BENEFICIAL EFFECT OF A BILE-ACID RESIN BINDER ON ENTERAL FEEDING INDUCED DIARRHEA

Objectives: Diarrhea is a complication of enteral feeding, occurring i n 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 le ads to choleretic diarrhea. Hence, diarrhea induced by enteral feeding should improve with the use of a bile acid binding agent, such as Col estid Granules. Methods: We evaluated the effect of Colestid on entera l feeding-induced diarrhea in a double-blind placebo-controlled study. Nineteen patients who were nil per os (NPO) for 5 days before initiat ion of enteral feeding were enrolled in the study and treatment contin ued for 7 days. The severity and frequency of diarrhea were quantified . Fecal bile acids were measured enzymatically. Stool nutrient loss wa s measured by fat extraction, microkjeldahl determination of nitrogen, and bomb calorimetry of dried fecal specimens. Results: Enteral feedi ng resulted in a high frequency of diarrhea (95%) at some time during the observation period. The majority of episodes of diarrhea in both g roups were of low volume. Colestid significantly decreased the prevale nce and severity of diarrhea. Colestid had no significant effect on fe cal calorie or nutrient losses. The average bile acid concentration in the stool increased significantly after enteral feeding. Conclusion: Enteral feeding-induced diarrhea is, at least in part, due to malabsor ption of bile acids. The bile acid resin binding agent Colestid improv es diarrhea induced by enteral feeding. (Am J Gastroenterol 1998; 93:9 67-971. (C) 1998 by Am. Cell. of Gastroenterology).