THE ROLE OF THE GASTROENTEROLOGIST IN THE PROVISION OF ARTIFICIAL NUTRITION SUPPORT

Background: Nutrition support is required for the prevention or treatm ent of malnutrition in patients with intestinal failure and those who are unable to eat, Aims: To determine the demands upon gastroenterolog ists for nutrition support, the available resources, and compliance wi th the British Society of Gastroenterology (BSG) guidelines. Method: A questionnaire was circulated to all 483 consultant physician members of the BSG. Results: There were 336 (70%) replies, Fifty-three per cen t of respondents reported malnutrition in 20% or more of their patient s, Seventy-nine per cent of consultants supervised patients on enteral feeding, and 64% supervised parenteral feeding, Feeding jejunostomy w as used by 61% of Teaching Hospital (TH) consultants but only 38% of D istrict General Hospital (DGH) consultants (P < 0.001), Twenty-seven p er cent of respondents headed, or were members of, a nutrition support team (NST). Forty-five and 38% of respondents did not follow written protocols for peripheral and central parenteral nutrition, respectivel y. Fifty-five per cent monitored catheter complications, of whom 44% r eported catheter infections in 5% or more of their patients. Weights o f inpatients were obtained by 76% of DGH consultants and 91% of TH con sultants (P < 0.001). Fifty-eight per cent of respondents did not arra nge for nutritional screening, Ninety-six per cent of consultants coul d access a dietitian, 55% had access to an NST and 36% had a nutrition nurse specialist (NNS), An NNS was available to 57% of TH consultants but only 23% of DGH consultants (P < 0.001). Conclusions: Gastroenter ologists have a major role in nutrition support. Facilities are subopt imal. Observing guidelines may improve nutritional care. These finding s have implications for resources and training.