Biopsychosocial Considerations to Avoid and Wean Parenteral Nutrition in patients without intestinal failure..., 2026, Paine et al

[Hutan]

Biopsychosocial Considerations to Avoid and Wean Parenteral Nutrition in patients without intestinal failure: An expert practice and position paper from the European Society of Clinical Nutrition and Metabolism and the Rome Foundation.

Spoiler: Authors

Paine, P.; Moulton, C.; Chisholm, A.; Twist, K.; Pironi, L.; Jeppesen, P.; Wanten, G.; Cuerda, C.; Klek, S.; Joly, F.; Mundi, M.; Schneider, S.; Szczepanek, K.; Van Gossum, A.; Tack, J.; Vanuytsel, T.; Lal, S.

Abstract
The European Society of Clinical Nutrition and Metabolism (ESPEN), the European Society of Neuro-gastroenterology and Motility and the Rome Foundation for Disorders of Gut-Brain Interaction consensus is that parenteral nutrition (PN) should not be prescribed for patients without intestinal failure (IF), where the oral and/or enteral route can be used.

In this further expert practice and position paper from ESPEN, biopsychosocial considerations to avoid and wean PN in such patients without IF are described. These include specifically distinguishing between conditions such as chronic intestinal pseudo-obstruction, enteric dysmotility, opioid bowel dysfunction, narcotic bowel syndrome, disorders of gut-brain interaction and eating disorders/disordered eating to positively identify those with evidence of intrinsic small bowel dysmotility that can lead to intestinal failure.

A holistic biopsychosocial framing of these conditions with attention to, and management of, pain and sensory, psychiatric, psychological, behavioural and social components beyond a reductionist motility focus, aims to mitigate iatrogenic harm and support more sustainable recovery. The role of limited investigations, their pitfalls and the importance of contextualising medical and psychiatric comorbidities are reviewed. Psychiatric approaches to eating disorders/disordered eating, the use of gut-brain neuromodulators, behavioural therapies and psychosocial strategies to avoid and/or wean PN are detailed. Specific practical approaches to optimising nutritional care are described, including graded food re-exposure.

Regular multidisciplinary team reviews ensure clear, consistent messaging, while a cohesive approach across all disciplines reduces burnout and, helps patients feel supported, improving adherence, symptom outcomes and overall healthcare utilisation. Safe and effective weaning from parenteral nutrition requires a structured, compassionate and psychologically informed approach.

Web | DOI | Clinical Nutrition

 

[Hutan]

This paper was first highlighted by Nightsong,

Not specifically about ME/CFS, although may have implications for a small subset of severe pwME who are considered to have a "disorder of gut-brain interaction" -

Biopsychosocial Considerations to Avoid and Wean Parenteral Nutrition in patients without intestinal failure: An expert practice and position paper from the European Society of Clinical Nutrition and Metabolism and the Rome Foundation

I think this is pretty specifically about ME/CFS and I am not at all surprised to see Peter Payne as first author. This is the policy that led to Maeve's death, now agreed Europe wide by a group of faith healers.

Apparently they now have gut/brain neuromodulators too.

 

[bobbler]

DO they check that they've actually treated and improved the cause (ie not psychologically but actually) that meant it was needed, or should be tried before they basically move into this mode of 'weaning' [gross term, is there really a coincidence that it is used for very young babies moving onto food from being breast fed?]

Or do these people set up this experiment as 'if it fails then its nowt to do with us needing to learn that that particular condition/circumstance isn't what we thought, just that the person isn't doing it properly and if we've no evidence of it then somehow deceiving us' etc'?

 

[Peter T]

Such an important topic.

How many of these ‘experts’ have successfully treated people with very severe ME/CFS that ended up dying of malnutrition and/or dehydration.