Tube feeding (mainly via the nose into the stomach or directly into the stomach) in people with cystic fibrosis

Review question

We planned to review the evidence about the effects of tube feeding (via either the nose or the stomach) in people with cystic fibrosis.

Background

Cystic fibrosis is an inherited condition which causes damage to the lungs and pancreas (an organ needed to produce chemicals that help to digest food). People with cystic fibrosis often need more calories in order to achieve a good nutritional status because their condition means food is not absorbed well and they burn more energy at rest and when breathing than people who don't have cystic fibrosis. They also often have poor appetites. Supplements are often given via a tube which is either placed through the nose into the stomach (nasogastric feeding) or directly into the stomach (gastrostomy feeding)), often overnight but sometimes during the day too. This type of feeding helps to improve weight gain, nutritional status, lung function and may improve quality of life. This is important as it is known that in cystic fibrosis nutritional status is closely linked to lung function. However, tube feeding is expensive and may also impact on self-esteem and body image. Tubes through the nose may also become dislodged by coughing. Tube feeding may also cause nausea, vomiting and diarrhoea, but these issues are usually resolved by either changing the type of feed, rate of feeding or the way pancreatic enzymes are given.

Search date

We last searched for evidence on: 13 February 2015.

Study characteristics

We found 38 trials in our searches, but none of the trials put volunteers into different treatment groups completely at random comparing the effects of tube feeding to no tube feeding over a period of at least a month. We therefore did not include any trials in this review.

Key results

Ideally, more research is needed to compare tube feeding with oral supplements and with normal diet. New trials should also look at when tube feeding should be started for the best results. These trials may be difficult to run as it may be wrong not to provide people with the extra calories they need, and when they need them, in this way.

Authors' conclusions: 

Supplemental enteral tube feeding is widely used throughout the world to improve nutritional status in people with cystic fibrosis. The methods mostly used, nasogastric or gastrostomy feeding, are expensive and may have a negative effect on self-esteem and body image. Reported use of enteral tube feeding suggests that it results in nutritional and respiratory improvement; but, efficacy has not been fully assessed by randomised controlled trials. It is acknowledged, however, that performing a randomised controlled trial would be difficult due to the ethics of withholding an intervention in a group of patients whose nutritional status necessitates it.

Read the full abstract...
Background: 

Enteral tube feeding is routinely used in many cystic fibrosis centres when oral dietary and supplement intake has failed to achieve an adequate nutritional status. The use of this method of feeding is assessed on an individual basis taking into consideration the patients age and clinical status.

Objectives: 

To examine the evidence that in people with cystic fibrosis, supplemental enteral tube feeding improves nutritional status, respiratory function, and quality of life without significant adverse effects.

Search strategy: 

We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. We also contacted the companies that market enteral feeds and reviewed their databases.

Date of the most recent search of the Group's Cystic Fibrosis Trials Register: 13 February 2015.

Date of the most recent hand search of PubMed and conference abstract books: 13 February 2015.

Selection criteria: 

All randomised controlled trials comparing supplemental enteral tube feeding for one month or longer with no specific intervention in people with cystic fibrosis.

Data collection and analysis: 

The searches identified 38 trials; however, none were eligible for inclusion in this review.

Main results: 

There are no trials included in this review.

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