FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 342:308-313 February 3, 2000 Number 5 Next

	Full Text PDF Editorial by Rabbani, G.H. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Although standard glucose-based oral rehydration therapy corrects the dehydration caused by cholera, it does not reduce the diarrhea. Short-chain fatty acids, which are produced in the colon from nonabsorbed carbohydrates, enhance sodium absorption. We conducted a study to determine the effects of an orally administered, nonabsorbed starch (i.e., one resistant to digestion by amylase) on fecal fluid loss and the duration of diarrhea in patients with cholera.

Methods We randomly assigned 48 adolescents and adults with cholera to treatment with standard oral rehydration therapy (16 patients), standard therapy and 50 g of rice flour per liter of oral rehydration solution (16 patients), or standard therapy and 50 g of high-amylose maize starch, an amylase-resistant starch, per liter of oral rehydration solution (16 patients). The primary end points were fecal weight (for every 12-hour period during the first 48 hours after enrollment) and the length of time to the first formed stool.

Results The mean (±SD) fecal weights in the periods 12 to 24 hours, 24 to 36 hours, and 36 to 48 hours after enrollment were significantly lower in the resistant-starch group (2206±1158 g, 1810±1018 g, and 985±668 g) than in the standard-therapy group (3251± 766 g, 2621±1149 g, and 2498±1080 g; P=0.01, P= 0.04, and P=0.001, respectively). From 36 to 48 hours after enrollment, fecal weight was also significantly lower with the resistant-starch therapy than with the rice-flour therapy (985±668 g vs. 1790±866 g, P=0.01). The mean duration of diarrhea was significantly shorter with the resistant-starch therapy (56.7±18.6 hours) than with standard therapy alone (90.9±29.8 hours, P=0.001) or the rice-flour therapy (70.8±20.2 hours, P=0.05). Fecal excretion of starch was higher with the resistant-starch therapy (32.6±30.4) than with the standard therapy (11.7±4.1 g, P=0.002) or the rice-flour therapy (15.1±8.4 g, P=0.01).

Conclusions The addition of a resistant starch to oral rehydration solution reduces fecal fluid loss and shortens the duration of diarrhea in adolescents and adults with cholera.

Source Information

From the Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore, India (B.S.R., S.V., P.S., P.D.); Flinders University of South Australia, Adelaide, Australia (G.P.Y.); and the Yale University School of Medicine, New Haven, Conn. (H.J.B.).

Address reprint requests to Dr. Ramakrishna at the Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore 632004, India, or to Dr. Binder at 89 LMP, Department of Internal Medicine, P.O. Box 208019, Yale University, New Haven, CT 06520-8019, or at henry.binder{at}yale.edu.

Full Text of this Article

Related Letters:

Amylase-Resistant Starch plus Oral Rehydration Solution for Cholera
Pierce N. F., Fontaine O., Sack R. B., Ramakrishna B.S., Binder H. J.
Extract | Full Text  
N Engl J Med 2000; 342:1995-1996, Jun 29, 2000. Correspondence

This article has been cited by other articles:

• Niderman-Meyer, O., Zeidman, T., Shimoni, E., Kashi, Y. (2010). Mechanisms Involved in Governing Adherence of Vibrio cholerae to Granular Starch. Appl. Environ. Microbiol. 76: 1034-1043 [Abstract] [Full Text]  
• Ayoub, A. S., Rizvi, S. S. H. (2009). An Overview on the Technology of Cross-Linking of Starch for Nonfood Applications. Journal of Plastic Film and Sheeting 25: 25-45 [Abstract]  
• Subramanya, S. B., Rajendran, V. M., Srinivasan, P., Nanda Kumar, N. S., Ramakrishna, B. S., Binder, H. J. (2007). Differential regulation of cholera toxin-inhibited Na-H exchange isoforms by butyrate in rat ileum. Am. J. Physiol. Gastrointest. Liver Physiol. 293: G857-G863 [Abstract] [Full Text]  
• Donowitz, M., Li, X. (2007). Regulatory Binding Partners and Complexes of NHE3. Physiol. Rev. 87: 825-872 [Abstract] [Full Text]  
• Kiela, P. R., Kuscuoglu, N., Midura, A. J., Midura-Kiela, M. T., Larmonier, C. B., Lipko, M., Ghishan, F. K. (2007). Molecular mechanism of rat NHE3 gene promoter regulation by sodium butyrate. Am. J. Physiol. Cell Physiol. 293: C64-C74 [Abstract] [Full Text]  
• Yoon, S. S., Mekalanos, J. J. (2006). 2,3-Butanediol Synthesis and the Emergence of the Vibrio cholerae El Tor Biotype. Infect. Immun. 74: 6547-6556 [Abstract] [Full Text]  
• Roy, C. C., Kien, C. L., Bouthillier, L., Levy, E. (2006). Short-Chain Fatty Acids: Ready for Prime Time?. Nutr Clin Pract 21: 351-366 [Abstract] [Full Text]  
• Gancz, H., Niderman-Meyer, O., Broza, M., Kashi, Y., Shimoni, E. (2005). Adhesion of Vibrio cholerae to Granular Starches. Appl. Environ. Microbiol. 71: 4850-4855 [Abstract] [Full Text]  
• Hoque, K. M., Rajendran, V. M., Binder, H. J. (2005). Zinc inhibits cAMP-stimulated Cl secretion via basolateral K-channel blockade in rat ileum. Am. J. Physiol. Gastrointest. Liver Physiol. 288: G956-G963 [Abstract] [Full Text]  
• Alam, N H, Meier, R, Sarker, S A, Bardhan, P K, Schneider, H, Gyr, N (2005). Partially hydrolysed guar gum supplemented comminuted chicken diet in persistent diarrhoea: a randomised controlled trial. Arch. Dis. Child. 90: 195-199 [Abstract] [Full Text]  
• Casburn-Jones, A C, Farthing, M J G (2004). Management of infectious diarrhoea. Gut 53: 296-305 [Full Text]  
• Krishnan, S., Rajendran, V. M., Binder, H. J. (2003). Apical NHE isoforms differentially regulate butyrate-stimulated Na absorption in rat distal colon. Am. J. Physiol. Cell Physiol. 285: C1246-C1254 [Abstract] [Full Text]  
• Le Leu, R. K., Brown, I. L., Hu, Y., Young, G. P. (2003). Effect of resistant starch on genotoxin-induced apoptosis, colonic epithelium, and lumenal contents in rats. Carcinogenesis 24: 1347-1352 [Abstract] [Full Text]  
• Martinez-Puig, D., Perez, J. F., Castillo, M., Andaluz, A., Anguita, M., Morales, J., Gasa, J. (2003). Consumption of Raw Potato Starch Increases Colon Length and Fecal Excretion of Purine Bases in Growing Pigs. J. Nutr. 133: 134-139 [Abstract] [Full Text]  
• Triplehorn, C., Millard, P. S (2002). A rice based diet with green banana or pectin reduced diarrhoea in infants better than a rice alone diet. Evid. Based Med. 7: 55-55 [Full Text]  
• Kiela, P. R., Hines, E. R., Collins, J. F., Ghishan, F. K. (2001). Regulation of the rat NHE3 gene promoter by sodium butyrate. Am. J. Physiol. Gastrointest. Liver Physiol. 281: G947-G956 [Abstract] [Full Text]  
• Topping, D. L., Clifton, P. M. (2001). Short-Chain Fatty Acids and Human Colonic Function: Roles of Resistant Starch and Nonstarch Polysaccharides. Physiol. Rev. 81: 1031-1064 [Abstract] [Full Text]  
• Musch, M. W., Bookstein, C., Xie, Y., Sellin, J. H., Chang, E. B. (2001). SCFA increase intestinal Na absorption by induction of NHE3 in rat colon and human intestinal C2/bbe cells. Am. J. Physiol. Gastrointest. Liver Physiol. 280: G687-G693 [Abstract] [Full Text]  
• Pierce, N. F., Fontaine, O., Sack, R. B., Ramakrishna, B.S., Binder, H. J. (2000). Amylase-Resistant Starch plus Oral Rehydration Solution for Cholera. NEJM 342: 1995-1996 [Full Text]  
• (2000). Novel Oral Rehydration Therapy for Cholera. JWatch Infect. Diseases 2000: 5-5 [Full Text]  
• Rabbani, G.H. (2000). The Search for a Better Oral Rehydration Solution for Cholera. NEJM 342: 345-347 [Full Text]