A comparison of two feeding methods in the alleviation of diarrhoea in older tube-fed patients: a randomised controlled trial

Objective: to compare the effect of two feeding methods on older tube‐fed patients suffering from diarrhoea. Design: randomised controlled study. Setting: geriatric wards in a regional hospital. Subjects: 105 patients over the age of 60 who developed diarrhoea while on intermittent bolus tube feeding. Methods: subjects were randomised either to switch to continuous tube feeding or to continue with intermittent bolus tube feeding for 3 days, with some extended to 5 days. Incontinence pads were inspected 6 times per day by independent observers. Each motion was evaluated using a validated score according to its volume and consistency. Stools were sent for pathogen culture and Clostridium difficile cytotoxin assay. Those with positive assays were excluded from analysis. Gastric aspirations were performed at regular intervals and significant residual volumes recorded. Results: 86 patients completed the study. Twelve patients (14%) were excluded due to positive CD stool assays. Seventy‐four patients were entered into analysis. The median diarrhoea scores of the continuous infusion group and the intermittent bolus group were: day 0 (12 versus 10, P=0.18), day 3 (4 versus 6, P=0.23) and day 5 (5 versus 4, P=0.83) respectively. There was no statistical difference between the two groups. Two patients in the continuous infusion group (n=37) and 4 patients in the intermittent bolus group (n=37) had significant gastric residual volumes. The incidence did not differ significantly. Conclusion: contrary to common belief and recommendation, we could not find a significant difference between the continuous feeding method and the intermittent feeding method in the alleviation of diarrhoea in tube‐fed patients. We do not recommend routine switch to continuous pump feeding in the management of tube‐fed patients suffering from diarrhoea.