6.5 Nina, a patient with functional GI disorder / psychological illness
Nina, a 23-year-old woman, is admitted with a chest infection. She weighs 38 kg (height 1.72 m, BMI 13 kg/m2 ). She says her weight is always low and she thinks she should weigh no more than 42 kg. She complains of episodic vomiting, abdominal distention/pain and constipation, and has not menstruated for 5 years. General medical and gastrointestinal investigations have not found a cause though she has been noted to be mildly hypermobile (Beighton score 5). It has become apparent that she eats very little. Nina takes analgesics (including opiates) and antiemetics (including cyclizine) at home. She says she sometimes gets confused and has complained of feeling ‘down’. She wants to go home to finish her course of antibiotics. How should she be treated?
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5. Is there a role for a gastrostomy tube in this instance? What needs to be considered when obtaining consent for the procedure (and who should be involved)?
Nutritional support may be needed for a short time (months) to allow Nina to increase her BMI to an agreed safe level (eg 16 kg/m2 ). If oral intake including supplements is inadequate a nasogastric tube may be tried and failing that a nasojejunal tube. Occasionally if the nasal tube becomes frequently displaced a gastrostomy or jejunostomy may be needed to enable the patient’s nutritional needs to be met.
6. Is there a role for parenteral nutrition?
Generally parenteral nutrition is avoided if there is sufficient functioning gut, though in rare circumstances it is given most commonly as a short-term measure to increase the BMI while avoiding the abdominal pain associated with oral/enteral feeding.
