Evan Brand Gut Restoration / Better Belly Protocol

Overview

This educational video from ASPEN addresses the indications for enteral nutrition in patients with specific non-gastrointestinal diseases, specifically acute stroke and cystic fibrosis. The presentation features two expert speakers who discuss clinical considerations, assessment, and management strategies for nutritional support in these populations.

Enteral Nutrition in Stroke Patients

Arlene Oscuro, an advanced practice dietitian at the Cleveland Clinic, explains that dysphagia affects 25-50% of acute stroke patients and is a major risk factor for malnutrition and aspiration pneumonia. Early detection through bedside swallow screening and speech pathology evaluation is critical. Nutrition interventions include modified diets, oral supplements, or enteral nutrition support.

• Malnutrition prevalence post-stroke ranges from 6% to 62%, necessitating regular screening and reassessment.
• Enteral nutrition is recommended early via nasogastric tube if swallowing function is unlikely to recover within seven days.
• Post-pyloric feeding is advised for patients with upper GI dysfunction or delayed gastric emptying.
• PEG tube placement is considered for patients with persistent swallowing inability beyond two to four weeks.

A clinical case of a 68-year-old male stroke patient illustrates these principles, including the use of nasogastric feeding and subsequent PEG placement after no improvement in swallowing function.

Enteral Nutrition in Cystic Fibrosis Patients

Brian Strang, a clinical pharmacy specialist at Tucson Medical Center, discusses enteral nutrition indications in pediatric cystic fibrosis patients. Weight loss despite oral intake and supplements signals the need for supplemental enteral nutrition.

• Patients with BMI below the 50th percentile should start supplemental enteral nutrition to support growth.
• Nocturnal enteral feeds via nasogastric tube are the first-line approach for short-term support (usually under three months).
• If BMI remains low after eight weeks of NG feeding, gastrostomy tube placement is considered for long-term support.

The video emphasizes monitoring tolerance and symptoms such as nausea or reflux during enteral feeding.

Source Information

This video is produced by ASPEN and supported by Cardinal Health. The content is based on the ASPEN Consensus Statement 1: Enteral Nutrition Indicated, published in 2022 in the Journal of Parenteral and Enteral Nutrition (JPEN). It provides evidence-based guidance on enteral nutrition indications in non-GI diseases, focusing on practical clinical decision-making and patient care.