[The treatment of intolerance for enteral nutrition of unknown origin with parenteral nutrition].

In recent years, there has been a notable rise in referrals to specialised chronic intestinal failure centres of patients with self-reported intolerance to enteral feeding. Despite incomplete or inconclusive diagnostic procedures and no convincing clinical evidence for the presence of intestinal failure, patients often urge physicians to start with total parenteral nutrition (TPN). The frequent use of opioids in these patients is a complicating factor concerning the diagnostic workup for motility disorders and the interpretation of clinical symptoms. Despite TPN administration, these patients continue to pose a significant burden to medical staff and hospital resources because of persistent complaints, no improvement in quality of life and the occurrence of severe life-threatening complications. Therefore, we strongly advise against initiating TPN in patients with intolerance for enteral nutrition who are not diagnosed with intestinal failure. Instead, we encourage our colleagues to consult an expert centre and engage a mental healthcare professional early.