Homann H H, Kemen M, Fuessenich C, Senkal M, Zumtobel V
Department of Surgery, Ruhr University, Bochum, Germany.
JPEN J Parenter Enteral Nutr. 1994 Nov-Dec;18(6):486-90. doi: 10.1177/0148607194018006486.
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.
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 < .05).
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.
胃肠道副作用，尤其是腹泻，仍是停止肠内营养的主要原因。尽管腹泻的病因多种多样，但肠内营养制剂常被怀疑在导致腹泻方面起主要作用。
我们对100例患者进行了随机、前瞻性、双盲试验，评估了给予标准饮食（Nutrodrip Standard）与每1000 mL添加20 g含部分水解瓜尔胶（Sunfiber）的可溶性纤维的相同饮食的效果。30例患者术后接受全肠内营养，70例患者接受肠内补充营养。
接受含可溶性纤维全肠内营养的患者腹泻减少但胃肠胀气增加。这些患者中无一例因胃肠道副作用而不得不停止肠内喂养，而4例接受标准饮食的患者因腹泻不得不中断肠内喂养（p < 0.05）。接受肠内补充营养的患者也有类似的观察结果。与标准饮食相比，两组中接受含可溶性纤维饮食的患者腹泻发生率均显著降低（6例对15例，p < 0.05）。
无论腹泻病因如何，使用添加部分水解瓜尔胶的配方进行肠内喂养可降低接受全肠内营养患者以及接受肠内补充营养患者的腹泻发生率。氢气产生增加和胃肠胀气发生率显著升高可能是由于结肠中可溶性纤维发酵，同时产生短链脂肪酸，这导致结肠细胞对短链脂肪酸、钠和水的吸收增加。这种作用，连同观察到的胆囊收缩素介导的部分水解瓜尔胶使结肠转运时间缩短，可能解释了本研究中腹泻发生率的降低。
