The Effects of Enteral Nutrition on the Intestinal Environment in Patients in a Persistent Vegetative State

Abstract

Enteral nutrition (EN) is a rational approach to providing nutritional intake via the intestines in patients who are unable to tolerate parenteral nutrition. We conducted a preliminary study to investigate the effects of EN on the intestinal environment in 10 patients in a persistent vegetative state (PVS) (n = 5 each in the EN and EN with probiotics; Clostridium butyricum MIYAIRI 588) groups compared with 10 healthy controls. The results of 16S amplicon sequencing of the intestinal microbiota showed that EN led to dysbiosis with a decrease in α-diversity and an obvious change in β-diversity. A particularly significant decrease was seen in useful intestinal bacteria such as Bifidobacterium and butyrate-producing bacteria. Analysis of intestinal metabolites also supported these results, showing significant decreases in butyric and pyruvic acid after EN. Although C. butyricumMIYAIRI 588 improved some intestinal metabolites that were decreased after EN, it did not improve the dysbiosis of the intestinal microbiota. These findings indicate that EN causes dysbiosis of the intestinal microbiota and an imbalance in some intestinal metabolites in patients in a PVS. Moreover, although C. butyricumMIYAIRI 588 improved the imbalance of some intestinal metabolites after EN, it did not prevent dysbiosis of the intestinal microbiota.

A super‐geriatric patient with gastrostomy underwent life‐threatening prothrombin time‐international normalized ratio prolongation by warfarin following fasting and antibiotic therapy

“…In actuality, the variability in the intestinal environment is limited by flora, particularly in gastrostomies with enteral nutrition as the sole dietary intake. 13 Furthermore, our patient was fasting between Days 1 and 6 before starting warfarin, and the infusion did not contain vitamin K. These suggest the following: (1) low gut bacteria with reduced vitamin K-producing gut microbiota; (2) no oral and transinfusional vitamin K; 14,15 In conclusion, we should be careful when administering antibiotics to patients receiving warfarin, regardless of the functional group of the antibiotic, especially in some patients with multiple risks for harm of warfarin including nutrition status. We need to keep these in mind and monitor PT-INR more carefully.…”

“…This patient was bedridden and being cared for by in‐home medical care with a gastrostomy. In actuality, the variability in the intestinal environment is limited by flora, particularly in gastrostomies with enteral nutrition as the sole dietary intake 13 . Furthermore, our patient was fasting between Days 1 and 6 before starting warfarin, and the infusion did not contain vitamin K. These suggest the following: (1) low gut bacteria with reduced vitamin K‐producing gut microbiota; (2) no oral and transinfusional vitamin K; 14,15 and (3) antibiotics that strongly change the intestine flora, started before warfarin, being the principal mechanism of drastic enhancement of PT‐INR.…”

Dietary supplement of mushrooms promotes SCFA production and moderately associates with IgA production: A pilot clinical study

“…DNA extraction from fecal samples was performed as previously reported ( 20 ). The fecal samples were initially lyophilized and shaken vigorously using a Shake Master (1,500 rpm, 10 min; Biomedical Science Co., Ltd., Tokyo, Japan).…”