Chyme Reinfusion (CR) is a practice in the management of patients with High-Output Enterocutaneous Fistulas, and High-Output Enterostomies. Chyme Reinfusion enables patients to reestablish oral feeding and wean off the Parenteral Nutrition (PN) in as little as 3 days (1), resulting in significant health economic benefits and improvements in quality of life (QoL).
Compared to the standard approach of Parenteral Nutrition (PN) which provides nutritional support intravenously, Chyme Reinfusion maintains gut continuity and prevents gut atrophy (i.e. wasting away) by continuing to use all the functional gastrointestinal (GI) tract to deliver a person’s caloric requirements (enteral nutrition) (2,3). The process involves returning chyme (partially digested food) collected in the ostomy appliance from the proximal (i.e. upstream) limb of the fistula or stoma, back into the distal (i.e. downstream) limb (4).
Chyme is traditionally referred to as ‘waste output’ that is discarded, but is in fact, a natural composition of valuable digestive secretions, nutrients and electrolytes from oral food that is crucial in maintaining fluid and electrolyte balance, and gut microbiome (2). There is now a growing body of literature which describes the benefits of Chyme Reinfusion for reestablishing intestinal function in High-Output Enteroatmospheric, and High-Output enterostomy and Ileostomy patients (1–5).
Chyme Reinfusion was first described in detail by Dr Etienne Levy in 1977, and has gained increasing traction from clinical bodies such as ESPEN (European Society for Clinical Nutrition and Metabolism), being recommended as an alternative therapy for patients presenting with high intestinal output losses of stomal or fistula contents (6,7). The process is clinically proven to improve patient outcomes and nutrition by promoting the absorption of valuable contents in Chyme that would have otherwise been discarded. By maintaining gut continuity and function, Chyme Reinfusion allows for the preservation of liver enzymes which minimizes the risk of liver injury (5). By restoring the function of the distal gut which is primarily responsible for water reabsorption, Chyme Reinfusion allows for fluid and electrolyte balances to be maintained, reducing the risk of short and long-term kidney injury (8).
The physiological and overall clinical benefits of Chyme Reinfusion continue to be recognized by international leaders around the world in regard to its importance on gut health and the microbiome. There is a growing consensus that Chyme Reinfusion has a significant cost saving effect as it reduces length of stay in hospital and readmissions, and prevents complications associated with Parenteral Nutrition such as Catheter-line associated blood stream infections (CLABSI) (5,9).
The Insides Company, a leader in this therapeutic space, has developed “The Insides™ System” for the effective chyme reinfusion treatment of enteroatmospheric fistulas and high-output enterostomies. To learn more about our innovative system for chyme reinfusion, please see the following link or contact us via:
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1. Layec S, Seynhaeve E, Trivin F, Carsin-Mahé M, Dussaulx L, Picot D. Management of entero-atmospheric fistulas by chyme reinfusion: A retrospective study. Clin Nutr [Internet]. 2020 Apr; Available from: https://linkinghub.elsevier.com/retrieve/pii/S0261561420301485
2. Thibault R, Picot D. Chyme reinfusion or enteroclysis in nutrition of patients with temporary double enterostomy or enterocutaneous fistula. Curr Opin Clin Nutr Metab Care. 2016;19(5):382–7.
3. Pflug AM, Utiyama EM, Fontes B, Faro M, Rasslan S. Continuous reinfusion of succus entericus associated with fistuloclysis in the management of a complex jejunal fistula on the abdominal wall. Int J Surg Case Rep [Internet]. 2013;4(8):716–8. Available from: https://linkinghub.elsevier.com/retrieve/pii/S221026121300179X
4. Picot D, Layec S, Dussaulx L, Trivin F, Thibault R. Chyme reinfusion in patients with intestinal failure due to temporary double enterostomy: A 15-year prospective cohort in a referral centre. Clin Nutr [Internet]. 2017 Apr;36(2):593–600. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0261561416300668
5. Bhat S, Sharma P, Cameron N-R, Bissett IP, O’Grady G. Chyme Reinfusion for Small Bowel Double Enterostomies and Enteroatmospheric Fistulas in Adult Patients: A Systematic Review. Nutr Clin Pract [Internet]. 2019 Sep 24; Available from: http://doi.wiley.com/10.1002/ncp.10417
6. Lévy E, Parc R, Loygue L, Loygue J. [Temporary, live-saving, terminal, jejunal or ileal stomas with autoregulated reinstallation]. Nouv Presse Med [Internet]. 1977 Feb 12;6(6):461–2. Available from: http://www.ncbi.nlm.nih.gov/pubmed/138848
7. Pironi L, Arends J, Baxter J, Bozzetti F, Peláez RB, Cuerda C, et al. ESPEN endorsed recommendations. Definition and classification of intestinal failure in adults. Clin Nutr [Internet]. 2015 Apr;34(2):171–80. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0261561414002349
8. Fielding A, Woods R, Moosvi SR, Wharton RQ, Speakman CTM, Kapur S, et al. Renal impairment after ileostomy formation: a frequent event with long-term consequences. Color Dis [Internet]. 2019 Oct 17;codi.14866. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/codi.14866
9. Dreesen M, Foulon V, Spriet I, Goossens GA, Hiele M, De Pourcq L, et al. Epidemiology of catheter-related infections in adult patients receiving home parenteral nutrition: A systematic review. Clin Nutr [Internet]. 2013 Feb;32(1):16–26. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0261561412001719
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This blog will discuss the process for transitioning from total parenteral nutrition (TPN) to oral feeding when starting chyme refeeding.