Composition and preliminary evaluation of a hydrolyzed rice-based oral rehydration solution for the treatment of acute diarrhea in children.

Objective: The purpose of this study was to experimentally develop and clinically evaluate the safety and potential usefulness of a rice-based, short glucose polymer oral rehydration solution (ORS), Amylyte, in the treatment of acute diarrhea. Amylyte has a similar osmolality but a higher caloric density than the WHO ORS.

Methods: Different amounts of rice were cooked in 500 ml of water containing salts (1.

High-calorie, rice-derived, short-chain, glucose polymer-based oral rehydration solution in acute watery diarrhea.

In this study, we have compared the effects of the World Health Organization oral rehydration solution (WHO ORS) and an ORS containing short polymers of glucose (Amylyte ORS) at a high caloric density (five times) and comparable osmolality, on stool output, duration of diarrhea, weight gain and fluid and electrolyte balance, in randomized, open-labeled, controlled clinical trials in five centers. A total of 198 male children (4 months to 10 years) with acute diarrhea ( <72 h after onset) were assigned by random allocation to either WHO ORS or Amylyte ORS at five centers in Asia. Children were stratified according to grade of dehydration (mild, moderate or severe) and the initial purging rates during the first 6 h (low ( < 2 ml/kg/h), moderate (2-5 ml/kg/h) and high ( > 5 ml/kg/h) purgers).

Thermophilic amylase-digested rice-electrolyte solution in the treatment of acute diarrhea in children.

Objective: To compare the efficacy of an oral rehydration solution (ORS) containing short polymers of glucose derived from rice (Amylyte-ORS) and five times the caloric density of current ORS to the standard glucose-ORS (World Health Organization [WHO] = ORS) in the treatment of acute diarrhea in children.

Methods: The rice ORS (Amylyte-ORS) was obtained by adding thermophilic amylase (252,500 MW units) and salts (1.5 g NaCl, 600 mg KCl, and 150 mg CaCl2) to 100 g rice and boiling for 10 minutes in 500 mL water.

Effect of perfusion of oral rehydration solutions containing glucose polymers from corn on disaccharidases and mucosal morphology in rat small intestines.

This study aims to determine the effect of glucose and glucose polymers (GP) from corn in oral rehydration solutions (ORS) on disaccharidases and morphometric measurements in small intestinal mucosa of rats. ORS containing standard composition of salts as in WHO ORS and 2, 5, or 10 per cent glucose or GP [initial glucose polymers, long chain (> 9 molecules) and short chain (2-9 molecules) glucose polymers] from corn were infused into the duodenum of 72 Sprague-Dawley rats (250-350 g). Six rats were sham operated as controls.

Small intestinal glucoamylase deficiency and starch malabsorption: a newly recognized alpha-glucosidase deficiency in children.

To determine the prevalence of short polymers of glucose and starch malabsorption caused by small intestinal glucoamylase deficiency in children with chronic diarrhea, we studied small bowel biopsy specimens from 511 children (aged 1 month to 9 years) with chronic diarrhea evaluated at 54 medical centers. Glucoamylase and disaccharidase (lactase, sucrase, maltase, and palatinase) enzyme assays were performed. Of the 511 children, 15 had glucoamylase deficiency.

In vitro uptake of amino acids in the jejunal mucosa of patients with cholera.

In vitro uptake of 14C-labelled amino acids was studied in jejunal mucosa biopsy specimens from 64 adults admitted for treatment of cholera (proven by stool culture) within 48 hours of onset of watery diarrhoea to determine the state of amino acid carriers in the jejunal mucosa during actively purging disease. Continued absorption of amino acids by the NBB carrier (for neutral amino acids), the Y+ system (for dibasic amino acids), and the PHE carrier were operative even during the actively purging stage of watery diarrhoea due to cholera. The IMINO carrier for absorption of N-substituted amino acids was found to be inoperative during cholera but the imino acids could be absorbed by the PHE carrier.

The effect of Escherichia coli heat-stable (STA) enterotoxin on in vitro uptake of amino acids by small intestine of sucking rats during fluid accumulation.

In vitro uptake of 14C-labelled amino acids by segments of small intestine was determined in sucking (2-4-d-old) Wistar rats. Intragastric injections of heat-stable (ST) toxin of enterotoxigenic Escherichia coli (ETEC) were given to produce fluid accumulation, defined as a gut weight: carcass weight value of > 0.085.

Absorption of glucose polymers from rice in oral rehydration solutions by rat small intestine.

Background: This study aims to determine the effect of replacing glucose in oral rehydration solution (ORS) with starch hydrolysates from rice on absorption in the small intestine and levels of glucose in portal venous blood and on disaccharidase levels and morphometric measurements in intestines of rats.

Methods: ORS containing standard composition of salts and 2% glucose (WHO ORS) or 2%, 5%, or 10% starch hydrolysates were infused into duodena of 60 Sprague-Dawley rats (250-350 g). Portal venous blood glucose levels were determined at 0, 30, 60, 90, and 120 minutes.

Effect of berberine on enterotoxin-induced intestinal fluid accumulation in rats.

We have determined the effects of berberine (Berberis aristita) on intestinal fluid accumulation due to enterotoxigenic E. coli (ETEC) heat-stable (ST) toxin in suckling (24-days old) Wistar rats. Intestinal fluid accumulation occurred in suckling Wistar rats by administration of culture filtrate containing ST-producing ETEC in serial dilutions up to 1/8 dilution by oral or intragastric route.

Epidemiology of small bowel bacterial overgrowth and rice carbohydrate malabsorption in Burmese (Myanmar) village children.

Breath hydrogen tests were performed after a rice meal (3 g of cooked rice/kg of body weight, equivalent to 1 g of carbohydrate/kg of body weight) on 256 village children (age range 1-59 months) who were known hydrogen (H2) producers. Anthropometric measurements were made every three months and growth rates were calculated. A breath H2 excretion pattern that suggested small bowel bacterial overgrowth (SBBO), which was recognized as a transient maximum level of 10 ppm or more at 20-, 40-, or 60-min breath samples following the rice meal, was present in 53 (20.

Sodium balance during acute diarrhoea in malnourished children.

Forty-six male children 12-59 months old (27 malnourished and 19 with normal nutrition) admitted for acute water diarrhoea of less than 48 hours' duration were studied. Using a metabolic balance and separate collections of urine and stools over each 6-hour period, balance studies were carried out up to 48 hours. Blood, stool, and urine samples were analysed for sodium and potassium levels.

Decreased phosphodiesterase activity in cholera toxin-induced hypersecretion in suckling rats.

During cholera toxin (CT)-induced hypersecretion in suckling rats, the rise in the intestinal cAMP concentration was found to be accompanied by a decrease in the cAMP-phosphodiesterase activity. The results suggest the involvement of phosphodiesterase (PDE) as one of the factors governing the rise of cAMP.

An optimal rice-based oral rehydration solution: the effect of different concentrations of amylase on production of short chain polymers of glucose.

As part of a plan to develop a rice-based oral rehydration solution containing short polymers of glucose instead of glucose, we determined the concentration of amylase that would yield the largest amount of short chain polymers. Thai rice (25 g) was boiled with 500 ml of distilled water for 30 min. Of 200 ml supernatant rice water obtained, 100 ml were digested with different amounts of amylase after cooling to 50 degrees C for 60 min, boiled for 5 min, and centrifuged (10,000 g, 25 degrees C) for 60 min.

In vitro hydrogen production by enteric bacteria cultured from children with small bowel bacterial overgrowth.

Lactulose breath hydrogen test and Enterotest string test were carried out simultaneously on 19 children 3-5 years old. Bacteria isolated from the jejunal fluid in upper small intestines of these children were incubated with lactulose at neutral pH. Anaerobes were present in all but one child, and in 15 children they were present in numbers greater than 5 log10 organisms per ml.

House-dust mite allergy and eosinophilia in patients with asthma in Rangoon (Yangon).

Skin tests were done by prick and intradermal techniques, using house dust mite (Dermatophagoides pteronyssinus) antigen on 35 patients with early onset asthma, 33 with late onset asthma, 43 with asthma and frequent cough with sputum production (chronic bronchitis) and 30 control subjects. Absolute blood eosinophil and sputum eosinophil (as percentage of leukocytes) counts were performed on each patient. Positive skin tests to house dust mite antigens were significantly more frequent in each of the patient groups (35-75%) than in control subjects (0%), but were not significantly different among the three groups of asthmatics.

Comparison of an in vitro faecal hydrogen test with the lactulose breath test: assessment of in vivo hydrogen-producing capability in Burmese village children.

In the assessment of carbohydrate malabsorption, it is important to determine if patients with a flat breath hydrogen (H2) response to an absorbable carbohydrate challenge are capable of producing H2. We compared the reliability of a rapid faecal incubation system with the lactulose breath test to assess in vivo H2 production in 64 children. Overall, 70% of subjects were in vivo H2-producers, with breath H2 peaks greater than 10 parts per million within 3 h of ingesting 10 g of the non-absorbable disaccharide lactulose.

Absorption of carbohydrate from rice in Ascaris lumbricoides infected Burmese village children.

With the objective of determining the relationship between ascariasis and carbohydrate absorption from rice, breath hydrogen tests (BHT's) were performed in two study populations of Burmese village children. Using a rice test meal, breath hydrogen peaks greater than 10 ppm above baseline within 4 hours (indicating rice malabsorption) were seen in 24 out of 55 (44 per cent) Ascaris lumbricoides infected children and 3 out of 18 (17 per cent) non-infected children (age 18-59 months). In another ascaris endemic village 139 children (age 36-108 months) underwent a rice meal BHT.

Comparison of glucose/electrolyte and maltodextrin/glycine/glycyl-glycine/electrolyte oral rehydration solutions in cholera and watery diarrhoea in adults.

One hundred and eight male adults (mean age 33 +/- 1.7 years) presenting with watery diarrhoea of less than 48 hours duration at home prior to hospitalization and with clinically evident (grade II, severe) dehydration were admitted into a randomized double-blind clinical trial; 54 were treated with standard oral rehydration solution (ORS)--WHO formulation containing citrate--and 54 with an improved ORS formulation which contained, in addition to the standard formula, maltodextrin 20 g (instead of glucose), glycine 4 g and glycyl-glycine 4 g. Patients with clinical cholera were given tetracycline 500 mg q.

Comparison of glucose/electrolyte and maltodextrin/glycine/glycyl-glycine/electrolyte oral rehydration solutions in acute diarrhea in children.

Male children (N = 101) 6-35 months of age presenting with acute watery diarrhea for less than 48 h at home before hospitalization were admitted into a randomized, double-blind clinical trial. Fifty-one children were treated with standard oral rehydration solution (ORS) (World Health Organization [WHO] formulation containing citrate) and 50 were treated with an improved ORS formulation (containing, in addition to the standard formula, 20 g maltodextrin instead of glucose, and 4 g glycine and 4 g glycyl-glycine). None were given antibiotics.

A pattern of breath hydrogen excretion suggesting small bowel bacterial overgrowth in Burmese village children.

Breath hydrogen tests (BHTs) were performed on 340 Burmese village children aged 1-59 months. Normalization (correction of breath H2 values to a constant mean O2 level) eliminated the variations in H2 levels due to sleep, storage temperature, or duration of storage. After a 10 g lactulose test meal, 145 (42.

Cereal-based oral rehydration therapy. II. Strategic issues for its implementation in national diarrheal disease control programs.

Field studies in Bangladesh demonstrated that after proper training, village mothers were able to prepare and use rice-based, salt-enriched oral rehydration solutions containing safe concentrations of sodium, and were capable of achieving significantly fewer treatment failures and a reduction in the duration of diarrhea than with glucose-based oral rehydration solutions (ORS). An additional longitudinal study showed that improved growth and weight gain occurred with the consistent use of ORS; the effect was greater when rice-based ORS were used. In addition, the following possible limitations and benefits of cereal-based oral rehydration therapy, which are relevant to the strategies for its implementation in national diarrheal disease control programs, are discussed: safety, osmolarity, hypernatremia, spoiling, effectiveness, rehydration ability, reduction in diarrhea volume and duration, nutritional effects, effect on food intake, acceptance and usage by care givers, training of health workers, self-reliance of families, effect on other child survival activities, costs, potential problems in changing to cereal-based ORS, and the role of industrial production in packaged cereal-based ORS.

Cereal-based oral rehydration therapy. I. Clinical studies.

Studies of "improved" oral rehydration solutions, in which glucose polymers (starch) derived from rice or other cereals were added to improve cotransport of sodium and to promote sodium and water absorption, have been reported. These solutions were administered to decrease diarrhea volume and duration, reduce vomiting, and replace volume loss in stools. In clinical trials of children and adults with high-output diarrhea, such as in cases of cholera, the use of cereal-based oral rehydration solutions (ORS) compared with glucose-based ORS produced significant (20% to 53%) reductions in stool volumes.

Effect of cholera toxin on L-[14C]glycine uptake and intestinal cell enzymes in rabbit.

The uptake of L-[14C]glycine and the activities of intracellular marker enzymes of enterocytes were studied in ligated small intestinal segments of rabbits during experimental cholera induced by intra-intestinal injection of pure cholera toxin (CT). No significant difference was observed in the active uptake of L-[14C]glycine between the CT-injected small intestinal segments and the saline-injected control segments, indicating that there is an intact active transport system for intestinal absorption of L-[14C]glycine during experimental cholera in rabbits. Apart from a significant increase in the activity of a brush border marker enzyme (alkaline phosphatase), there was no significant difference between the activities of marker enzymes for lysosomes (acid phosphate), microsomes (glucose-6-phosphatase), mitochondria (succinate dehydrogenase), and a cytosol enzyme (proteinase) in mucosal homogenates of CT-injected small intestinal segments compared to controls.