title: Malnutrition in healthcare settings and the role of gastrostomy feeding.
abstract: Malnutrition can adversely affect physical and psychological function, influencing both morbidity and mortality. Despite the prevalence of malnutrition and its associated health and economic costs, malnutrition remains under-detected and under-treated in differing healthcare settings. For a subgroup of malnourished individuals, a gastrostomy (a feeding tube placed directly into the stomach) may be required to provide long-term nutritional support. In this review we explore the spectrum and consequences of malnutrition in differing healthcare settings. We then specifically review gastrostomies as a method of providing nutritional support. The review highlights the origins of gastrostomies, and discusses how endoscopic and radiological advances have culminated in an increased demand and placement of gastrostomy feeding tubes. Several studies have raised concerns about the benefits derived following this intervention and also about the patients selected to undergo this procedure. These studies are discussed in detail in this review, alongside suggestions for future research to help better delineate those who will benefit most from this intervention, and improve understanding about how gastrostomies influence nutritional outcomes.
authors.affiliation: Academic Unit of Gastroenterology,Department of Infection,Immunity and Cardiovascular Disease,University of Sheffield,Sheffield S10 2RX,UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Kurien
authors.affiliation: Department of Gastroenterology,Royal Hallamshire Hospital,Sheffield S10 2JF,UK.
authors.forename: Jake
authors.initials: J
authors.lastname: Williams
authors.affiliation: Academic Unit of Gastroenterology,Department of Infection,Immunity and Cardiovascular Disease,University of Sheffield,Sheffield S10 2RX,UK.
authors.forename: David S
authors.initials: DS
authors.lastname: Sanders
mesh_terms: D035843:Biomedical Research / Q000379:methods / Q000639:trends; D003226:Congresses as Topic; D057210:Delayed Diagnosis; D003704:Dementia / Q000150:complications / Q000628:therapy; D004046:Dietetics / Q000379:methods / Q000639:trends; D004750:Enteral Nutrition / Q000009:adverse effects; D005774:Gastrostomy / Q000009:adverse effects; D006801:Humans; D007902:Length of Stay; D044342:Malnutrition / Q000150:complications / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy*; D019636:Neurodegenerative Diseases / Q000150:complications / Q000628:therapy; D015596:Nutrition Assessment; D052756:Nutritional Sciences / Q000379:methods / Q000639:trends; D009959:Oropharyngeal Neoplasms / Q000150:complications / Q000628:therapy; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012958:Societies, Scientific; D020521:Stroke / Q000150:complications / Q000628:therapy
keywords:  PEG percutaneous endoscopic gastrostomy; Gastrostomy; Hospitals; Malnutrition; Nutrition support