Seetha Lakshmanan, MD1, Dana Vinter, MD2, Lucas Beffa, MD1, Mariam Fayek, MD, FACG2, Bani C. Roland, MD, FACG2 1Kent Hospital, Warwick, RI; 2Women & Infants Hospital, Providence, RI
Introduction: Hyperemesis gravidarum (HG) is intractable vomiting experienced by < 1% of pregnant women causing dehydration, significant weight loss and electrolyte disturbances requiring hospital admission. HG is distinguished from nausea/vomiting in pregnancy by ketonuria and loss of >5% of prepregnancy weight. Nutritional support in early pregnancy reduces potential complications associated with HG. We present a patient with severe HG who failed all pharmacological treatment and had a jejunostomy (J) tube placed for nutrition.
Case Description/Methods: A 31-year-old G3P1 female presented in her 21stweek of pregnancy with intractable vomiting ( >20 episodes/day) and 13-lb weight loss in 2months. Symptoms began in her 6thweek and she failed a trial of scheduled Ondansetron, Promethazine, Vitamin B1/B6 and Famotidine. Patient later agreed to complete a regimen of IV Methylprednisolone followed by Prednisone taper; however, symptoms persisted. She continued to lose weight and developed protein-calorie malnutrition with ketonuria by her 24thweek. Enteral versus parenteral feeding options were reviewed and she agreed to endoscopic nasojejunal (NJ) tube placement. Tube feeds were uptitrated gradually, however her NJ tube dislodged after 2days due to vigorous vomiting. She subsequently had central line placed and was started on parenteral nutrition. To prevent long-term complications, we opted for J-tube placement laparoscopically to avoid puncturing the uterus during the procedure. Tube feeds were restarted and increased as tolerated to reach nutritional goals. The J-tube will remain in place until she delivers.
Discussion: Currently, antiemetics are recommended for HG as there are no superior treatments available with proven efficacy based on the latest Cochrane review. Glucocorticoids or Droperidol are tried for refractory cases, while smaller studies have reported benefits with Gabapentin and Mirtazapine. Early enteral or parenteral feeding should be initiated in parallel for better outcomes. Generally, post-pyloric feeding tubes are preferred due to the changing anatomy in pregnancy. Extensive literature review only revealed 1 case series reporting jejunostomy feeding in 5 patients with HG. In 2 patients, the J-tube was removed or dislodged while the remainder kept it until delivery. All patients successfully delivered at term without maternofetal complications. Though J-tubes appear to be well-tolerated, further large-scale studies are required to assess the actual benefits and risks involved.
Seetha Lakshmanan indicated no relevant financial relationships.
Dana Vinter indicated no relevant financial relationships.
Lucas Beffa indicated no relevant financial relationships.
Mariam Fayek indicated no relevant financial relationships.
Bani Roland indicated no relevant financial relationships.
Seetha Lakshmanan, MD1, Dana Vinter, MD2, Lucas Beffa, MD1, Mariam Fayek, MD, FACG2, Bani C. Roland, MD, FACG2. P0401 - Jejunostomy Feeding in Refractory Hyperemesis Gravidarum - A Case Report and Review of Literature, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.