Gastrointestinal obstruction by solidification of enteral nutrition: a result of impaired digestion in critically ill patients

Objective Solidification of enteral nutrition may cause gastrointestinal obstruction with severe complications. The effect of the composition of enteral nutrition on the tendency of casein to coagulate is increasingly acknowledged and new formulas may prevent solidification. To identify patients in need for specific enteral nutrition, we need to know the clinical risk factors for the development of gastrointestinal obstruction by the solidification of enteral nutrition. Methods The 58 cases summarized in this review were identified through a PubMed search. Results Critically ill patients have several risk factors, including an impaired digestion, and treatment with medication that interfere with gastrointestinal function. Surgery of the upper gastrointestinal tract is thought to be the most important risk factor, leading to changes in anatomical structure, secretion of digestive enzymes, and neurohormonal function of the gastrointestinal tract. Conclusion Awareness of risk factors in critically ill patients may help intensivists and surgeons take appropriate measures to prevent this complication. Critically ill patients with an impaired digestion (e.g. Whipple surgery), should be considered for alternative enteral nutrition formulas with non-coagulating proteins or hydrolysed proteins.