A systematic review of the use of probiotics in enteral feeding to improve enteral associated gastrointestinal symptoms

Abstract

Abstract Background: Enteral nutrition is an important therapy for patients who cannot satisfy their nutritional requirements orally. However, it often leads to gastrointestinal issues such as diarrhoea, nausea, vomiting and abdominal pain. Probiotics have been suggested as a potential intervention to alleviate these symptoms, but their efficacy in this context remains unclear. The present study aimed to systematically review the impact of probiotics on gastrointestinal symptoms in adult patients receiving enteral nutrition. Methodology: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed and Medline databases were searched for English-language randomised controlled trials (RCTs) published since 2010. The search terms combined keywords related to gastrointestinal symptoms, probiotics and enteral nutrition. The reviewed studies had adult participants receiving enteral nutrition, compared probiotics with placebos and reported on gastrointestinal symptoms. The quality of the studies was assessed using the updated Cochrane risk-of-bias tool (RoB 2). Primary outcomes included changes in gastrointestinal symptoms, such as diarrhoea and nausea, while secondary outcomes covered biochemistry tests, mortality rates, length of ICU and hospital stays and BMI changes. Results: Of the 549 initially identified studies, 7 RCTs met the inclusion criteria. The results showed that probiotics were associated with a reduction in diarrhoea incidence in several studies, including significant findings from Zhao et al. (2017) and Motoori et al. (2022). Probiotics also significantly reduced vomiting and abdominal pain in specific trials, such as those conducted by Karolina et al. (2020) and Shao et al. (2013). However, the impact of probiotics on secondary outcomes, such as biochemistry tests, mortality rates and ICU and hospital stays, was limited, with no significant improvements observed in these areas. Conclusion: Probiotics appear to be beneficial in managing certain gastrointestinal symptoms associated with enteral nutrition, particularly diarrhoea and vomiting. Although some studies found significant improvements, others did not observe notable effects. The evidence supports the potential of probiotics as an adjunctive therapy in enteral nutrition management. However, further research is needed to identify the most effective probiotic strains, dosages and treatment durations to enhance overall patient outcomes.