Regional Meeting Report Pan-London Regional BAPEN Meeting


“Bridging the North South Divide” King’s College London • 23rd February 2010


On Tuesday 23rd February, a cold & dreary day in London, 62 healthcare professionals gathered at King's College London for the inaugural North & South Thames Regional BAPEN meeting. We were treated to a rich mixture of case studies, debate, personal research and current evidence-based practice.


The meeting was started by Clare Soulsby, Senior Dietitian at Barts & the London Hospital, who presented an overview of gastric emptying. The talk covered the anatomy and physiology of gastric emptying; the differences between European and American practice (predominantly bolus feeding) and the current trend in the UK for continuous feeding; an overview of her own research interests using Electrical Impedence Topography in critical care patients; and ended with a healthy discussion on the current evidence base for gastric residual volume in critically ill patients.


David Gertner then adjudicated a debate on the preferred route of feeding for patients with severe acute pancreatitis. An apparently one-sided discussion (particularly as both sides were presented by North Thames!) soon turned into a very healthy debate. Our expert panel consisted of Jeremy Nightingale and Sheena Visram arguing for parenteral nutrition (PN) and Javaid ‘where's the evidence’ Subhani and Andrea ‘what's there to debate’ Cartwright presenting the case for enteral nutrition (EN). The debate in fact focused on the quality of the evidence where PN is often associated with a high complication rate, and where frequently too much energy is provided without tight blood glucose control. The debate included discussion of the recent Cochrane review and the practicalities of delivering EN correctly in a timely manner. The debate was unofficially closed by Rick Wilson (from the South) who sagely reminded us that enteral and parenteral routes are not mutually exclusive. David Gertner took a straw poll and announced Jeremy and Sheena the winners – not on a majority vote but on the fact that they had increased the number of people who would consider using PN in this condition.


The first half was closed by Andrea Cartwright who presented an update of important nutrition related announcements of local, national and international importance. Delegates were reminded to use the BAPEN website and Andrea highlighted the new BAPEN Facebook and Twitter group; Simon Gabe had already been tweeting so many of you will know about this anyway!


After refreshments we were treated to two high quality updates of evidence base and best practice from Simon Gabe and Kevin Whelan. Simon spoke about abnormal liver function tests (LFTs) and PN – a dilemma familiar to many of the audience, although more prevalent in paediatrics. A useful 'rule of thumb' for patients with abnormal LFTs prior to starting PN is that 60% will worsen whilst 30% will improve.


The discussion focused on four factors to consider: patient-dependent


factors, the lack of EN, nutrient deficiency, and nutrient toxicity. Patient dependent causes included pre-existing liver disease, sepsis (in particular abdominal), ultra-short bowel and infant prematurity. The lack of concurrent EN for patients on PN increases the risk of biliary stasis, bacterial overgrowth and a reduction in intestinal motility.


Both choline


and taurine are reduced in patients on PN and Simon presented the evidence for supplementing both these nutrients. He finished his presentation by demonstrating that 'not all lipids are the same' and reiterating the link between glucose content and steatosis – with clear evidence highlighting the risks of nutrient toxicity.


Kevin whisked us through the (variable lack of) evidence for prebiotics and probiotics in inflammatory bowel disease. He also introduced us to the concept of synbiosis and dysbiosis; current evidence is lacking, but it was agreed that this is a very interesting area of research that is likely to significantly influence practice in future years. Kevin is currently coordinating a pan-London research project in this area, the results of which were presented in March at the British Society of Gastroenterology Conference.


The meeting concluded with a case presentation from Sue Cullen. Although the final diagnosis was extremely rare, the presenting symptoms were familiar to us all: vomiting, diarrhoea and weight loss. The case highlighted both the diagnostic challenges we routinely face as well as the multi-professional nature of nutrition. Having spent an afternoon of lively debate and reviewing current evidence it was appropriate to end by discussing a real patient.


The feedback from the meeting was extremely positive:


‘Very interactive and educational meeting, well done!’ ‘Excellent range and depth’ ‘Good lively debate’


The organising committee chaired by Jeremy Nightingale (N Thames) and Rick Wilson (S Thames) with Sheena Visram (treasurer & secretary), Andrea Cartwright (publicity) and Andrew Rochford (trainee representative & communication) wish to acknowledge and thank the sponsors of the event: Fresenius Kabi / Calea, Willow / Baxter, GBUK, Bupa Homecare and Abbott Nutrition. We would particular like to extend our warmest thanks to all the speakers and all the delegates for making this an enjoyable and informative meeting. We are very much looking forward to the return fixture in North London next year.


9 BAPEN In Touch No.57 May 2010


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