The role of probiotics and prebiotics in the management of diarrhoea associated with enteral tube feeding.
BACKGROUND
Diarrhoea is a common and serious complication of enteral tube feeding, and has a range of aetiologies. Manipulation of the colonic microflora may reduce the incidence of enteral tube feeding diarrhoea via suppression of enteropathogens and production of short-chain fatty acids. Probiotics and prebiotics are commonly used during enteral tube feeding to manipulate the colonic microflora; however, their efficacy is as yet uncertain.


METHODS
English-language studies investigating the pathogenesis of enteral tube feeding diarrhoea and the use of probiotics and prebiotics were identified by searching the electronic databases CINAHL, EMBASE and MEDLINE from 1980 to 2001. The bibliographies of articles obtained were searched manually.


RESULTS
Only two prospective, randomized, double-blind, placebo-controlled trials have investigated the effect of a probiotic on enteral tube feeding diarrhoea; however, results are conflicting. No prospective, randomized, double-blind, placebo-controlled studies have specifically addressed the effect of a prebiotic on the incidence of enteral tube feeding diarrhoea.


CONCLUSIONS
Theoretically, probiotics and prebiotics may be of benefit in prophylaxis against enteral tube feeding diarrhoea; however, there is currently insufficient evidence to support their routine use. Prospective, randomised, double-blind, placebo-controlled studies investigating their effect on diarrhoea are required. These observations are discussed with reference to the current literature.
Whelan
K
K
Department of Nutrition and Dietetics, Kings College London, 150 Stamford Street, London SE1 9NN, UK. kevin.whelan@kcl.ac.uk
Gibson
G R
GR
Judd
P A
PA
Taylor
M A
MA
D003967:Diarrhea / Q000628:therapy*; D004750:Enteral Nutrition / Q000009:adverse effects*; D006801:Humans; D019936:Probiotics / Q000627:therapeutic use*