[Amyotrophyc lateral sclerosis; gastrointestinal complications in home enteral nutrition].

OBJECTIVES: To analyze the complications related to enteral nutritional support in patients with lateral amyotrophic sclerosis included in our home-based mechanical ventilation program (HMVP), with a special emphasis on gastrointestinal complications.

METHOD: Retrospective, descriptive study of the patients included in our HMVP directed by intensive care physicians, by means of systematic review of the medical records (included in a Microsoft Access database) during the period 2004-2011.

RESULTS: In the period 2004-2011, 73 patients with a diagnosis of lateral amyotrophic sclerosis were followed: 34 (46.6%) refused nutritional support through gastrostomy or nasogastric tube, whereas 39 (53.4%) accepted. Twenty (51.3%) of the 39 patients with (home-based nutritional support) were females. The mean age of the patients was 60.6 + 13.4 years (95% CI 56.4-64.8). Diagnoses at the time of inclusion in the HMVP were: LAS, 21 cases (53.8%), and LAS with bulbar impairment 18 (43.1%). 34 patients (87.2%) were fed through percutaneous endoscopic gastrostomy (PEG), 3 (7.7%) through surgical gastrostomy, and 3 (7.7%). PEG was performed at the time of inclusion of the patients in the program, with a mean duration of 222.7 + 356.6 days (95% CI: 110.8-334.7). In patients with LAS, the mean duration was 271.4 + 449.5 days (95% CI: 130.3-412.1), and with LAS and bulbar impairment of 126.4 + 131.3 days (95% CI: 90-172.6). The mean duration of the nasogastric tube was 7.3 + 4.8 months (95% CI: 4-10.6). The mean duration of enteral nutrition was 578.6 + 872.9 days (95% CI: 304.7-852.6). There were complications in 35 patients (89.7%), and no complications occurred in only 4 patients (10.3%) (See table 2). Constipation occurred after initiating EN in 30 patients (76.9%); however, it was already present in 18 of them (60%). The remaining gastrointestinal complications observed were: abdominal bloating (9 patients; 23.1%); abdominal pain (6; 15,.4%); nausea and vomiting (5; 12.8%); diarrhea (3; 7.7%).

CONCLUSIONS: Gastrointestinal complications are the most common ones; constipation stands out as the main problem in patients with LAS and HEN. However it may not be considered as a complication exclusively due to nutritional support since it is also a manifestation in the disease course. The occurrence of granulomas is also common.