In enteral nutrition, diarrhea is one of the most common complications; however, before interrupting N,T it is necessary to rule out other causes of this complication, such as use of some drugs (antibiotics, magnesium-based antacids and prokinetic agents), hypoalbuminemia, pseudomembranous colitis, malabsorption and intestinal atrophy (1).
A Brazilian study analyzed the frequency of intestinal motility disorders and risk factors associated with diarrhea and intestinal constipation in hospitalized patients receiving exclusive ENT. The study included 110 hospitalized adult patients who were followed up daily for 21 consecutive days. They were classified into three (3) groups according to the presented intestinal transit disorders: D group (diarrhea: defined as three (3) or more watery stools in 24 hours); C group (constipation: defined as those with less than one bowel movement in 3 days); and N group (absence of diarrhea and constipation).
Patients were also classified in accordance with the presence of fiber in the enteral formula: fiber group (those receiving EN with soluble and insoluble fiber at the dose of 1.5 g/100 ml for at least five (5) consecutive days) and the fiber-free group (receiving fibre-free EN for two (2) consecutive days).
Those belonging to the C group accounted for 70% of studied patients. The D group appeared in 13% of the total sample and the N group accounted for 17%.
The fiber-free enteral diet was associated with constipation (p <0.001) and most of these subjects were receiving mechanical ventilation (p <0.001) (2).
In accordance with this study, constipation was the most common intestinal motility disorder in ENT patients.\"Constipation in patients receiving EN seems to be barely discussed in relation to diarrhea, maybe because it requires less attention from the multidisciplinary staff involved in the treatment of patients.
On the other hand, constipation is a disorder that can often be associated with gastroparesis, ileoparesia and consequently insufficient EN supply, influencing the patients’ prognosis,\" the authors observe (2).
The enteral diet with fiber seems to protect from intestinal motility disorders and, in this study, it was associated with the prevention of constipation in patients receiving ENT.
1. Romito R. Early Administration of Enteral Nutrients in Critically Ill Patients. AACN Clinical Issues 6(2): 242-256, 1995.
2. Bittencourt et al. Constipation is more frequent than diarrhea in patients fed exclusively by enteral nutrition: results of an observational study. Nutr Clin Pract. 2012;27(4):533-9.