REVIEW ARTICLE Nutritional support in patients with gastrointestinal fistula F. Yanar • H. Yanar Received: 17 February 2011 / Accepted: 28 February 2011 / Published online: 19 April 2011 Ó Springer-Verlag 2011 Abstract Gastrointestinal fistulas (GIFs) arise as a com- plication of the surgical treatment of a number of malig- nant and non-malignant diseases. Fluid loss and electrolyte and nutritional imbalance are related to increased mor- bidity and mortality in these patients. A multidisciplinary approach under the leadership of the surgeon is essential for successful therapy. Because complication rates are higher in malnourished patients with fistulas, enteral or total parenteral nutritional (TPN) support should be initi- ated after the patient has been stabilized with respect to fluid loss, acid–base, and sepsis. Pharmacotherapy with somatostatin and octreotide has been shown to reduce fis- tula output and shorten closure time. Keywords Gastrointestinal fistula Á Enterocutaneous fistula Á Nutrition Á Surgery Introduction Gastrointestinal fistulas (GIFs) occur as a devastating complication following postoperative abdominal surgery or secondary to a primary intra-abdominal pathologic process. The management of fistulas is generally complex and presents a challenge in surgical practice, with a high rate of morbidity and mortality [1–4]. In these patients, malnutri- tion is a common problem, and adequate nutritional support is essential, enteral where possible, although supplemental parenteral nutrition is often required for high-output small bowel fistulas. Even with the recent advances in medical treatment, the rates of spontaneous fistula closure have not improved significantly. Prognosis depends on several fac- tors, such as the site of origin, number of fistulas, output, the patient’s nutritional status, and the development of complications. History Malnutrition is closely associated with the site and output of a fistula and is a major concern in patients with upper GIFs. In a review of 157 patients treated at the Massa- chusetts General Hospital between 1946 and 1959, the incidence of malnutrition ranged from 20% in patients with a colonic fistula to 74% in those with jejunal or ileal fistulas; the incidence of malnutrition in patients with gastric or duodenal fistulas fell midway between these extremes, at 53%. The authors highlighted the relationship between the incidence of malnutrition and mortality, with an overall mortality rate of 54% for small intestinal fistulas compared with 16% for colonic fistulas [5]. Sub- sequently, 4 years later in 1964, 56 patients with entero- cutaneous fistula were reviewed by Chapman et al. [6]. The prognostic importance of an adequate supply of nutrients in fistula management was emphasized in their study. They reported that patients who received 1,500–2,000 calories per day had a mortality rate of 16%, whereas patients who received \ 1,000 calories per day had a mortality rate of 58%. Most of these patients received their nutritional support via intestinal tube feedings administered distal to the fistula exit, toge- ther with intravenous supplementation with protein F. Yanar (&) General Surgery Service, Bakırko ¨y Sadi Konuk Training and Education Hospital, Istanbul, Turkey e-mail: yanar_fatih@yahoo.com H. Yanar General Surgery Service, Istanbul University, Istanbul Faculty of Medicine, C ¸ apa, Istanbul, Turkey Eur J Trauma Emerg Surg (2011) 37:227–231 DOI 10.1007/s00068-011-0105-6