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.
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