Gastric Cancer Patients | Effects of Fiber and Probiotics with Enteral Nutrition

The Occurrence of Gastric Cancer

Gastric Cancer is a common type of cancer that affects people worldwide. More than 50% of cases occur in Eastern Asia. People who have gastric cancer often have malnutrition, increasing the risk of death and sickness after surgery.

What is Enteral Nutrition?

Enteral nutrition is a type of food that people can eat after surgery to help them recover. A study showed that enteral nutrition could help preserve intestinal structure and function, improve immunity, and shorten the length of hospital stay. However, enteral nutrition can also cause some problems. One of the most common problems is diarrhea, affecting the overall recovery of postoperative patients with gastric cancer. This can cause fluid and electrolyte loss, which leads to intestinal disorders and a more extended hospital stay. Many studies have shown that the prevalence rate of diarrhea in patients who are receiving enteral nutrition is between 12% and 68%. 

Therefore, it is essential to find ways to reduce diarrhea in patients receiving enteral nutrition.

Several factors that can cause diarrhea when you’re on Enteral Nutrition were observed. One of the risk factors was an imbalance in the intestinal flora. Previous studies have shown that an imbalance in the intestinal flora can occur in patients with diarrhea that’s associated with Enteral Nutrition and might be involved in its pathogenesis. Patients who experienced diarrhea during Enteral Nutrition had a low level of bifidobacteria in the intestinal flora. These patients also had a high level of clostridia, which are the pathogenic bacteria that cause diarrhea. An imbalance in the intestinal flora can affect intestinal function, leading to diarrhea, vomiting/nausea, abdominal distension, and abdominal pain.

How Fiber and Probiotics may help reduce diarrhea

Fiber-based enteral formulas may help reduce diarrhea associated with Enteral Nutrition, but there is not enough evidence to say for sure. Meanwhile, probiotics have been shown to have several beneficial effects, such as protecting against colonization by pathogenic bacteria and enhancing intestinal barrier function. Some studies have found that probiotics are ineffective in preventing diarrhea, while other studies have found that they are effective. There is still not enough evidence to say whether or not probiotics are effective in preventing diarrhea associated with Enteral Nutrition.

The Study on Patients with Gastric Cancer and Fiber-Probiotic supplementation

120 patients with Gastric cancer were studied. They were put into 3 groups by picking envelopes at random. The groups were fiber-free nutrition formula, fiber-enriched nutrition formula, and fiber- and probiotic-enriched nutrition formula. All patients were given EN formulas (liquid food) for 7 days after surgery.

The Results

Study showed that ( Fiber Free Group ) had the most diarrhea cases. While the ( Fiber Enriched Probiotic Group ) had the least diarrhea cases. Intestinal disorders were similar between the ( Fiber Enriched and Fiber Free group ). While the ( Fiber-Enriched with Probiotics group )  had a lowest number of intestinal disorders. Length of Hospital Stay in the ( Fiber Enriched and Fiber Enriched with Probiotics groups ) was shorter than the Fiber Free Groups.

Conclusion

Fiber and Probiotics can help treat diarrhea caused by EN in postoperative patients with GC.

Abbreviations: ALB = albumin, BMI = body mass index, EN = enteral nutrition, ERAS = enhanced recovery after surgery, FE = fiber-enriched nutrition formula, FEP = fiber- and probiotic-enriched nutrition formula, FF = fiber-free nutrition formula, GC = gastric cancer, LOHS = length of hospital stay, PA = prealbumin, RCT = randomized-controlled trial, TLC = total lymphocyte count, TRF = transferrin.

Reference

Effects of fiber and probiotics on diarrhea associated with enteral nutrition in gastric cancer patients: A prospective randomized and controlled trial

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