Hypothesis: Bolus jejunal feeding via an enteral feeding tube simulates key features of gastric bypass to initiate similar clinical benefits.

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dc.contributor.authorBeale, E.O.
dc.contributor.authorHorowitz, M.
dc.date.issued2022
dc.description.abstractBackground: Therapy for obesity and related comorbidities should be clinically effective, widely available and acceptable, and used in conjunction with an optimized lifestyle. Dieting is widely available and acceptable but has poorly sustained clinical efficacy. By contrast, Roux-en-Y gastric bypass (GB) is highly effective but cost and safety concerns limit widespread use. In this article this we discuss the hypothesis that bolus jejunal feeding (BJ) via an enteral feeding tube simulates key features of GB with the potential for similar clinical benefits. We further hypothesize that a practical manner of providing BJ therapeutically is via an externally inapparent orojejunal feeding tube. Rationale: The first hypothesis is underpinned by the outcomes of research in three fields: 1) investigations into the mechanisms underlying the benefit of GB, 2) studies investigating gastrointestinal physiology and pathophysiology using enteral feeding tubes, and 3) investigations into the mechanism underlying involuntary anorexia and weight loss in clinical situations that entail rapid nutrient delivery to the jejunum. There is compelling evidence that a supraphysiologic rate of delivery of nutrient to the jejunum suppresses appetite and energy intake and improves glucose homeostasis, and that these effects can be achieved non-surgically using an enteral feeding tube. The second hypothesis is supported by clinical demonstration of the feasibility of administering intermittent cycles of bolus feeds via an intraorally anchored feeding tube in ambulatory obese adults. Conclusion: The hypotheses are testable in clinical studies. If validated, BJ could be used to induce the clinical benefits of GB, but without its costs or safety concerns.
dc.description.statementofresponsibilityElizabeth Ogden Beale, Michael Horowitz
dc.identifier.citationNutrition, 2022; 94:111537-1-111537-4
dc.identifier.doi10.1016/j.nut.2021.111537
dc.identifier.issn0899-9007
dc.identifier.issn1873-1244
dc.identifier.orcidHorowitz, M. [0000-0002-0942-0306]
dc.identifier.urihttps://hdl.handle.net/2440/145925
dc.language.isoen
dc.publisherElsevier BV
dc.rights© 2021 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
dc.source.urihttps://doi.org/10.1016/j.nut.2021.111537
dc.subjectJejunal feeding; Gastric bypass; Enteral feeding; Obesity; Diabetes
dc.subject.meshJejunum
dc.subject.meshHumans
dc.subject.meshWeight Loss
dc.subject.meshEnteral Nutrition
dc.subject.meshGastric Bypass
dc.subject.meshIntubation, Gastrointestinal
dc.subject.meshAdult
dc.titleHypothesis: Bolus jejunal feeding via an enteral feeding tube simulates key features of gastric bypass to initiate similar clinical benefits.
dc.typeJournal article
pubs.publication-statusPublished

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