Damecour E., Henry-Amar M. Quality of life and home enteral tube feeding: A French prospective study in patients with head and neck or oesophageal cancer. Br. J. Cancer. 2000;82:263–269. doi: 10.1054/bjoc.1999.0913.
    1. Schneider S.M., Pouget I., Staccini P., Rampal P., Hebuterne X. Quality of life in long-term home enteral nutrition patients. Clin. Nutr. 2000;19:23–28. doi: 10.1054/clnu.1999.0068.
    1. Wu Z., Wu M., Wang Q., Zhan T., Wang L., Pan S., Chen G. Home enteral nutrition after minimally invasive esophagectomy can improve quality of life and reduce the risk of malnutrition. Asia. Pac. J. Clin. Nutr. 2018;27:129–136.
    1. Zeng J., Hu J., Chen Q., Feng J. Home enteral nutrition’s effects on nutritional status and quality of life after esophagectomy. Asia. Pac. J. Clin. Nutr. 2017;26:804–810.
    1. Kumar S., Langmore S., Goddeau R.P., Jr., Alhazzani A., Selim M., Caplan L.R., Schlaug G. Predictors of percutaneous endoscopic gastrostomy tube placement in patients with severe dysphagia from an acute-subacute hemispheric infarction. J. Stroke Cerebrovasc. Dis. Off. J. Natl. Stroke Assoc. 2012;21:114–120. doi: 10.1016/j.jstrokecerebrovasdis.2010.05.010.
    1. National Institute for Health and Care Excellence (2006) Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. [(accessed on 1 March 2019)]; Available online: .
    1. Dunn S. Maintaining adequate hydration and nutrition in adult enteral tube feeding. Br. J. Community Nurs. 2015;20:S16–S23. doi: 10.12968/bjcn.2015.20.Sup6a.S16.
    1. Kurien M., White S., Simpson G., Grant J., Sanders D.S., McAlindon M.E. Managing patients with gastrostomy tubes in the community: Can a dedicated enteral feed dietetic service reduce hospital readmissions? Eur. J. Clin. Nutr. 2012;66:757–760. doi: 10.1038/ejcn.2012.19.
    1. Reeves A., White H., Sosnowski K., Leveritt M., Desbrow B., Jones M. Multidisciplinary evaluation of a critical care enteral feeding algorithm. Nutr. Diet. 2012;69:242–249. doi: 10.1111/j.1747-0080.2012.01598.x.
    1. Apezetxea A., Carrillo L., Casanueva F., Cuerda C., Cuesta F., Irles J.A., Virgili M.N., Layola M., Lizán L. The NutriQoL questionnaire for assessing health related quality of life (HRQoL) in patients with home enteral nutrition (HEN): Validation and first results. Nutr. Hosp. 2016;33:1260–1267. doi: 10.20960/nh.769.
    1. Martin L., Blomberg J., Lagergren P. Patients’ perspectives of living with a percutaneous endoscopic gastrostomy (PEG) BMC Gastroenterol. 2012;12:126. doi: 10.1186/1471-230X-12-126.
    1. Alivizatos V., Gavala V., Alexopoulos P., Apostolopoulos A., Bajrucevic S. Feeding Tube-related Complications and Problems in Patients Receiving Long-term Home Enteral Nutrition. Indian J. Palliat. Care. 2012;18:31–33. doi: 10.4103/0973-1075.97346.
    1. Apezetxea A., Carrillo L., Casanueva F., de la Cuerda C., Cuesta F., Irles J.A., Lizán L. Rasch analysis in the development of the NutriQoL(R) questionnaire, a specific health-related quality of life instrument for home enteral nutrition. J. Patient Rep. Outcomes. 2018;2:25. doi: 10.1186/s41687-018-0050-9.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera