Effect of Psyllium Fiber Supplementation on Diarrhea Incidence in Enteral Tube‐Fed Patients: A Prospective, Randomized, and Controlled Trial

Abstract

Background Diarrhea in enteral tube‐fed patients is not uncommon and can lead to unfavorable outcomes. Fiber in enteral nutrition (EN) formula might play a role in postfeeding diarrhea. Theoretically, soluble fiber is beneficial for both prevention and treatment of postfeeding diarrhea, but different types of soluble fiber may not provide the same effect. This study aims to determine whether supplementation with psyllium in standard EN reduces the incidence of diarrhea in tube‐fed patients. Methods We conducted a prospective, randomized, double‐blind, controlled study in general medical wards patients who were expected to receive EN for ≥5 days. Exclusion criteria were hemodynamic instability, known significant gastrointestinal problems, and recent pancreatitis. Eligible patients were randomized to receive either Mucilin SF (15.2 g/L)‐added Blendera (psyllium‐added formula: Psyllium group [PG]) or Blendera (fiber‐free formula: Control group [CG]). All patients were given EN for 10 days or until discharge/oral intake/death. Bowel movements (BMs) were monitored using King's Stool Chart. Results Eighty‐three patients were enrolled, 42 in the PG and 41 in the CG. Baseline characteristics were similar. The proportion of patients with ≥1 day of diarrhea (King's stool score ≥15) was comparable (42.9% vs 31.7%; P = 0.41, in PG and CG, respectively). There were no significant differences in the frequency of daily BMs and the median diarrhea score between PG and CG (3 vs 2, P = 0.06 and 3.8 vs 2.4, P = 0.42, respectively). Conclusion Supplementation with psyllium showed no beneficial effect on reducing incidence of diarrhea in general medical patients receiving EN. This study was registered on Thai Clinical Trials Registry (http://www.clinicaltrials.in.th: TCTR identification number TCTR20170821004).

Diarrhea in tube‐fed hospitalized patients: Feeding formula is not the most common cause

“…We used the King's stool chart, 13 which was developed specifically to evaluate fecal output in patients receiving enteral tube feeding, instead of using the more generalized definition of >3 bowel movements per day, considering that hospitalized patients receiving EN are often in diapers, which makes an assessment of bowel movement frequency difficult and perhaps even invalid. In our study, the excellent agreement among the nursing staff was observed with an intra‐class correlation coefficient of 0.878 after the King's stool chart training 12 . Diarrhea was defined as a King's stool score ≥15.…”

“…As mentioned earlier, we used the King's stool chart, 13 which was specifically developed to assess fecal output in patients on EN in this study, instead of using the more generalized definition of >3 bowel movements per day. The King's stool chart has been validated in tube‐fed patients and showed concurrent validity and inter‐rater reliability, 13,16–18 including in our RCT, as an excellent agreement was observed with an intra‐class correlation coefficient of 0.878 12 . In the present study, post‐feeding diarrhea occurred in 37.1% of hospitalized patients in general medical wards, which is similar to the 39–41% from other studies in the same setting of general medical patients on EN feeding 15,19 …”

“…This is an analysis of the prospectively collected data of the patients enrolled in “Effect of Psyllium Fiber Supplementation on Diarrhea Incidence in Enteral Tube‐Fed Patients: A Prospective, Randomized, and Controlled Trial” (RCT). The design and results of the study have been reported 12 …”

“…Briefly, adult patients admitted to general medical wards whom EN was initiated were randomized to receive the RCT's EN formula of either psyllium‐added ( N = 42) or fiber‐free EN ( N = 41) for 10 days or until discharge/switch to oral intake/death (whichever occurred first), and diarrhea was monitored during enteral feeding with the study's formula using the King's stool chart 13 . The patients with contraindications to an EN initiation, for example, hemodynamic instability, gastrointestinal hemorrhage/obstruction/severe ileus, known diarrheal illness caused by a pre‐existing gastrointestinal pathology were excluded from the RCT 12 . The RCT results revealed no difference in diarrheal occurrences between both formulas.…”

The role of nutrition and dietary supplements in the management of diarrhoea in HIV patients: a review of the literature

“…Some authors suggest a dose of 18-30 g/day of P. psyllium to normalise the stools in patients with chronic diarrhoea, suggesting a gradually increasing dose to improve tolerance [55]. More recently, Lertpipopmetha et al reported no beneficial effect on reducing incidence of diarrhoea in general medical patients (43% with infectious diseases) receiving enteral nutrition enriched with 15.2 g/l of psyllium fibre [56].…”