Enteral nutrition

Enteral nutrition is associated with dysbiosis in the microbiota often causing diarrhea. Probiotics have proven effective for prevention.

Around 10% of hospitalized patients are fed enterally1 and this number increases regularly2.

Dysbiosis in the intestinal microbiota

Enteral nutrition (EN) considerably changes the nutrients that are supplied to the intestine. This phenomenon, associated with metabolic stress and administered drugs, causes significant dysbiosis in the intestinal microbiota3,4,5,6. It is characterized by a reduction in the microorganisms with anti-inflammatory properties (e.g. Faecalibacterium), an increase in potentially pathogenic microorganisms (e.g. Enterobacter and Staphylococcus species) and a reduction in the number of individual bacterial strains. Dysbiosis is often accompanied by increased sensitivity to nosocomial infections, septicemia, and failure of one or more organs7-8. The primary complication, diarrhea9, can have numerous negative clinical consequences and can be a reason to reduce or even stop EN in hospitalized patients10 .

Probiotics effective as prevention

These bacterial disruptions have prompted trials with prebiotics and probiotics to attempt to reduce the frequency and severity of diarrhea. Probiotics have also shown an improvement in the tolerance of EN in preterm or low birth weight infants11. Several clinical studies and meta-analysis on the enteral administration of probiotics (Saccharomyces boulardii), synbiotics, or high soluble fiber foods have shown a significant reduction in diarrhea, overall infectious complications, and the length of use of systemic antibiotics12-16. In the case of diarrhea, it is then possible to switch medication , slow and regulate the rate of enteral nutrition, and/or prescribe drugs that slow intestinal transit17

Improve EN effectiveness through the microbiota

Another issue in modulating the microbiota is increasing the nutritional effectiveness of EN by supplementing it with probiotics. They increase the ability to extract energy from nutrients, control the metabolism of triglycerides, and even contribute to controlling inflammation18. These are important assets in cases of undernutrition.

Sources : 

1. nutritionDay. National reports. Vienna2015 [25/10/2015] ; Available from : http://www.nutritionday.org/en/about-nday/ national-reports/index.html.
2. Bouteloup C, Thibault R. Arbre décisionnel du soin nutri- tionnel. Nutr Clin Métabol 2013 ; 28 : 52-6.
3. Schneider SM et al. Total artificial nutrition is associated with major changes in the fecal flora. Eur J Nutr 2000 ; 39 : 248-55.
4. Whelan K et al. Fructooligosaccharides and fiber partially prevent the alte- rations in fecal microbiota and short-chain fatty acid concen- trations caused by standard enteral formula in healthy humans. J Nutr 2005 ; 135 : 1896-902.
5. Benus RF et al. Association between Faecalibacterium prausnitzii and dietary fibre in colonic fermentation in healthy human subjects. Br J Nutr 2010 ; 104 : 693-700.
6. Schneider SM. Microbiota and enteral nutrition. Gastroenterol Clin Biol. 2010 Sep;34 Suppl 1:S57-61
7. McDonald D, Ackermann G, Khailova L. Extreme dysbiosis of the microbiome in critical illness. mSphere 2016; 31:1
8. Koekkoek. Nutrition in the critically ill patient. Curr Opin Anaesthesiol. 2017 Apr;30(2):178-185.
9. Whelan K. Enteral-tube-feeding diarrhoea: manipulating the colonic microbiota with probiotics and prebiotics. Proc Nutr Soc 2007 ; 66 : 299-306.
10. Martins JR et al. Factors leading to discrepancies between pres- cription and intake of enteral nutrition therapy in hospitalized patients. Nutrition 2012 ; 28 : 864-7.
11. Athalye-Jape G et al. Benefits of probiotics on enteral nutrition in preterm neonates: a systematic review. Am J Clin Nutr 2014 ; 100 : 1508-19.
12. Bleichner G et al. Saccharomyces boulardii prevents diarrhea in critically ill tube-fed patients. A multicenter, randomized, double-blind placebo-controlled trial. Intensive Care Med 1997 ; 23 : 517-23.
13. Schlotterer M et al. Intérêt de Saccharomyces boulardii dans la tolérance digestive de la nutrition entérale à débit continu chez le brûlé. Nutr Clin Metabol 1987 ; 1 : 31-4.
14. Tempé JD et al. Prévention par Saccharomyces boulardii des diarrhées de l’alimentation entérale à débit continu. Sem Hop Paris 1983 ; 59 : 1409-12.
15. Wang C, Chaudhary R, Berg S. Using probiotics in the critically ill: a metaanalysis of 2808 patients. Crit Care Med 2016; 44 (12 Suppl 1):191.
16. Manzanares  et al. Restoring the Microbiome in Critically Ill Patients: Are Probiotics Our True Friends When We Are Seriously Ill? JPEN J Parenter Enteral Nutr. 2017 May;41(4):530-533.
17. Razungles-Ducasse F et al. Aspects pratiques de la nutrition entérale en réanimation. 52e congrès national d’anesthésie et de réanimation
18. Cani PD et al. Gut microflora as a target for energy and metabolic homeostasis. Curr Opin Clin Nutr Metab Care 2007 ; 10 : 729-34.

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