Review articles
Enteral nutrition: An historical perspective
Hernando García Hernández, MD.1
Technological University of Pereira
Summary
It is a known and ancient biological fact that nutrients are essential for life.
Life can be maintained to the extent that we are an active part of the cycles of nature and integrate into them.
When we cannot maintain a balance between the elements we gain and those we lose, we enter a process of decay that if not stopped leads inexorably to death.
Nutritional support has been one of the aspects underestimated for decades in patients in the hospitalization and intensive care service. In such magnitude that the degree of malnutrition in them reaches alarming figures. Up to 50% incidence in the world, and undernutrition is associated with increased hospital stay, mechanical ventilation time, higher readmission rates, delayed recovery, and lower quality of life. As well as higher hospital costs and mortality.
Although in recent years great advances have been made in enteral therapy, and its determining role in the prognosis and survival of patients has been established, little is known about its beginnings and evolution. Therefore, the objective of this review is to historically analyze various feeding routes, types of diet and enteral nutritional therapy techniques.
Keywords: Enteral feeding, gastric feeding tubes, dietary formulations, chemically defined diet, historical aspects. (Fountain: MeSH).
Abstract
Since ancient times it has been well known that nutrients are essential for life. Life can be sustained only as long as we are integrated into the cycles of nature.
When we cannot maintain balance between the elements we add and those we lose, a process of decay begins and, if not stopped, will continue inexorably until death.
For decades nutritional support has been one of the most underestimated elements of patient care in hospitals, including in intensive care units.
Undernourishment among hospital patients has reached alarming numbers as high as 50% of patients in hospitals around the world.
Undernourishment is associated with increased length of hospital stays, increased mechanical ventilation time, greater number of readmissions, recovery delays, lower patient quality of life, higher levels of mortality, and greater hospital costs.
Although great improvements have been made in enteral feeding in recent years, to the point that it’s determining role in patients’ prognoses and survival is well established, we do not know enough about its beginnings and evolution over time.
For this reason this review analyzes the historical evolution of enteral nutrition, including the feeding routes used, types of diets, and refinements in techniques for enteral nutritional support.
Key words: Enteral feeding; tube feeding; gastric feeding tubes; dietary formulations; chemically defined diet; historical aspects.
Evolution of life and ancient civilizations
Since the very origin of life, nutrition has been a determining factor in the process of evolution. 3.5 billion years ago, prokaryotic cells were nourished by materials from the environment itself, and gradually evolved into more complex organisms capable of feeding on other forms of life. With which they took advantage of organized matter from other microorganisms, constituting the appearance of eukaryotic cells.
450 million years ago plants colonized the earth, and 50 million years later animals diversified, evolved or became extinct, largely in accordance with the availability of food for each species.(1)
But the first documented steps in the attempt to provide nutritional support date back to the year 3,500 BC when, according to Herodotus, in Ancient Egypt, medicines and nutrients were administered through rectal enemas using ceramic or clay tubes covered with animal bladders. (2) Later in the same millennium around 400 BC, the Greeks, including Hippocrates, describe the administration of washes of wine, milk, wheat and barley, through the rectum. (2)
Nutrition and the Modern Age
More recently, around 1500 AD, Arculanus, Ryff and Scultetus described the use of orogastric nutrition, using silver and lead tubes to retrieve chicken bones, fish and other foreign bodies from the esophagus.(3) In 1598, Capivacceus of Venice, attached a tube to the animal bladder for the delivery of nutrients through an oroesophageal tube, and in 1617, Fabricius, administered a nutrient solution into the oral cavity or through a silver nasopharyngeal or nasoesophageal tube in patients with tetanus, saving some patients.(4) Flexible leather probes advanced to the esophagus were introduced by Van Helmont in 1646.
But it was John Hunter in 1790, the first doctor to use an orogastric tube made of a whale bone and covered with eel skin to feed a patient with a swallowing disorder using a mixture of jelly, beaten eggs, milk, sugar and wine. .(3,4)
(Read Also: 20th Century: The revolution of enteral nutrition)
Contemporary age
In the 19th century, various tubes and devices for enteral feeding were described by Dupuytren and Renault.(5,6)
However, despite the effort in the development of feeding tubes, there continued to be a limitation for their administration. And it was the posterior ileus that was generated in patients with intra-abdominal pathology or undergoing surgical procedures.(7) Therefore, nutrition through the rectum continued to be the most popular method of administering enteral nutrition.
In 1878, Brown Sequard described in a patient with severe esophageal spasm the use of feeding through the rectum using 2/3 parts meat and 1/3 pork pancreas for 5-8 days.(8)
The same year, Dr. Kaufmann provided nutrition through rectal enemas to nine patients, seven with esophageal cancer, one with pyloric cancer and one patient with chronic gastric ulcer, with good results achieving an average lifespan of nine months or more.
But the technique became popular when the then president of the United States James A. Garfield, wounded by a gunshot, was fed this way for 79 days with peptonized beef, broth, whiskey and defibrinated blood. This “nutritive enema”(9) was administered every 4 hours, day and night.(9)
Author
1 Hernando García Hernandez. Fellow Critical Medicine and Intensive Care. Adjunct professor at the Technological University of Pereira. San Jorge University Hospital.
Correspondence: nandogark@gmail.com
Received: May 2011
Accepted for publication: May 2011
RMNC 2011; 2(1): 45-53.