Enteral Tube Feeding Diarrhea - Can Probiotics Help

Whether taking probiotics can help with the diarrhea caused by enteral tube feeding has not been studied much, according to this 2007 report.

Florastor has helped with the diarrhea caused through enteral tube feeding

There has been one study using Saccharomyces boulardii with critically ill tube fed patients and this did reduce the amount of diarrhea from 18.9% to 14.2%.1

The 64 patients in the trial were given 500mg Saccharomyces boulardii four times a day and the other 64 patients received a placebo. When additional risk factors such as fever and presence of an infection site were taken in to account the result was even more significant. The conclusion was that "S boulardii prevents diarrhea in critically ill tube-fed patients, especially in patients with risk factors for diarrhea."1

It is thought that this beneficial result came about through an increase in the production of short-chain fatty acid.

S boulardii is a yeast and more current thinking (the above trial was in 1997) is that it should not be taken by immunosuppressed people. It is popular in Europe and South America and has a well documented history against diarrhea in general after being "discovered" in a popular anti-diarrhea medicine brewed up by local Indochinese using lychee fruit.

Saccharomyces boulardii is available in a number of supplements including this online source of Florastor.

Another trial using Lactobacillus acidophilus plus Lactobacillus delbruckii ssp bulgaricus had no effect on whether people developed diarrhea or if they did, how often.2

Lactobacillus delbruckii ssp bulgaricus is one of the standard "starter" bacteria used in yogurt making.

Another top probiotic that has been trialled for this particular problem and found of no real help is Lactobacillus GG5.

The information on using probiotics to prevent diarrhea amongst enteral tube-fed people is very limited at present and the scientists reviewing these two trials from the 1990's said "at the moment there is not enough evidence from clinical trials to recommend the use of probiotics in the prevention of diarrhea in tube-fed patients."3

The C difficile bacteria is the leading cause of hospital releated diarrhea and accounts for 30% of patients with antibiotic associated diarrhea. It is known that one of the causes is the prolonged use of elemental diets that are completely absorbed within the small intestine4.

It is now believed that a diet containing adequate indigestible carbohydrate after the first week of critical illness is important. As one expert said: "While there is irrefutable evidence that conventional enteral tube feeding reduces respiratory and bloodstream infectious morbidity, the technique has been associated with increased risk of C. difficile infection." You can read more on this topic here.


1. Bleichner G, Blehaut H, Mentec H, Moyse D. Saccharomyces boulardii prevents diarrhea in critically ill tube-fed patients. A multicenter, randomized, double-blind placebo-controlled trial. Intensive Care Med. 1997;23:517?23.

2. Heimburger DC, Sockwell DG, Geels WJ. Diarrhea with enteral feeding: prospective reappraisal of putative causes. Nutrition. 1994;10:392?6.

3. Michael de Vrese3, Philippe R. Marteau. Probiotics and Prebiotics: Effects on Diarrhea. The American Society for Nutrition J. Nutr. 137:803S-811S, March 2007

4. O'Keefe SJ. Tube feeding, the microbiota, and Clostridium difficile infection. World J Gastroenterol. 2010 Jan 14;16(2):139-42.

5. Ferrie S, Daley M. Lactobacillus GG as treatment for diarrhea during enteral feeding in critical illness: randomized controlled trial. JPEN J Parenter Enteral Nutr. 2011 Jan;35(1):43-9. Epub 2010 Oct 26.