Which of the following is a documented cause of abdominal distention in patients receiving enteral nutrition?

• A. Adequate fluid provision
• B. Prolonged fasting
• C. Rapid administration of feeding (bolus feeds)
• D. Use of lactose-free formula

Answer: (C)

Abdominal distention during enteral nutrition is most often a tolerance issue related to how quickly the feed is delivered. Delivering feeds rapidly in a bolus introduces a large volume into the stomach all at once, which can overwhelm gastric capacity and slow gastric emptying. The stomach and proximal gut become distended as they try to accommodate and move the contents forward, producing bloating, fullness, and sometimes nausea or vomiting. In patients with slowed GI motility or critical illness, this effect is even more pronounced, making rapid bolus feeds a well-documented cause of distention.

Maintaining adequate hydration is important for overall GI function but doesn’t by itself cause distention. Prolonged fasting reduces luminal content and does not typically cause distention, and lactose-free formula removes lactose-related gas but is not a direct cause of distention. To improve tolerance if distention occurs, slow the rate, switch to continuous feeding, or decrease the volume per feed while monitoring tolerance.