Effects of pectin on diarrhea in critically ill tube-fed patients receiving antibiotics

Abstract

BACKGROUND: Anaerobic colonic flora are necessary for the fermentation of fiber into short-chain fatty acids and constitute the bulk of fecal mass. Lack of dietary fiber in most enteral feedings, compounded by antibiotic therapy, suppresses normal colonic metabolism, resulting in diarrhea. Pectin, a water-soluble fiber, stimulates epithelial growth in the colon and thus reduces diarrhea. METHODS: Forty-four critically ill patients receiving enteral nutrition and antibiotic therapy were randomized to receive fiber-containing or fiber-free tube feedings and pectin or placebo. Data on frequency, consistency, and volume of fecal output; energy (caloric) intake; and administration of specific medications were collected for 9 days. Diarrhea was defined as 2 or more days with scores of 12 or higher on the Hart and Dobb diarrhea scale. RESULTS: Subjects in the 4 groups did not differ significantly in age, sex, severity of illness, or energy intake. Twelve subjects (27.3%) experienced diarrhea. Significantly fewer subjects in the fiber-free/placebo and fiber/pectin groups experienced diarrhea than did subjects in the fiber/placebo group (P = .02). On the basis of repeated-measures analysis of variance of daily mean scores, the severity of diarrhea did not differ significantly among the study groups over time (P = .16). CONCLUSIONS: The reduced rate of diarrhea found in this study may be related to the stringent definition of diarrhea used. The therapeutic dose of pectin for reducing diarrhea needs further exploration. The trend was toward less diarrhea in the fiber/pectin group, but the study needs to be replicated with a larger sample.

Benefits of Dietary Fiber in Clinical Nutrition

“…Significantly fewer patients in the fiber-free/placebo and fiber/pectin groups experienced diarrhea as compared with the fiber/ placebo group. 111 Although there was a trend toward a lower incidence of diarrhea in the fiber/pectin group, the small sample size in each arm of the study may have prevented this from reaching significance. In a multicenter, randomized controlled study, children aged 1-6 years requiring tube feeding (n = 94) were randomized to receive standard formula without fiber or an energy-dense formula with the 5-fiber blend for 21 days.…”

“…Critically ill patients receiving EN and antibiotics (n = 44) were randomized to receive the fiber-supplemented formula or control. 111 These groups were again divided so that half received pectin and half received placebo. Significantly fewer patients in the fiber-free/placebo and fiber/pectin groups experienced diarrhea as compared with the fiber/ placebo group.…”

Systematic review and meta‐analysis: the clinical and physiological effects of fibre‐containing enteral formulae

“…1 In 18 of 38 (47%) studies, feeding was administered via a nasogastric tube; 28-31, 35, 36, 39, 40, 42, 49, 50, 53, 58, 60, 65, 66, 68, 71 2 In three of 38 (8%) studies, feeding was administered via a nasojejunal tube ⁄ needle catheter jejunostomy tube; 14,33,38 3 In three of 38 (8%) studies, a variety of tube feeding routes was used 8,27,37 and 4 In 14 of 38 (37%) studies, the route of tube feeding was not explicitly stated. 32,41,48,51,52,54,55,57,59,63,64,67,69,70 Reported end points Diarrhoea and constipation were the most frequently reported clinical end points. Stool ⁄ bowel frequency, transit time, stool weight, stool consistency, shortchain fatty acids (SCFA) and stool microflora were the most commonly reported physiological parameters.…”

“…A number of studies investigated the effects of different fibre sources. 9,32,34 Overall, there was considerable variability between the studies in the amount of fibre administered daily ( Table 3). The actual daily fibre intake was not explicitly reported in 18 studies, 10, 29-31, 35, 36, 41, 48, 55, 57, 59, 60, 63, 64, 68-70, 72 however, it was possible in several cases to calculate the actual intake based on information reported in the article.…”

“…1.3); P = 0.001] were analysed separately. This type of meta-regression is subject to a 61 2 1 3 0 Oat (n = 1) 9 2 1 1 5 Galactomannan (n = 1) 65 2 1 2 8 FOS (n = 1) 56 2 1 18.5 Carrot (pectin ⁄ cellulose) (n = 1) 42 2 2 2 4 FOS ⁄ pea (n = 1) 15 2 2 2 6 Soy oligosaccharides (n = 1) 9 2 1 1 5 Ispaghula husk (n = 1) 40 2 1 7 Oat, soy, gum arabic, carboxymethylcellulose, FOS, pectin (n = 1) 32 2 6 2 9 Not reported (n = 3) 62, 68, 72 6 2 0 * Some studies examined more than one fibre source. As reported in the articles, amount of total dietary fibre was used whenever available.…”