A REVIEW OF THE NUTRITIONAL MANAGEMENT OF CHYLE LEAKAGE IN ADULTS

Background: Dietitians at the Oxford Radcliffe Hospital encountering t he problem of chyle leakage found a lack of information regarding its dietetic management. This study was undertaken to review the literatur e and to survey current dietetic practice and medical opinion in the U K. Methods: A postal survey of dietitians and clinicians in relevant s pecialities at hospitals involved in the clinical training of dietetic students (n=110) was undertaken. The dietitians' questionnaire examin ed knowledge and experience of chyle leakage, types of patients treate d, dietary therapies employed, responsibilities for prescriptions and outcomes. A different questionnaire was used to assess clinician's opi nions on appropriate management. Results: A link between the origin of chyle leakage and the effectiveness of conservative management became apparent from the literature review. Conservative management appears to be most effective in chyle leakage associated with head and neck su rgery, and least effective when chyle leakage is associated with malig nancy. Completed questionnaires were received from 336 dietitians in 9 0 training departments and 132 clinicians. Dietitians reported the use of a number of dietary therapies, including low-fat diets. These rang ed from minimal long chain triglycerides (LCT) to 'standard' low-fat d iets. These were sometimes used in conjunction with medium chain trigl ycerides (MCT). The use of total parenteral nutrition (TPN) was also r eported, either alone or in combination with a 'low-fat diet'. No clea r pattern emerged as to when a particular therapy was indicated or sho uld be revised. More than 70% of respondents to the medical survey con sidered there to be a role for conservative management in the treatmen t of chyle leakage. TPN appeared to be slightly favoured over minimal- fat (LCT) diet. Dietitians are hampered by the lack of consensus about the optimum nutritional therapy for this condition. This was reflecte d in the wide variation in the composition of reported dietary regimen s. The majority of dietitians who had treated such patients reported t he use of 'low-fat' diets, but only 5 (13%) respondents specified a le vel of fat restriction. Conclusions: The literature suggests that TPN may be the most effective treatment for reducing chyle no iv. However, given the risks of TPN an initial trial of minimal-fat (LCT) diet plu s MCT is warranted. The need for readily accessible practice guideline s for dietitians is apparent.