Refeeding syndrome in the gastroenterology practice: how concerned should we be?

source extracted confidence: high 2026-04-09
#gastroenterology #humans #malnutrition #nutritional-status #nutritional-support

Refeeding syndrome in the gastroenterology practice: how concerned should we be?

Nunes et al., 2018 | Eur J Gastroenterol Hepatol | Systematic Review

Citation

Nunes Gonçalo, Brito Mariana, ... Fonseca Jorge. Refeeding syndrome in the gastroenterology practice: how concerned should we be?. Eur J Gastroenterol Hepatol. 2018-Nov;30(11):1270-1276. doi:10.1097/MEG.0000000000001202

Abstract

Clinical nutrition is emerging as a major area in gastroenterology practice. Most gastrointestinal disorders interfere with digestive physiology and compromise nutritional status. Refeeding syndrome (RS) may increase morbidity and mortality in gastroenterology patients. Literature search using the keywords "Refeeding Syndrome", "Hypophosphatemia", "Hypomagnesemia" and "Hypokalemia". Data regarding definition, pathophysiology, clinical manifestations, risk factors, management and prevention of RS were collected. Most evidence comes from case reports, narrative reviews and scarse observational trials. RS results from the potentially fatal shifts in fluid and electrolytes that may occur in malnourished patients receiving nutritional therapy. No standard definition is established and epidemiologic data is lacking. RS is characterized by hypophosphatemia, hypomagnesemia, hypokalemia, vitamin deficiency and abnormal glucose metabolism. Oral, enteral and parenteral nutrition may precipitate RS. Awareness and risk stratification using NICE criteria is essential to prevent and manage malnourished patients. Nutritional support should be started using low energy replacement and thiamine supplementation. Correction of electrolytes and fluid imbalances must be started before feeding. Malnourished patients with inflammatory bowel disease, liver cirrhosis, chronic intestinal failure and patients referred for endoscopic gastrostomy due to prolonged dysphagia present high risk of RS, in the gastroenterology practice. RS should be considered before starting nutritional support. Preventive measures are crucial, including fluid and electrolyte replacement therapy, vitamin supplementation and use of hypocaloric regimens. Gastroenterology patients must be viewed as high risk patients but the impact of RS in the outcome is not clearly defined in current literature.

Key Findings

Gastroenterology patients must be viewed as high risk patients but the impact of RS in the outcome is not clearly defined in current literature.

Outcomes Measured

  • inflammatory markers

Population

Field Value
Population inflammatory bowel disease
Sample Size See abstract
Age Range See abstract
Condition deficiency

MeSH Terms

  • Gastroenterology
  • Humans
  • Malnutrition
  • Nutritional Status
  • Nutritional Support
  • Prognosis
  • Refeeding Syndrome
  • Risk Factors

Evidence Classification

  • Level: Systematic Review
  • Publication Types: Journal Article, Systematic Review
  • Vertical: thiamine

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09