Current approach to nutritional support in patients with enterocutaneous fistulas

Enterocutaneous fistulas (ECFs) are a severe and potentially life-threatening complication that occurs primarily after abdominal surgery or inflammatory diseases of the gastrointestinal tract, such as Crohn's disease, diverticulitis and complicated forms of ulcerative colitis. ECF is accompanied by pronounced disorders of the water-electrolyte and protein-energy balance, the development of infectious complications, sepsis, as well as severe nutritional insufficiency. The latter is one of the key factors determining the prognosis in this category of patients, significantly affecting the outcome of treatment, the duration of hospitalization, terms of the fistula healing and the mortality rate.

This review examines in detail modern approaches to nutritional support for patients with ECF at various stages of treatment. The article highlights the diagnosis options for nutritional deficiency, including clinical and laboratory parameters, scales for assessing nutritional status and instrumental control options. Special attention is paid to the indications for parenteral, enteral and combined nutrition, the choice of route and composition of nutritional mixtures, as well as the potential use of special substrates (glutamine, omega-3 fatty acids, etc.) to modulate the metabolic response and reduce inflammation.

The data from leading clinical studies on the effectiveness of various nutritional support strategies in patients with enterocutaneous fistulas, including those in specialized centers, are analyzed. The review provides an overview of current recommendations from international expert communities, including ESPEN, ASPEN, the experience of Chinese colleagues and Russian experts. The need for an individualized approach to the choice of nutritional tactics is emphasized, taking into account the localization, the volume of intestinal discharge losses, the general condition of a patient and the phase of the disease.