Total artificial nutrition is associated with major changes in the fecal flora.
BACKGROUND
Animal studies have demonstrated dramatic changes in the intestinal flora during total enteral (TEN) or parenteral (TPN) nutrition.


OBJECTIVE
To assess the impact of TEN and TPN on human intestinal microflora.


METHODS
Eight patients on fiber-free TEN, five patients on TPN, and ten controls were studied. Fecal bacteria were identified and numbered (logCFU/g feces), and fecal short-chain fatty acids (SCFAs) were measured in stool samples, by gas-liquid chromatography.


RESULTS
In TEN patients, compared to controls (P < 0.01), aerobes were increased (8.46 +/- 0.24) while anaerobes were decreased (5.79 +/- 0.84). In TPN patients, both aerobes and anaerobes were decreased compared to controls (5.64 +/- 0.27 and 5.31 +/- 1.09 respectively, P < 0.01). Total SCFAs were lower in TPN patients than in TEN patients (48.3 +/- 16.6 vs 118.6 +/- 24.1 mmol/kg, P < 0.05).


CONCLUSIONS
Both TPN and TEN induce modifications in the intestinal microflora. During TPN, a homogeneous decrease occurs in both aerobic and anaerobic bacteria. TEN decreases only anaerobic bacteria, while aerobic bacteria are increased. This imbalance may play a role in the pathophysiology of TEN-induced diarrhea.
Schneider
S M
SM
Gastroentérologie et Nutrition CHU de Nice-L'Archet Université de Nice-Sophia Antipolis BP 3079 06202 Nice Cedex 3, France. schneide@unice.fr
Le Gall
P
P
Girard-Pipau
F
F
Piche
T
T
Pompei
A
A
Nano
J L
JL
Hébuterne
X
X
Rampal
P
P
D001420:Bacteria, Aerobic / Q000254:growth & development*; D001421:Bacteria, Anaerobic / Q000254:growth & development*; D002849:Chromatography, Gas; D015169:Colony Count, Microbial; D004750:Enteral Nutrition / Q000009:adverse effects*; D005232:Fatty Acids, Volatile / Q000032:analysis; D005243:Feces / Q000737:chemistry / Q000382:microbiology*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000382:microbiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*
D005232:Fatty Acids, Volatile