Practical Use of Home Elemental Hyperalimentation (Are We Looking for the Further Development of Home Medical Care in Japan)

Home enteral nutrition （HEN） has been used for a long time in Japan, and been further developed after the concept of home elemental enteral hyperalimentation （HEEH） was established. HEEH is indicated for patients with a variety of diseases, and therapeutic effects of HEEH are widely accepted. In addition, the number of the patients on HEEH is gradually increasing. Instruments required for HEEH include feeding tubes, irrigating bags, shaking bottles, liquid diet, and infusion pumps. Prior to the beginning of the naso-gastric tube feeding, patients have to learn and be accustumed to the self-intubation technique, in which they introduce the specific tube into their own stomach. A feeding tube can also be set intraoperatively or endoscopically into the G-I tract. Elemental diet （ED） or low residue diet （LRD） is selected depending on the patients' diseases or conditions. Concentration and infusion speed of the liquid diet must slowly be increased. Otherwise, diarrhoea and abdominal pain often ensues. It is basically important to evaluate, once a month, the nutritional status of the patients who undergoing HEEH for a long period. Health insurance has supported the HEEH, confined to the tube feeding by elemental diet. Although there are many diseases on which HEEH is effective, up to the present, the health insurance only covers a limited part of them. To increase the number of the diseases covered by the health insurance is strongly expected