Protective Effect of Low Molecular Weight Seleno-Aminopolysaccharide on the Intestinal Mucosal Oxidative Damage.

Low molecular weight seleno-aminopolysaccharide (LSA) is an organic selenium compound comprising selenium and low molecular weight aminopolysaccharide (LA), a low molecular weight natural linear polysaccharide derived from chitosan. LSA has been found to exert strong pharmacological activity. In this study, we aimed to investigate the protective effect of LSA on intestinal mucosal oxidative stress in a weaning piglet model by detecting the growth performance, intestinal mucosal structure, antioxidant indices, and expression level of intracellular transcription factor nuclear factor erythroid 2-related factor 2 (Nrf2) and its related factors. Our results indicated that LSA significantly increased the average daily gain and feed/gain (p < 0.05), suggesting that LSA can effectively promote the growth of weaning piglets. The results of scanning electron microscope (SEM) microscopy showed that LSA effectively reduced intestinal damage, indicating that LSA improved the intestinal stress response and protected the intestinal structure integrity. In addition, diamine oxidase (DAO) and d-lactic acid (d-LA) levels remarkably decreased in LSA group compared with control group (p < 0.05), suggesting that LSA alleviated the damage and permeability of weaning piglets. LSA significantly increased superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px), and total antioxidant capacity (T-AOC) levels, but decreased malondialdehyde (MDA) level, indicating that LSA significantly enhanced the antioxidant capacity and reduced oxidative stress in weaning piglets. RT-PCR results showed that LSA significantly increased GSH-Px1, GSH-Px2, SOD-1, SOD-2, CAT, Nrf2, HO-1, and NQO1 gene expression (p < 0.05). Western blot analysis revealed that LSA activated the Nrf2 signaling pathway by downregulating the expression of Keap1 and upregulating the expression of Nrf2 to protect intestinal mucosa against oxidative stress. Collectively, LSA reduced intestinal mucosal damage induced by oxidative stress via Nrf2-Keap1 pathway in weaning stress of infants.

Recomendaciones para el empleo de probióticos en la diarrea en la infancia / Recommendations for the use of probiotics in childhood diarrhea

La pediatría es una de las especialidades médicas donde los ensayos clínicos aleatorizados con probióticos han demostrado la eficacia y seguridad de éstos en diversas patologías, sobre todo digestivas. La mayor evidencia corresponde al empleo de probióticos en diversos tipos de diarreas, por lo que han sido incluidos en diferentes guías de práctica clínica. El efecto del probiótico debe valorarse en función de la cepa utilizada, la dosis y la duración del tratamiento. Los probióticos son eficaces en el tratamiento de la diarrea aguda infecciosa infantil, ya que acortan la duración media del proceso, el número de deposiciones y el porcentaje de episodios que se prolongan más de 4 días. De igual modo, han sido ampliamente estudiados para prevenir el desarrollo de la diarrea asociada a antibióticos, siendo los que tienen mayor nivel de evidencia la levadura (AU)

Pediatrics is one of the medical specialties where randomized clinical trials with probiotics have demonstrated its efficacy and safety in various pathologies, especially digestive being their use in different types of diarrhea, where more evidence there is for what are included in different clinical practice guidelines. The effect of probiotic should be assessed according to the used strain, dose, administration time and the duration of the same. Probiotics are effective in the treatment of acute infectious diarrhea in children by shortening the average duration of the process, the number of liquid stools, and the percentage that lasts more than 4 days. In the same way, have been widely studied for preventing the development of antibiotic-associated diarrhea being those that have higher level of evidence the yeast Saccharomyces boulardii and strain Lactobacillus rhamnosus GG (AU)

Congenital Glucose-Galactose Malabsorption: A Case Report.

Congenital glucose-galactose malabsorption (CGGM) is a rare cause of intractable infantile diarrhea, with only a few hundred cases recognized worldwide. This life-threatening disorder must be considered in the differential diagnosis of an infant who presents with diarrhea and dehydration that fails to respond to standard therapy. The clinical and diagnostic course of an infant with recurrent episodes of watery diarrhea and hypernatremic dehydration found to be homozygous for a rare variant in the SLC5A1 gene, c.187C>T (p.R63X) is described.

Oral zinc provision in acute diarrhea.

PURPOSE OF REVIEW: The clinical management of acute diarrhea is based on the use of oral rehydration salts and appropriate nutrition. In addition, the WHO and The United Nations Children's Fund recommend zinc supplementation for diarrhea in children below 5 years. This article aims at reviewing recent literature on the effects of oral zinc for treating acute diarrhea in children. RECENT FINDINGS: Recent studies confirm that zinc supplementation has a benefit in children below 5 years with acute diarrhea in countries at medium or high risk of zinc deficiency. A few small trials have reported a benefit of zinc in children at low risk of zinc deficiency, with heterogeneity in results. No recent study has explored the effects of zinc in children younger than 6 months, and in this age group previous research refuted any benefit from zinc. SUMMARY: Current literature supports the use of oral zinc in treating diarrhea in children older than 6 months, especially if at risk of zinc deficiency, such as children with poor diets exposed to recurrent gastrointestinal infections. More research is needed to confirm findings in children at low risk of zinc deficiency. Currently there is no evidence that zinc benefits children younger than 6 months.

Lactose-free milk for infants with acute gastroenteritis in a developing country: study protocol for a randomized controlled trial.

BACKGROUND: Acute gastroenteritis is a major cause of pediatric morbidity and mortality, accounting for 15% of all childhood deaths worldwide. In developing countries, diarrheal diseases continue to be a major public health burden. Evidence from developed countries suggests that intake of lactose-free milk during diarrheal episodes may reduce the duration of the illness in pediatric inpatients. It is unknown whether lactose-free milk reduces the severity or duration of acute gastroenteritis in infants treated in outpatient settings in developing countries where diarrhea is more severe, and results in higher morbidities and mortalities. We hypothesize that lactose-free milk intake during acute gastroenteritis would significantly decrease the duration and severity of diarrhea in infants presenting to the Emergency Department (ED), as compared with lactose-containing milk. METHODS/DESIGN: An open-label randomized clinical trial. STUDY POPULATION: 40 infants with acute gastroenteritis, age between 2 and 12 months, presenting to the ED, will be randomized to control or intervention group. INTERVENTION: Lactose-free milk, whereas the control group will continue on regular infant formula for a total of 7 days. Infants will be followed up for 7 days. OUTCOME MEASURES: Diarrhea duration, weight loss, illness clinic visits, hospitalization rate, parental satisfaction, and time to symptom resolution. STATISTICAL ANALYSIS: Descriptive and regression analysis will be conducted under the intention-to-treat basis by using SPSS version 21. DISCUSSION: Acute gastroenteritis is a public health burden for developing countries, with a significant impact on infant morbidity and mortality. Provision of infant formula that may reduce the duration and severity of diarrhea can decrease this burden in countries with limited healthcare resources, like Lebanon. The findings from this study are anticipated to provide evidence-based dietary recommendations for ambulatory infants with acute diarrhea in developing countries. TRIAL REGISTRATION: ClinicalTrials.gov NCT02246010; September 2014.

Empleo de probióticos y prebióticos en atención primaria / Use of probiotics and prebiotics in primary care

Los probióticos se utilizan en gran número de patologías tanto pediátricas como en el adulto, principalmente en problemas gastrointestinales como la diarrea aunque también se ha valorado su efecto beneficioso en alteraciones inmunológicas como la dermatitis atópica y, en los últimos años, en diferentes patologías de la mujer como las vulvovaginitis y las mastitis. Sin embargo, el empleo de probióticos no está del todo incorporado a la práctica clínica habitual por los médicos de Atención Primaria debido en parte a los resultados poco concluyentes de la mayoría de los estudios, y por otro lado a la gran diversidad en el diseño de los mismos, lo que justifica la variabilidad en los resultados de su eficacia. Esto trae consigo una importante dificultad para desarrollar guías definitivas de tratamiento, aunque hay excepciones como, por ejemplo, la de la WGO. El objetivo del presente taller, impartido en el VI Workshop de la Sociedad Española de Probióticos y Prebióticos es formar a los médicos de Atención Primaria, tanto pediatras como generalistas, en las aplicaciones clínicas de estos preparados nutricionales en diversas patologías: diarrea aguda y diarrea asociada a antibióticos, enterocolitis necrotizante, empleo en fórmulas lácteas infantiles, cólico del lactante, síndrome de intestino irritable, enfermedad inflamatoria intestinal, vulvovaginitis y mastitis (AU)

Probiotics are used in a great number of both paediatric and adult diseases, mainly in gastrointestinal disorders, like diarrhoea. Nevertheless, their beneficial effect on immune alterations, such as atopic dermatitis and, more recently, in women related diseases such as vulvovaginitis and mastitis have also been observed. However, the use of probiotics is not completely implemented into the routine clinical practice for primary care physicians. There is still a great controversy with scarce scientific evidence, due to the diversity in the designs thereof which justifies the variability in the efficacy results. This outcome leads to difficulties in developing definitive treatment guidelines although there are exceptions, for example, WGO. The aim of this workshop, held at the VI Congress of the Spanish Society of Probiotics and Prebiotics is the training of primary care physicians, both paediatricians and general practitioners in the clinical applications of these nutritional preparations in different diseases: acute diarrhoea; antibiotic associated diarrhoea, necrotizing enterocolitis, employment in infant milk formulas, infant colic, irritable bowel syndrome and inflammatory bowel disease, as well as vulvovaginitis and mastitis (AU)

Probióticos en la diarrea aguda y asociada al uso de antibióticos en pediatría / Probiotics for the treating acute diarrhea and preventing antibioticassociated diarrhea in children

Los probióticos son beneficiosos en el tratamiento de la diarrea aguda. Una revisión sistemática demuestra que el uso de probióticos reduce en un día la duración de la diarrea y disminuye el 59% el riesgo de que la diarrea persista más allá de 4 días. También disminuye en 24 horas la duración de la estancia hospitalaria. El efecto beneficioso de los probióticos es específico para cada especie. Lactobacillus rhamnosus GG y Saccharomyces boulardii son los dos probióticos que han demostrado su eficacia en la diarrea aguda. El uso de probióticos disminuye en un 50% la incidencia diarrea asociada a antibióticos. No se han descrito efectos secundarios de importancia en los ensayos clínicos realizados aunque se han descrito infecciones invasivas en niños inmunodeprimidos o portadores de vías centrales (AU)

Probiotics are helpful in the treatment of acute diarrhea. Several systematic reviews show that the use of probiotics shortens the duration of diarrhea in one day and reduces by 59% the risk of diarrhea lasting longer than 4 days. Hospital stay is 24 hours shorter in children treated with probiotics. The benefitial effect of probiotics is species-specific; Lactobacillus rhamnosus GG and Saccharomyces boulardii are the two species with proven efficacy in the treatment of acute diarrhea. The use of probiotics reduces by 50% the risk of antibiotic-associated diarrhea. No significant side effects were found in the clinical trials but rare cases of invasive infections have been reported in immunosuppressed children or those with indwelling central venous catheters (AU)

Zinc and Vitamin Supplementation in an Under-5 Indigenous Population of Guatemala: Influence of Lay Health Promoters in Decreasing Incidence of Diarrhea.

BACKGROUND: Malnutrition is an urgent problem in the developing world, especially for children under 5 years of age. The article describes the utilization of a standard of practice designed to prevent illness in a malnourished, under-5 indigenous population and reinforced by weekly basic health messages taught by lay community health promoters. METHOD: The two villages were chosen for observation after administration of the standard of care among the Maya-Kíché, the most numerous Mayan group in Guatemala. The standard of practice, 20 mg of daily oral zinc, was administered for 10 days in the home and followed by daily vitamin supplementation that continued throughout the 3 months of the project. All patients received four monthly clinic visits, with one of the village groups receiving weekly health promoter visits. RESULTS: Data evaluated after the quality improvement project showed significant differences in adherence to the zinc regimen (χ(2) = 3.677, p ≤ .05) as well as lower rates of diarrheal illnesses (χ(2) = 5.850, p ≤ .05), with both of these improved in the health promoter group. DISCUSSION: This study suggests that the training and implementation of para-health professionals from the lay community in response to specific health care needs could be considered a best practice in developing countries. IMPLICATIONS: Public health professionals are key to health promoter training and direction, and their importance in the global setting cannot be understated.

Aplicaciones clínicas del empleo de probióticos en pediatría / Clinical applications of the use of probiotics in pediatrics

Introducción: El empleo de probióticos supone un novedoso avance en el campo de la Pediatría puesto que pueden ser útiles en la prevención y tratamiento de múltiples patologías gastrointestinales, constituyendo un elemento más en nuestro arsenal terapéutico. Objetivo: En este artículo se presenta una revisión actualizada de la literatura científica sobre el uso de los probióticos en Pediatría, principalmente en problemas gastrointestinales con alteración en la microbiota intestinal describiéndose las principales aplicaciones del empleo de los probióticos y prebióticos en la infancia y repasando las líneas de investigación futuras. Resultados y conclusiones: A pesar de existir suficiente evidencia científica en varias patologías, la utilización de probióticos no está del todo incorporado a la práctica clínica habitual de los pediatras. Se emplea en el contexto de las enfermedades gastrointestinales (diarrea aguda infecciosa, la diarrea asociada a antibióticos, sobredesarrollo bacteriano) y, más recientemente, en procesos inflamatorios crónicos como la enfermedad inflamatoria intestinal o en trastornos funcionales como el cólico del lactante o el estreñimiento. También se ha valorado su efecto beneficioso en alteraciones extraintestinales, tales como la alergia (dermatitis atópica) o los efectos sobre las mucosas respiratorias o urogenitales y, en los últimos años, en la prevención de patología del recién nacido pretérmino y en la infección por H. pylori. Además existen varias líneas de investigación abiertas en la suplementación alimentaria con probióticos y prebióticos. Cada cepa prebiótica debe ser estudiada individualmente y extensamente para determinar su eficacia y seguridad en todas aquellas situaciones en que su empleo puede ser aconsejable (AU)

INTRODUCTION: The use of probiotics supposes a novel advance in the field of Pediatrics since they can be useful in the prevention and treatment of many gastrointestinal pathologies, constituting one more element in our therapeutic arsenal. OBJECTIVE: This article presents an updated review of the scientific literature on the use of probiotics in paediatrics, mainly in gastrointestinal problems with alteration in the intestinal microbiota describing the main applications of the use of probiotics and prebiotics in childhood and reviewing the future lines of research. RESULTS AND CONCLUSIONS: Although there enough scientific evidence in various pathologies, the use of probiotics is not entirely incorporated into the clinical practice of pediatricians. It is used in the context of the gastrointestinal diseases (acute infectious diarrhea, diarrhea associated with antibiotics, bacterial overcast) and, more recently, in chronic inflammatory processes such as inflammatory bowel disease or functional disorders as colic infant or constipation. Also have been assessed their beneficial effect in extraintestinal alterations, such as the allergies (atopic dermatitis) or the effects on respiratory or urogenital mucosae and, in recent years, in the prevention of pathology of the preterm newborn and in the H. pylori infection. In addition there are several lines of research open in nutritional supplementation with probiotics. and prebiotics. Each strain probiotics should be studied individually and extensively to determine its efficacy and safety in all situations in which their employment may be advisable (AU)

Effect of provision of daily zinc and iron with several micronutrients on growth and morbidity among young children in Pakistan: a cluster-randomised trial.

BACKGROUND: Powders containing iron and other micronutrients are recommended as a strategy to prevent nutritional anaemia and other micronutrient deficiencies in children. We assessed the effects of provision of two micronutrient powder formulations, with or without zinc, to children in Pakistan. METHODS: We did a cluster randomised trial in urban and rural sites in Sindh, Pakistan. A baseline survey identified 256 clusters, which were randomly assigned (within urban and rural strata, by computer-generated random numbers) to one of three groups: non-supplemented control (group A), micronutrient powder without zinc (group B), or micronutrient powder with 10 mg zinc (group C). Children in the clusters aged 6 months were eligible for inclusion in the study. Powders were to be given daily between 6 and 18 months of age; follow-up was to age 2 years. Micronutrient powder sachets for groups B and C were identical except for colour; investigators and field and supervisory staff were masked to composition of the micronutrient powders until trial completion. Parents knew whether their child was receiving supplementation, but did not know whether the powder contained zinc. Primary outcomes were growth, episodes of diarrhoea, acute lower respiratory tract infection, fever, and incidence of admission to hospital. This trial is registered with ClinicalTrials.gov, number NCT00705445. RESULTS: The trial was done between Nov 1, 2008, and Dec 31, 2011. 947 children were enrolled in group A clusters, 910 in group B clusters, and 889 in group C clusters. Micronutrient powder administration was associated with lower risk of iron-deficiency anaemia at 18 months compared with the control group (odds ratio [OR] for micronutrient powder without zinc=0·20, 95% CI 0·11-0·36; OR for micronutrient powder with zinc=0·25, 95% CI 0·14-0·44). Compared with the control group, children in the group receiving micronutrient powder without zinc gained an extra 0·31 cm (95% CI 0·03-0·59) between 6 and 18 months of age and children receiving micronutrient powder with zinc an extra 0·56 cm (0·29-0·84). We recorded strong evidence of an increased proportion of days with diarrhoea (p=0·001) and increased incidence of bloody diarrhoea (p=0·003) between 6 and 18 months in the two micronutrient powder groups, and reported chest indrawing (p=0·03). Incidence of febrile episodes or admission to hospital for diarrhoea, respiratory problems, or febrile episodes did not differ between the three groups. INTERPRETATION: Use of micronutrient powders reduces iron-deficiency anaemia in young children. However, the excess burden of diarrhoea and respiratory morbidities associated with micronutrient powder use and the very small effect on growth recorded suggest that a careful assessment of risks and benefits must be done in populations with malnourished children and high diarrhoea burdens. FUNDING: Bill & Melinda Gates Foundation.

Calcium ameliorates diarrhea in immunocompromised children.

Treatment of infectious diarrheas remains a challenge, particularly in immunocompromised patients in whom infections usually persist and resultant diarrhea is often severe and protracted. Children with infectious diarrhea who become dehydrated are normally treated with oral or intravenous rehydration therapy. Although rehydration therapy can replace the loss of fluid, it does not ameliorate diarrhea. Thus, during the last decades, there has been continuous effort to search for ways to safely stop diarrhea. Herein, we report 3 immunocompromised children who developed severe and/or protracted infectious diarrhea. Their diarrheas were successfully "halted" within 1 to 2 days following the administration of calcium.

Empleo de probióticos en la diarrea aguda infantil y en la prevención de la diarrea asociada a antibióticos / No disponible

No disponible

Dietary management of childhood diarrhea in low- and middle-income countries: a systematic review.

BACKGROUND: Current WHO guidelines on the management and treatment of diarrhea in children strongly recommend continued feeding alongside the administration of oral rehydration solution and zinc therapy, but there remains some debate regarding the optimal diet or dietary ingredients for feeding children with diarrhea. METHODS: We conducted a systematic search for all published randomized controlled trials evaluating food-based interventions among children under five years old with diarrhea in low- and middle-income countries. We classified 29 eligible studies into one or more comparisons: reduced versus regular lactose liquid feeds, lactose-free versus lactose-containing liquid feeds, lactose-free liquid feeds versus lactose-containing mixed diets, and commercial/specialized ingredients versus home-available ingredients. We used all available outcome data to conduct random-effects meta-analyses to estimate the average effect of each intervention on diarrhea duration, stool output, weight gain and treatment failure risk for studies on acute and persistent diarrhea separately. RESULTS: Evidence of low-to-moderate quality suggests that among children with acute diarrhea, diluting or fermenting lactose-containing liquid feeds does not affect any outcome when compared with an ordinary lactose-containing liquid feeds. In contrast, moderate quality evidence suggests that lactose-free liquid feeds reduce duration and the risk of treatment failure compared to lactose-containing liquid feeds in acute diarrhea. Only limited evidence of low quality was available to assess either of these two approaches in persistent diarrhea, or to assess lactose-free liquid feeds compared to lactose-containing mixed diets in either acute or persistent diarrhea. For commercially prepared or specialized ingredients compared to home-available ingredients, we found low-to-moderate quality evidence of no effect on any outcome in either acute or persistent diarrhea, though when we restricted these analyses to studies where both intervention and control diets were lactose-free, weight gain in children with acute diarrhea was shown to be greater among those fed with a home-available diet. CONCLUSIONS: Among children in low- and middle-income countries, where the dual burden of diarrhea and malnutrition is greatest and where access to proprietary formulas and specialized ingredients is limited, the use of locally available age-appropriate foods should be promoted for the majority of acute diarrhea cases. Lactose intolerance is an important complication in some cases, but even among those children for whom lactose avoidance may be necessary, nutritionally complete diets comprised of locally available ingredients can be used at least as effectively as commercial preparations or specialized ingredients. These same conclusions may also apply to the dietary management of children with persistent diarrhea, but the evidence remains limited.

The duration of diarrhea and fever is associated with growth faltering in rural Malawian children aged 6-18 months.

Nutrition support programs that only focus upon better complementary feeding remain an insufficient means of limiting growth faltering in vulnerable populations of children. To determine if symptoms of acute infections correlate with the incidence of growth faltering in rural Malawian children, the associations between fever, diarrhea, and cough with anthropometric measures of stunting, wasting, and underweight were investigated. Data were analyzed from a trial where 209 children were provided with adequate complementary food and followed fortnightly from 6-18 months of age. Linear mixed model analysis was used to test for associations. Diarrheal disease was inversely associated with changes in height-for-age Z-score (HAZ), mid-upper arm circumference Z-score (MUACZ), and weight-for-age Z-score (WAZ). Fever was also inversely associated with changes in MUACZ and WAZ. These results suggest that initiatives to reduce febrile and diarrheal diseases are needed in conjunction with improved complementary feeding to limit growth faltering in rural Malawi.

Utilidad de las proteínas de pollo y de soja en ratas nutridas o desnutridas con diarrea inducida por lactosa / Utility of chicken and soybean protein in well-nourished or undernourished rats with lactose-induced diarrhea

En el tratamiento nutricional de la diarrea infantil se han utilizado con éxito preparaciones líquidas que contienen pollo combinado con cereales y/o tubérculos, que se preparan en la institución de hospitalización o en la casa. En un estudio anterior, se comparó la efectividad de fórmulas con proteínas de pollo o aislado de soja en el tratamiento de la diarrea infantil. El objetivo de este trabajo fue estudiar en ratas con o sin diarrea, la utilización de las proteínas y la disponibilidad de nutrientes de dietas preparadas con pollo o aislado proteico de soja, para determinar si los resultados obtenidos en los niños eran comparables a los obtenidos en ratas. Dado que la diarrea y la desnutrición frecuentemente están presentes de manera simultánea, también se estudiaron grupos de animales con o sin diarrea previamente desnutridos. Los resultados mostraron que durante la diarrea las ratas desnutridas fueron igualmente eficientes que las nutridas en utilizar los nutrientes presentes en las dietas con pollo o soja, por lo que no experimentaron un deterioro nutricional mayor que las nutridas. Adicionalmente, la severidad de la diarrea fue similar en las ratas asignadas a las dietas con pollo o soja. Asimismo, las ratas con diarrea consumieron, crecieron, absorbieron y retuvieron menos de los macronutrientes dietarios que las ratas control. Sin embargo, este efecto de la diarrea fue similar en las ratas que consumieron proteína de soja o de pollo. Como estos resultados coinciden con los obtenidos previamente en niños con diarrea aguda, se concluye que la proteína de soja es tan efectiva como la de pollo en el manejo nutricional de la diarrea y que la diarrea producida con lactosa en ratas es un modelo apropiado para el estudio de las consecuencias nutricionales de la misma.

In the nutritional treatment of diarrhea, good results have been obtained using liquid formulas with chicken meat together with cereals and/or starchy vegetables, prepared at home or at the clinic. In a previous study, formulas prepared with chicken meat or isolated soybean protein were tested in the treatment of infantile diarrhea. In order to determine if the results obtained in children could be reproduced in rats, the objective of the present study was to evaluate the effectiveness of the same diets in the nutritional treatment of well-nourished as well as undernourished rats with lactose induced diarrhea. The results showed that all the rats with diarrhea absorbed and retained less of the dietary nutrients and consequently, grew less than their counterparts without diarrhea. However, the absorption and retention measured in the nourished as well as in the undernourished rats were similar, indicating that a short period of malnutrition previous to the diarrhea episode, did not affect rats' absorption capacity. In addition, similarly to the results previously obtained in children, the rats with lactose induced diarrhea utilised equally well the dietary nutrients present in the chicken as well as in the soybean protein based diets. These results confirmed the value of isolated soybean protein in the nutritional treatment of diarrhea and showed that lactose induced diarrhea in rats is an appropriate model to study the nutritional consequences of diarrhea.

Diarrea funcional como causa de diarrea crónica / Functional diarrhea as cause of chronic diarrhea

La diarrea funcional se presenta con frecuencia en la práctica pediátrica, y generalmente no se asocia a alteraciones nutricionales, pero sí a esquemas dietéticos incorrectos. Se actualiza su importancia clínica, se hace énfasis en la patogenia, diagnóstico y en los métodos de tratamiento. Consideramos que es la causa más frecuente de diarrea crónica inespecífica y que el interrogatorio dirigido según los criterios de Roma es útil para su diagnóstico. La mayoría de los pacientes con esta enfermedad en la infancia deben ser tratados en la atención primaria

The functional diarrhea is frequent in the pediatric practice and in general it is not associated with nutritional alterations, but to incorrect dietary schemes. Its clinical significance is updated and its pathogenesis, diagnosis and treatment methods are emphasized. Authors considered that the functional diarrhea is the more frequent cause of unspecific chronic diarrhea and the questioning directed according the Rome criteria is very useful for its diagnosis. Most of patients presenting with this disease during childhood must to be treated in primary care services

Diarrea funcional como causa de diarrea crónica / Functional diarrhea as cause of chronic diarrhea

La diarrea funcional se presenta con frecuencia en la práctica pediátrica, y generalmente no se asocia a alteraciones nutricionales, pero sí a esquemas dietéticos incorrectos. Se actualiza su importancia clínica, se hace énfasis en la patogenia, diagnóstico y en los métodos de tratamiento. Consideramos que es la causa más frecuente de diarrea crónica inespecífica y que el interrogatorio dirigido según los criterios de Roma es útil para su diagnóstico. La mayoría de los pacientes con esta enfermedad en la infancia deben ser tratados en la atención primaria(AU)

The functional diarrhea is frequent in the pediatric practice and in general it is not associated with nutritional alterations, but to incorrect dietary schemes. Its clinical significance is updated and its pathogenesis, diagnosis and treatment methods are emphasized. Authors considered that the functional diarrhea is the more frequent cause of unspecific chronic diarrhea and the questioning directed according the Rome criteria is very useful for its diagnosis. Most of patients presenting with this disease during childhood must to be treated in primary care services(AU)

Green banana-supplemented diet in the home management of acute and prolonged diarrhoea in children: a community-based trial in rural Bangladesh.

SUMMARY OBJECTIVE: To determine the effectiveness of green banana in the home management of acute (<7 days) or prolonged (≥ 7 days) diarrhoea at the community level. METHODS: A cluster randomized field trial was conducted among 2968 Bangladeshi rural children 6-36 months old. Wards (villages) were randomly assigned to either a standard care group or a standard care plus green banana group where mothers were instructed to add cooked green banana to the diets of diarrhoeal children. Through a village-based surveillance system, diarrhoeal morbidity data (severity, duration, compliance) were collected for 14 days. Treatment effects were determined by analysing cumulative probability of cure by testing Cox proportional hazards models and relative risk (RR). RESULTS: The cumulative probability of cure was significantly (P < 0.001) different in children receiving GB for both acute [hazard ratio (HR) = 0.63 (95% CI: 0.56-0.67)] and prolonged diarrhoea [HR = 0.38 (95% CI: 0.26-0.59)]. The recovery rates of children with acute diarrhoea receiving GB (vs. control) were significantly more by day 3: 79.9%vs. 53.3% [(RR) = 0.47, 95% CI: 0.41-0.55], (P < 0.001) and day 7: 96.6%vs. 89.1% (RR = 0.32; 0.22-0.46), (P < 0.001). Children with prolonged diarrhoea receiving green banana had significantly higher recovery rates by day 10: 79.8%vs. 51.9% (RR = 0.42; 0.23-0.73), (P < 0.001) and day 14: 93.6%vs. 67.2% (RR = 0.22; 0.08-0.54), (P < 0.001). CONCLUSION: A green banana-supplemented diet hastened recovery of acute and prolonged childhood diarrhoea managed at home in rural Bangladesh.