Reduction in diarrhea incidence by soluble
fiber in patients receiving total or supplemental enteral nutrition.
JPEN J Parenter Enteral Nutr. 1994 Nov-Dec;18(6):486-90.
Homann HH, Kemen M, Fuessenich C, Senkal M, Zumtobel V.
Department of Surgery, Ruhr University, Bochum, Germany.
Gastrointestinal side effects, particularly diarrhea, are still the
main reasons for discontinuation of enteral nutrition. Although the
causes of diarrhea are diverse, the enteral nutrition solution is frequently
suspected of playing a leading role in causing diarrhea.
Our randomized, prospective, double-blind trial with 100 patients assessed
the effects of feeding a standard diet (Nutrodrip Standard) vs the same
diet supplemented with 20 g of soluble fiber, containing partially hydrolyzed
guar gum (Sunfiber), per 1000 mL. Thirty patients received total enteral
nutrition postoperatively, and 70 patients received enteral supplementation.
RESULTS: The patients receiving total enteral nutrition with soluble
fiber had decreased diarrhea but increased flatulence. In none of these
patients did enteral feeding have to be discontinued because of gastrointestinal
side effects, whereas in four patients who were on a standard diet,
enteral feeding had to be interrupted because of diarrhea (p < .05).
Similar observations were made in patients receiving enteral supplementation.
In both groups, the incidence of diarrhea decreased significantly with
the soluble fiber diet compared with the standard diet (6 vs 15, p <
Enteral feeding with a formula supplemented with partially hydrolyzed
guar gum reduces the incidence of diarrhea in patients receiving total
enteral nutrition as well as in those receiving enteral supplementation,
regardless of the cause of diarrhea. The increased hydrogen production
and the significantly higher rate of flatulence are likely to result
from fermentation of the soluble fiber in the colon, with concomitant
production of short-chain fatty acids, which leads to increased absorption
of short-chain fatty acids, sodium, and water by the colonocytes. This
effect, together with the observed cholecystokinin-mediated decrease
in colonic transit time with partially hydrolyzed guar gum, may explain
the reduction in the incidence of diarrhea in this study.
Randomized Controlled Trial