Enteral feeding without pancreatic stimulation distal jejunal feeding

A recent publication of our findings [58] has supported the results of an earlier study from Holland [59] that it is possible to use enteral feeding without stimulating the pancreas, if the infusion is delivered 40-60 cm down the jejunum. This makes physiological sense, as there has to be a null point in between the duodenum, where feeding stimulates through cholinergic reflexes and CCK release [60, 61] and the ileum where feeding inhibits via the ileal brake mechanism [62]. We have shown that this distance is easy to achieve in clinical practice with tube systems that are commercially available [58] (Fig. 5.6). There is extensive literature that the presence of nutrients (in particular long chain fatty acids [63, 64], carbohydrate [63] and amino acids [65]) in the ileum suppresses pancreatic secretion in humans, principally through release of GLP-I and PYY from ileal L-cells and neurotensin

Influence of Feed Complexity and Feeding Position on Trypsin Secretory Response 900 -|Box Plot ^

Grouping Variable(s): subgroup

700 600 500

f 400 300 200 100 0

Influence of Feed Complexity and Feeding Position on Trypsin Secretory Response 900 -|Box Plot ^

Grouping Variable(s): subgroup

Fig. 5.6. Influence of feed complexity and feeding position on the pancreatic secretory response to feeding in healthy volunteers [58].

from N-cells [66]. Activation of the ileal brake in this way may have the additional benefit of inhibiting gastric acid secretion [62] and the need for NG decompression. Finally, it must be remembered that although the glycemic response to enteral feeding is lower than that to PN [29], hyperglycemia can still occur due to islet cell damage, and that the more effective the mode of enteral feeding, the greater the risk of hyperglycemia. Consequently, all forms of feeding must be closely monitored, with judicious use of insulin to control hyperglycemia.

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