Intolerance Decision Tree
- 03/12/2021
Video description
Our free multidsciplinary tool for identifying symptoms of feeding intolerance and offering pragmatic guidance for their management. Download it today!
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Nicola Graves
Medical & Scientific Affairs Dietitian, Nestlé Health Science & Intolerance Decision Tree Working Group
“It was a huge privilege to support the specialist working group with this project. GI symptoms can have such a negative impact on patients and their families, and in practice it’s sometimes difficult to identify the cause and find an effective management strategy. I’m excited to see how the tool can be used to support clinical practice and hopefully improve quality of life for patients.”
Keeping the Gut in Mind – Neurological Disorders and GI Intolerance
Described by some as ‘the second brain’, the gut and its connection with neurological disorders is becoming increasingly recognised. Gastrointestinal dysfunction can occur in neurological disorders such as Parkinson’s disease, multiple sclerosis and motor neurone disease, and may be related to the disease itself and the impact of treatments1-4. As patients with neurological diagnoses also account for a significant proportion of home enteral feeding registrations5, this may also have particular relevance for dietetics.
The prevalence of enteral feeding intolerance in this patient group has remained relatively unexplored in comparison to other disease areas. However, in an audit of long-term enterally fed neurology patients, 28% were found to have documented evidence of feeding intolerance6. To explore this further, Nestlé Health Science conducted a survey7 of healthcare professionals attending an educational event, in which respondents estimated 58% of their neurological patients experienced gastrointestinal symptoms. Furthermore, only 10% of respondents felt that they were ‘very confident’ in the management of these symptoms, while 86% felt that best practice guidelines would be helpful.
In view of these findings, Nestlé Health Science established a working group of specialist dietitians and a neuro-gastroenterologist to explore the development of a pragmatic guidance tool for healthcare professionals. Clinical experience and relevant evidence were drawn upon to form consensus opinions, and where there was a lack of supporting data the need for pragmatic guidance based on clinical judgement and best practice was highlighted.
A decision support tool was then designed based on the discussions of the working group.
The tool itself, now converted to a digital format for ease of use, supports multidisciplinary teams to evaluate GI symptoms, identify possible causes, and explore nutritional and medical management options. Using the digital format, it is possible to select the relevant GI symptom and progress through the suggested steps for assessment and management.
References
- Chalazonitis A, Meenakshi R. Enteric Nervous System Manifestations of Neurodegenerative Disease. Brain Res. 2018 August 15; 1693(Pt B): 207–213.
- Fasano A, Visanji N, Liu L, Lang A, Pfeiffer R. Gastrointestinal dysfunction in Parkinson’s disease. Lancet Neurol. 2015; 14: 625–39.
- Toepfer M, Folwaczny C, Klauser A, Riepl RL, Muller-Felber W, Pongratz D. Gastrointestinal dysfunction in amyotrophic lateral sclerosis. Amyotrophic Lateral Sclerosis and Other Motor Neuron Disorders. 2000; 1:1, 15-19.
- Levinthal DJ, Rahman A, Nusrat S, O'Leary M, Heyman R, Bielefeldt K. Adding to the burden: gastrointestinal symptoms and syndromes in multiple sclerosis. Mult Scler Int. 2013;2013:319201. doi:10.1155/2013/319201
- Stratton RJ, Evill RH, Smith TR. BANS Report 2018. Home Enteral Tube Feeding (HETF) in Adults (2010-2015). BAPEN 2018. Available at: https://www.bapen.org.uk/pdfs/reports/bans/bans-report-2018.pdf. Accessed 11/02/2021.
- Parry S. ESPEN Congress. 2016; Poster MON-P098
- Data on File. Nestle Health Science 2017.
- Data on File. Nestle Health Science 2020.