RESISTANT STARCH: ADJUNCT TO ORAL REHYDRATION SOLUTION

腹泻的口服补液疗法（ORT）虽然对纠正脱水有效，但在许多社区接受度较低。造成这种情况的一个重要原因是传统的ORT无法缩短腹泻或减少粪便流失。最近的研究表明，短链脂肪酸（SCFA）刺激结肠Na-CI吸收不受环AMP的抑制，这表明结肠短链脂肪酸可能作为标准ORT的辅助手段。我们最近发现，在结肠中代谢为短链脂肪酸的抗性淀粉（即对淀粉酶具有相对抗性的淀粉）可显著缩短成人霍乱患者腹泻的持续时间。由于儿童腹泻通常是由霍乱以外的原因引起的，因此拟议的研究将评估使用抗性淀粉的ORT是否会减少急性腹泻儿童的粪便流失量和腹泻持续时间。258名患有腹泻和轻度至中度脱水的儿童将被随机分为两组，一组接受葡萄糖- ors的标准治疗，另一组接受含有抗性玉米淀粉50 g/l的葡萄糖- ors治疗。两组患者都将按照世卫组织推荐的标准化方案进行治疗，包括在初始补液4小时后重新进食。终点将包括测量粪便量和从入院到最后一次未成形粪便的时间，由一名对所接受的治疗不知情的观察者评估。处理失败将被分类和记录。如果发现抗性淀粉可以减少粪便量和/或腹泻持续时间，那么必须在社区中对这种创新疗法进行测试以获得接受。

Oral rehydration therapy (ORT) of diarrhea, while effective in correcting dehydration, is poorly accepted in many communities. One significant reason for this is the inability of conventional ORT to shorten diarrhea or reduce fecal fluid losses. The recent demonstration that short chain fatty acid (SCFA) stimulation of colonic Na-CI absorption is not inhibited by cyclic AMP suggested the possibility that colonic SCFA could provide an adjunct to standard ORT. We have recently found that resistant starch (i.e. starch that is relatively resistant to amylase), which is metabolized to SCFA in the colon, significantly reduces duration of diarrhea in adults with cholera. Since children often have diarrhea due to causes other than cholera, the proposed study will evaluate whether ORT with resistant starch will reduce fecal fluid losses and the duration of diarrhea in children with acute diarrhea. Two hundred and fifty-eight children with diarrhea and mild to moderate dehydration will be randomized to receive either standard treatment with glucose-ORS or treatment with glucose-ORS containing resistant maize starch 50 g/l. Both groups will be treated according to a standardized protocol recommended by the W.H.O., including refeeding after 4 hours of initial rehydration. The end-points will include measurement of fecal volumes and the time from admission to the last unformed stool, assessed by an observer who is blinded to the treatment received. Treatment failures will be categorized and recorded. If resistant starch is found to reduce fecal volumes and/or duration of diarrhea, this innovative therapy must then be tested in the community for acceptance.