Efficacy of partially hydrolyzed guar gum (PHGG) supplemented modified oral rehydration solution in the treatment of severely malnourished children with watery diarrhoea: a randomised double-blind controlled trial

Abstract

ObjectivesTo examine whether PHGG added ORS reduce duration of diarrhoea, stool output and enhance weight gain.MethodsIn a double-blind controlled clinical trial, 126 malnourished children (weight for length/weight for age < −3 Z-score with or without pedal edema), aged 6 – 36 months with acute diarrhoea <7 days were studied in two treatment groups; 63 received modified WHO ORS (Na 75, K 40, Cl 87, citrate 7, glucose 90 mmol/L) with PHGG 15 g/L (study group); 63 received modified WHO ORS without PHGG (control). Other treatments were similar in both groups. The study protocol was approved by Ethics Committee of icddr,b; the study was carried out at the Dhaka Hospital.ResultsThe mean duration of diarrhoea (h) was significantly shorter in children of the study group (Study vs. control, mean ± SD, 57 ± 31 vs. 75 ± 39, p = 0.01). Although there was a trend in stool weight reduction in children receiving ORS with PHGG (study vs. control, stool weight (g), mean ± SD; 1st 24 hour, 854.03 ± 532.15 vs. 949.11 ± 544.33, p = 0.32; 2nd 24 hour, 579.84 ± 466.01 vs. 761.26 ± 631.64, p = 0.069; 3rd 24 hour, 385.87 ± 454.09 vs. 495.73 ± 487.61, p = 0.196), especially in 2nd 24 h period, the difference was not statistically significant. The mean time (day) to attain weight for length 80% of NCHS median without edema was significantly shorter in the study group (study vs. control, mean ± SD, 4.5 ± 2.6 vs. 5.7 ± 2.8, p = 0.027).ConclusionPHGG added to ORS substantially reduced duration of diarrhoea. It also enhanced weight gain. Further studies might substantiate to establish its beneficial effect.Clinical trial registration numberNCT01821586

Oral rehydration of malnourished children with diarrhoea and dehydration: A systematic review

“…After screening and evaluation, six studies were identified that investigated ORS in children with SAM complicated by dehydration, incorporating a total of 686 children. All six of these studies were conducted in Asia, four of which were conducted at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B) 18– 21 and two in India (New Delhi 22 and Calcutta 23 ). One study included children with and without SAM 18 , but reported independently on outcomes for children with SAM.…”

“…All of the studies reported on stool output, either by measuring weight of stools or nappies (Alam et al 2003, 2009, 2015 and Dutta 2015) 19– 21, 23 or recording frequency (Alam et al 2000 and Kumar et al 2015) 18, 22 . Of the two studies comparing standard with hypo-osmolar ORS, both found that the stool output was significantly less in the group receiving hypo-osmolar ORS (Alam et al 2000 found that daily stool frequency was 4.27 compared with 5.86 episodes, p<0.05, and Dutta et al (2001) found that stool output was 52.3 versus 96.6 g/Kg/day, p=0.0001).…”

“…Alam et al (2003) 19 and (2015) 21 Kumar et al (2015) 22 reported the number of patients requiring IV fluids after randomisation. There were no significant differences in this outcome between groups receiving ORS (hypo-osmolar or old WHO) and ReSoMal, nor did addition of PHGG to ORS reduce the treatment failure rate).…”

“…This is fine but in this case, one wonders whether two papers now included in the evidence base should not be excluded, namely the Alam 2009 1 and Alam 2015 papers 2 . These two papers compare oral rehydration solutions with identical electrolyte content, and are not really relevant to the hypothesis discussed here.…”

Drug development and acute gastrointestinal infections

“…Compared with ORS, the addition of only partially hydrolyzed guar gum (a soluble fiber, which turns into short-chain fatty acids in the intestine, enhancing colonic mucosa regeneration and water absorption) shortened the duration of diarrhea and enhanced weight gain. However, there was no effect on stool volume [3]. Improved ORS that will reduce stool volume and duration of diarrhea is still desired.…”