From the Guidelines
For a patient with neurological symptoms, a positive syn-one test, and requiring a jejunostomy tube (j-tube), I recommend proceeding with j-tube placement as this is appropriate for nutritional support in patients with neurological disorders affecting swallowing, as indicated by the most recent guidelines from the AGA clinical practice update on endoscopic enteral access 1. The positive syn-one test suggests alpha-synuclein pathology, which is consistent with conditions like Parkinson's disease, multiple system atrophy, or Lewy body dementia. These conditions often progress to cause dysphagia and nutritional challenges. The j-tube placement should be performed by an experienced gastroenterologist or surgeon, with pre-procedure assessment including coagulation studies and review of current medications. Post-procedure care should include monitoring for complications like infection, displacement, or obstruction. The patient should receive enteral nutrition formulations appropriate for their metabolic needs, typically starting at 10-20 mL/hour and gradually increasing as tolerated. Regular assessment of the stoma site, tube patency, and nutritional status is essential. This approach addresses the immediate nutritional needs while acknowledging the underlying neurodegenerative process indicated by the positive syn-one test, and is supported by guidelines from the ESPEN guideline on clinical nutrition in neurology 1 and the multidisciplinary practical guidelines for gastrointestinal access for enteral nutrition and decompression from the Society of Interventional Radiology and American Gastroenterological Association (AGA) Institute 1. Key considerations in the management of these patients include the risk of aspiration, the need for early enteral nutrition, and the importance of careful monitoring and adjustment of the enteral nutrition regimen to meet the patient's changing needs, as highlighted in the guidelines for enteral feeding in adult hospital patients 1. In terms of the specific type of j-tube to be used, the choice will depend on the individual patient's needs and the availability of resources, but the use of a percutaneous endoscopic gastrojejunostomy (PEG-J) tube or a direct percutaneous endoscopic jejunostomy (DPEJ) tube may be considered, as discussed in the AGA clinical practice update on endoscopic enteral access 1. Ultimately, the goal of j-tube placement in these patients is to provide adequate nutritional support while minimizing the risk of complications and improving the patient's overall quality of life, as emphasized in the ESPEN guideline on clinical nutrition in neurology 1.
From the Research
Positive Syn-One Test in Patient with Neuro Symptoms Needing J-Tube
- The provided studies do not directly address the topic of a positive syn-one test in a patient with neuro symptoms needing a J-tube 2, 3, 4, 5, 6.
- However, some studies discuss the use of antibiotics such as ceftriaxone and metronidazole in treating complicated intra-abdominal infections 2, 3, 5.
- One study found that the addition of metronidazole to ceftriaxone and doxycycline was well tolerated and effective in reducing endometrial anaerobes and pelvic tenderness in women with acute pelvic inflammatory disease 4.
- Another study suggested that ceftriaxone and metronidazole may not be sufficient as empirical therapy in cases involving perforated small and large bowel, including complicated sigmoid diverticulitis, due to the presence of antibiotic-resistant organisms 5.
- There is no direct evidence to support the use of a specific antibiotic regimen in a patient with a positive syn-one test and neuro symptoms needing a J-tube, and further research is needed to determine the best course of treatment.