Persistent diarrhoea: clinical efficacy and nutrient absorption with a rice based diet

Article Abstract:

Persistent diarrhea is usually defined as an episode of apparently acute diarrhea that lasts for more than 14 days. Enteropathogenic bacteria are rarely isolated from the stools of these patients. Malabsorption of nutrients in persistent diarrhea has been attributed to specific enzyme loss, small intestinal bacterial overgrowth, derangement of bile acid metabolism, intestinal mucosa injury consistent with lactose intolerance, and severe protein energy malnutrition. The proper choice of a successful diet to relieve this condition requires an assessment of the intestinal absorption capacity. Approximately 300 cases of persistent diarrhea were diagnosed from approximately 70,000 annual patient visits to the International Center for Diarrheal Disease Research, Bangladesh (ICDDRB). Twenty-six boys, 4 to 18 months, were included on the basis of symptoms of nonbloody diarrhea for more than 14 days, four or more liquid or watery stools daily, the absence of Vibrio cholerae, Salmonella spp. or Shigella spp. from stools, no systemic infections, no kwashiorkor (malignant malnutrition), or exclusive breast feeding. Controls were selected from among children with previous cases of diarrhea who had been disease-free for the previous two months. Routine blood counts, urine and stool analyses, electrolyte determinations, assays for Giardia and Cryptosporidia organisms, cultures for enteric pathogens and the ELISA test for rotaviruses were collected for all participants. The liquid test diet consisted of rice powder, egg white, soya oil, glucose, salt and water. Electrolytes were added after the diet was blended together. Balance studies were conducted to measure intestinal absorption. Most of the patients recovered after feeding on this diet for three to seven days. Those who failed after seven days were fed a comminuted chicken-based diet. All recovered after 9 to 39 days. This diet seems to have significant value in treating this condition. (Consumer Summary produced by Reliance Medical Information, Inc.)

Rice, Diet therapy, Diarrhea in children, Childhood diarrhea

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Double blind, placebo controlled trial of metronidazole in Crohn's disease

Article Abstract:

Crohn's disease, also known as regional ileitis, is an inflammatory condition afflicting the intestinal tract, in particular the lower portion of the ileum. Treatment of Crohn's disease is problematic; various therapeutic approaches are used, including corticosteroids, immunosuppressants, and nutritional therapy. The administration of metronidazole, an anti-infective medication generally used to treat bacterial and ameboid infections, remains controversial in the treatment of Crohn's disease. To provide additional information concerning the efficacy and potency of metronidazole, a clinical trial initially involving 105 patients was carried out. Patients were administered one of two doses of metronidazole (10 milligrams per kilogram per day or 20 milligrams per kilogram per day) or inactive placebo for 16 weeks. Twenty-one patients had to withdraw from the study because of deterioration of symptoms, 17 for adverse side effects, and 11 for violating the protocol of the study, leaving 56 patients who completed the entire course of treatment. Improvements were seen in the drug-treated group in disease index (a composite measure of the severity of Crohn's disease symptoms) and in several blood-borne indices of disease state. There was a tendency of the high-dose group to show greater improvement than the low-dose group, but this difference was not statistically significant (most likely because of the small sizes of the remaining groups). Analysis of patient subpopulations indicated that metronidazole was more effective in patients with disease activity in either the large intestine alone or both large and small intestine than in patients with disease activity restricted to the small intestine. (Consumer Summary produced by Reliance Medical Information, Inc.)

Metronidazole, Gastrointestinal diseases, Crohn's disease

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Double blind trial of loperamide for treating acute watery diarrhoea in expatriates in Bangladesh

Article Abstract:

The safety and effectiveness of loperamide, an antiperistaltic drug used to treat acute diarrhea and chronic diarrhea associated with inflammatory bowel disease, was evaluated in the treatment of watery diarrhea. Fifty adult patients with at least four unformed stools over a 24-hour period and an illness of less than 72 hours were treated with either loperamide or a placebo, a pill of no pharmacological value. Loperamide was shown to have little effect on the disease in its final stages. There were no significant differences in stool frequencies, proportion of patients with cramps, nausea, or vomiting during the last three days of the study. Neither group suffered serious side effects. Loperamide is considered effective in treating patients with symptoms of watery diarrhea, by decreasing stool frequency during the early stage of illness.

Diarrhea, Loperamide

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