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Food and drink pass naturally through the mouth, the stomach and then the intestine.
Mouth → Stomach → Intestine
Understanding nutritional support
When your usual diet no longer sufficiently meets your needs, several solutions exist: oral nutritional supplements, enteral nutrition or parenteral nutrition.
When eating can no longer meet your needs
Gastroparesis can sometimes make food intake insufficient, especially because of early satiety, nausea or vomiting.
When dietary adjustments are no longer enough, different forms of nutritional support can be considered by the medical team.
The aim remains the same: providing enough energy, protein, nutrients and fluids.
Different ways to support nutritional intake
The solution chosen depends on the medical situation, nutritional needs, tolerance and whether the digestive tract can be used.
ONS
Oral nutritional supplements boost intake while still eating and drinking by mouth.
Supplement → By mouth
Enteral nutrition
A nutritional formula is given directly into the digestive tract through a tube.
Tube → Digestive tract
Parenteral nutrition
Nutrients are given intravenously, directly into the bloodstream.
Intravenous line → Blood
This diagram does not show a compulsory progression. The nutritional strategy is tailored to each person and can change over time.
Oral nutritional supplements (ONS)
Oral nutritional supplements are nutritional products designed to provide more energy, protein and other nutrients in a small volume.
They may be offered when usual eating cannot meet needs sufficiently, while still eating by mouth.
They come in different forms and textures, notably drinks or cream-type preparations, to suit needs and tolerance.
Enteral nutrition
Enteral nutrition means giving a liquid nutritional formula directly into the digestive tract through a tube.
In some severe forms of gastroparesis, nutrition can be delivered directly into the small intestine to bypass the stomach.
Different devices can be used depending on the situation and how long nutritional support is expected to last.
Understanding the main access routes
The name of a tube depends in particular on its route and where its tip delivers the nutrition.
1
Nose / mouth
2
Stomach
3
Jejunum
Part of the small intestine
Naso-enteric tube
A tube inserted through the nose can reach the stomach or be advanced into the small intestine, depending on its purpose and position.
A tube that reaches the intestine makes it possible to bypass the stomach when giving nutrition.
Gastrostomy
A tube passes through the abdominal wall directly into the stomach. It is often placed by endoscopy.
In gastroparesis, it is mainly used to empty the stomach (decompression) to relieve nausea and vomiting, and more rarely for feeding.
Jejunostomy
A jejunostomy tube goes through the abdominal wall directly into the jejunum, a part of the small intestine.
Nutrition is thus delivered beyond the stomach.
Gastro-jejunostomy
Some devices have both a gastric access and a jejunal access.
Depending on the device and the medical indication, the jejunal part can be used for feeding while the gastric access can be used for venting (decompression).
Why bypass the stomach?
The path of food, in pictures
- The stomach empties far too slowly: food sits there.
- This can cause nausea, vomiting, bloating and a feeling of being full very quickly.
- Too few nutrients reach the intestine, where they are absorbed: risk of weight loss and malnutrition.
- Nutrition flows through a tube, at a rate set by the care team.
- It arrives directly in the jejunum, the part of the small intestine where nutrients are absorbed.
- The stomach is bypassed: intake no longer depends on how it empties.
Simplified diagram. Depending on the device, the tube can go through the nose, through the stomach (gastro-jejunostomy) or directly through the abdominal wall into the jejunum (jejunostomy).
Bypassing the stomach does not mean treating gastroparesis. Jejunal feeding supports nutritional intake when it is indicated, but it does not necessarily make the other symptoms of the condition go away.
How enteral nutrition is given
The formula used, the rate and the duration are decided by the care team according to needs and tolerance.
Nutritional formula
Enteral nutrition products provide energy and nutrients in a controlled amount.
Feeding pump
A pump can deliver nutrition at a set rate over several hours.
Individual adjustment
The arrangements are prescribed and adapted to each person’s needs and tolerance.
In practice, at home (in France)
- A medical prescription: home enteral or parenteral nutrition is set up on prescription, often after an assessment in hospital.
- A home healthcare provider delivers the equipment (pump, bags, tubing), installs it and teaches you how to use it.
- A nurse can come to your home for some care, especially for an intravenous line.
- Costs: on prescription, the equipment and products are generally reimbursed by the French national health insurance (Assurance maladie).
- Specialist centres: long-term home parenteral nutrition is usually followed by an approved expert centre, which trains the patient and coordinates care.
- Travelling, going on holiday: it is often possible with advance planning with your team and your home-care provider (equipment delivered on site, prescriptions and medical letter, permission for flying). The association La Vie par un Fil ↗ shares lots of practical tips.
Parenteral nutrition
Parenteral nutrition does not use the digestive tract. Nutrients are given intravenously, directly into the bloodstream.
In severe gastroparesis, it may be considered when other treatments and other forms of nutritional support cannot sufficiently meet needs.
Depending on the situation, it may be used temporarily or for longer.
ONS, enteral or parenteral?
ONS
ENTERAL
PARENTERAL
Route
Mouth
Digestive tract
Intravenous
Form
Oral nutritional product
Formula given through a tube
Intravenous nutritional solution
Digestive tract
Used normally
Used
Bypassed
Aim
Supplementing intake
Delivering nutrients through the digestive tract
Delivering nutrients directly into the blood
ONS
- Route
- Mouth
- Form
- Oral nutritional product
- Digestive tract
- Used normally
- Aim
- Supplementing intake
Enteral
- Route
- Digestive tract
- Form
- Formula given through a tube
- Digestive tract
- Used
- Aim
- Delivering nutrients through the digestive tract
Parenteral
- Route
- Intravenous
- Form
- Intravenous nutritional solution
- Digestive tract
- Bypassed
- Aim
- Delivering nutrients directly into the blood
There is no “best” route in absolute terms. The strategy depends on the medical situation, nutritional needs, how long support is expected to last and whether the digestive tract can be used.
Monitoring is part of the treatment
Medical nutritional support requires follow-up to assess its effectiveness, tolerance and changes in needs.
Nutritional status
Weight, intake and certain clinical or biological parameters are monitored depending on the situation.
Tolerance
Feeding arrangements may need adjusting according to tolerance and needs.
Device
A tube or an intravenous line requires appropriate care and monitoring.
Changes
Needs can change and nutritional support can be reassessed over time.
When to call?
- Fever or chills with an intravenous catheter: this is an emergency (risk of infection). Call the team that follows you straight away, or 15 (in France).
- Tube pulled out or moved: do not put it back yourself, and contact the care team or your provider straight away, without waiting until the next day.
- Blocked tube: never force it; contact the care team or your provider.
- Redness, pain or discharge around the tube or catheter, unusual vomiting or pain: seek medical advice.
In an emergency (France): call 15 or 112. Our “I’m going to A&E” sheet (PDF, in French) ↗
Nutritional support can also change daily life
A tube or an intravenous line also changes everyday life.
Organising care, equipment, getting around, sleep, clothing, going out and how others see you can also be affected.
It may take time to learn how to use the equipment and find a routine that fits with daily life.
Sources
NIDDK — National Institutes of Health
Treatment of gastroparesis and nutritional support
→
ESPEN
Guidelines on clinical, enteral and parenteral nutrition
→
La Vie par un Fil
Association for people on artificial nutrition and their loved ones (in French)
→
Important information
This page provides general information. It cannot determine which form of nutritional support is right for a person.
The indication, choice of device, composition of the nutrition and how it is given are decided by a medical and nutrition team.
Also worth reading
Our other pages on gastroparesis, diet and the care pathway.