ABSTRACT
The indications for parenteral nutrition should be approached from two points of view. First, does the patient need nutritional support and second, is the parenteral route the preferred way of giving nutrients to the patient? In a number of gastrointestinal diseases keeping the patient nil per os (NPO) results in an improvement of symptoms. This effect is most obvious in patients with Crohn's disease, where this form of therapy is conceptually equivalent to diverting the luminal stream from the inflamed bowel. Cancer is associated with weight loss and in a number of studies it has been shown that weight loss is associated with a poor prognosis. The role of nutritional support in cancer cachexia awaits further trials. Growth retardation is a frequent and unfortunate consequence of Crohn's disease and results in cessation of growth and maturation in adolescents with this condition. Despite the presence of growth retardation, the bowel disease in these patients may not be clinically active.
