RESISTANT STARCH: ADJUNCT TO ORAL REHYDRATION SOLUTION

口服补液疗法(ORT)治疗腹泻，虽然在纠正脱水方面有效，但在许多社区接受程度较低。其中一个重要原因是传统的ORT无法缩短腹泻或减少粪便液体损失。最近有证据表明，短链脂肪酸(SCFA)对结肠Na-CI吸收的刺激不受环状AMP的抑制，提示结肠SCFA有可能作为标准ORT的辅助物质。我们最近发现，抗性淀粉(即对淀粉酶相对抗性的淀粉)在结肠中代谢为SCFA，可显著缩短成年霍乱患者的腹泻持续时间。由于儿童经常因霍乱以外的原因而腹泻，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液体损失和腹泻持续时间。258名腹泻和轻度至中度脱水的儿童将被随机分为两组，一组接受标准的葡萄糖-ORS治疗，另一组接受含有抗性玉米淀粉50g/L的葡萄糖-ORS治疗。两组都将按照世界卫生组织推荐的标准化方案进行治疗，包括初始补液4小时后重新喂养。终点将包括测量粪便体积和从进入最后一次未成形大便的时间，由对所接受的治疗视而不见的观察者进行评估。治疗失败将被分类和记录。如果发现抗性淀粉可以减少粪便体积和/或腹泻持续时间，则必须在社区中测试这一创新疗法以供接受。

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.