How is weight loss treated in amyotrophic lateral sclerosis (ALS)?

Updated: Jan 02, 2020
  • Author: Divakara Kedlaya, MBBS; Chief Editor: Ryan O Stephenson, DO  more...
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Answer

Answer

Symptomatic treatment of weight loss with high-calorie nutritional supplements and/or percutaneous endoscopic gastrostomy (PEG) should be offered more frequently. Consult a gastroenterologist early so that placement of a feeding tube is not delayed while weight loss progresses. PEG placement is preferred while the patient still is able to eat by mouth. In this situation, enteric feeding can be presented as a positive option, because it allows the patient to eat for enjoyment, rather than simply for nutritional necessity. This prevents the fatigue and frustration associated with mealtimes experienced by some of these patients.

Initially, nasogastric or orogastric feeding may be an option, but these methods can lead to traumatic irritation of the mucosa with prolonged use. For long-term feeding, options include standard gastrostomy, PEG, and jejunostomy. Preferred intervention is usually PEG tube placement, because other types of long-term feeding tubes require placement under general anesthesia, while a PEG tube can be placed under local anesthesia. [22] Increased risk of regurgitation is associated with gastrostomy/PEG tubes; therefore, some may prefer placement of a jejunostomy tube, which decreases the risk of aspiration.

Dorst et al studied the effect of high-caloric food supplements in ALS patients. [23] In their study of 26 ALS patients, high-caloric food supplements with high fat and high carbohydrate content are both suitable to stabilize the body weight. The effect of a high-fat diet might be more pronounced. They propose that since body weight is an independent prognostic factor in ALS, it is possible that a high-caloric food supplement improves survival in ALS patients.


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