Conduite à tenir lors d’une diarrhée sous nutrition entérale

Abstract

Numerous definitions of diarrhoea are found in the literature. The onset of at least three liquid or soft stools per day is the simplest and the most applicable definition for the daily clinical practice. Aetiologies of diarrhoea are multiple. The context is sometimes obvious: recent intestinal surgery (short bowel syndrome), digestive disease leading to malabsorption (e.g., Crohn's disease), or digestive infection (e.g., Clostridium difficile). Once these different aetiologies ruled out, drug intake (e.g., laxatives, antibiotics) or enteral nutrition (EN) can be suspected. EN constitutes the first choice of nutritional support when the gastrointestinal tract is functional. The onset of EN-associated diarrhoea should not be systematically considered as a non-functionality of the gastrointestinal tract, and should not lead to a systematic stop of EN. The management of EN-associated diarrhoea is mandatory, because of the several consequences of diarrhoea on the patient, the daily work of health care professionals, and finally, health-related costs. The maintaining of fluid and electrolytes balance is a priority. This article proposes a flow chart for the management of EN-associated diarrhoea. If EN is considered as the primary cause of diarrhoea, changes in the administration flow rate or replacement of the EN solution have to be considered. The best management of EN-associated diarrhoea is its prevention, based on the respect of EN initiation and administration rules.