Constipation Is More Frequent Than Diarrhea in Patients Fed Exclusively by Enteral Nutrition

Abstract

Background:Digestive complications in enteral nutrition (EN) can negatively affect the nutrition clinical outcome of hospitalized patients. Diarrhea and constipation are intestinal motility disorders associated with pharmacotherapy, hydration, nutrition status, and age. The aim of this study was to analyze the frequency of these intestinal motility disorders in patients receiving EN and assess risk factors associated with diarrhea and constipation in hospitalized patients receiving exclusive EN therapy in a general hospital.Materials and Methods:The authors performed a sequential and observational study of 110 hospitalized adult patients fed exclusively by EN through a feeding tube. Patients were categorized according to the type of intestinal transit disorder as follows: group D (diarrhea, 3 or more watery evacuations in 24 hours), group C (constipation, less than 1 evacuation during 3 days), and group N (absence of diarrhea or constipation). All prescription drugs were recorded, and patients were analyzed according to the type and amount of medication received. The authors also investigated the presence of fiber in the enteral formula.Results:Patients classified in group C represented 70% of the study population; group D comprised 13%, and group N represented 17%. There was an association between group C and orotracheal intubation as the indication for EN (P < .001). Enteral formula without fiber was associated with constipation (logistic regression analysis: P < .001).Conclusion:Constipation is more frequent than diarrhea in patients fed exclusively by EN. Enteral diet with fiber may protect against medication‐associated intestinal motility disorders. The addition of prokinetic drugs seems to be useful in preventing constipation.

The effects on nutritional status, bowel habits and tolerance of a high- protein, high-calorie, fiber- and fructo-oligosaccharide-enriched enteral formula: Safety and Effectiveness of Enteral Nutrition in Spanish patients (SENS Study).

“…Intestinal disorders are one of the most common complications of EN (11), and are reported to affect 30-60% of patients (1,11). Constipation, meanwhile, is very common in patients with reduced mobility (12), and is sometimes even more prevalent than diarrhea in patients receiving enteral feeding alone (13). These complications, aside from the immediate discomfort they cause for patients, can trigger additional problems: adequate nutrition may be limited and electrolyte imbalances may occur, generating additional costs associated with patient care.…”

Enteral Nutrition for Adults in the Hospital Setting

“…Many definitions of constipation exist, although most consistently identify infrequent and difficult defecation as defining characteristics 114 . The main causes of constipation among patients receiving EN are medications (benzodiazepines and opioids being the most common), inadequate fluid intake or dehydration, inadequate fiber intake, and lack of physical activity 67 , 73 , 112 . Other causes of constipation include neuromuscular disorders, hypothyroid disorders, GI motility disorders, and history of laxative abuse 112 .…”

“…Constipation can cause abdominal distension or bloating, vomiting, fecal impaction, and bowel perforation, therefore increasing the need for nursing, medical, and/or pharmaceutical interventions 74 . For these reasons, constipation has been associated not only with feeding intolerance and delays in EN therapy but also with difficulty weaning from mechanical ventilation in critically ill patients, longer length of ICU stay, and decreased quality of life 73 – 75…”

Quality indicators for enteral and parenteral nutrition therapy: application in critically ill patients "at nutritional risk"

“…One the other hand, the values in 2010 (10.5%) and 2012 (10.7%) were bordering the target established. Bittencourt et al (41), in an observational study with 110 patients, applied the diarrhea indicator and found a prevalence of 13%, while Martins et al (27) met 8%. In the literature, there are records with higher percentages of episodes of diarrhea, with values ranging from 14% to 41% of the days on ENT (41).…”