Beneficial effect of a bile acid resin binder on enteral feeding induced diarrhea.
OBJECTIVE
Diarrhea is a complication of enteral feeding, occurring in up to 68% of critically ill patients. We hypothesized that prolonged fasting results in abnormal bile acid homeostasis. Subsequent enteral feeding then causes a relative luminal excess of bile acids, which leads to choleretic diarrhea. Hence, diarrhea induced by enteral feeding should improve with the use of a bile acid binding agent, such as Colestid Granules.


METHODS
We evaluated the effect of Colestid on enteral feeding-induced diarrhea in a double-blind placebo-controlled study. Nineteen patients who were nil per os (NPO) for 5 days before initiation of enteral feeding were enrolled in the study and treatment continued for 7 days. The severity and frequency of diarrhea were quantified. Fecal bile acids were measured enzymatically. Stool nutrient loss was measured by fat extraction, microkjeldahl determination of nitrogen, and bomb calorimetry of dried fecal specimens.


RESULTS
Enteral feeding resulted in a high frequency of diarrhea (95%) at some time during the observation period. The majority of episodes of diarrhea in both groups were of low volume. Colestid significantly decreased the prevalence and severity of diarrhea. Colestid had no significant effect on fecal calorie or nutrient losses. The average bile acid concentration in the stool increased significantly after enteral feeding.


CONCLUSIONS
Enteral feeding-induced diarrhea is, at least in part, due to malabsorption of bile acids. The bile acid resin binding agent Colestid improves diarrhea induced by enteral feeding.
DeMeo
M
M
Department of Medicine (Division of Digestive Diseases and Nutrition), Loyola University Medical School, Maywood, Illinois, USA.
Kolli
S
S
Keshavarzian
A
A
Borton
M
M
Al-Hosni
M
M
Dyavanapalli
M
M
Shiau
A
A
Tu
N
N
Frommel
T
T
Zarling
E
E
Goris
G
G
Shawaryn
G
G
Mobarhan
S
S
D000368:Aged; D000837:Anion Exchange Resins / Q000627:therapeutic use*; D001647:Bile Acids and Salts / Q000378:metabolism*; D003084:Colestipol / Q000627:therapeutic use*; D003967:Diarrhea / Q000188:drug therapy* / Q000209:etiology*; D004311:Double-Blind Method; D004750:Enteral Nutrition / Q000009:adverse effects*; D005243:Feces / Q000737:chemistry; D006801:Humans; D008875:Middle Aged
D000837:Anion Exchange Resins; D001647:Bile Acids and Salts; D003084:Colestipol