The Experts below are selected from a list of 2232 Experts worldwide ranked by ideXlab platform
Henry J Binder - One of the best experts on this subject based on the ideXlab platform.
-
glucose stimulates calcium activated chloride secretion in small intestinal cells
American Journal of Physiology-cell Physiology, 2014Co-Authors: Pooja Vijaygopal, Henry J Binder, Gordon G Macgregor, Rejeesh Menon, Perungavur N Ranganathan, Sreekala Prabhakaran, Lurong Zhang, Mei Zhang, Paul Okunieff, Sadasivan VidyasagarAbstract:The sodium-coupled glucose transporter-1 (SGLT1)-based Oral Rehydration Solution (ORS) used in the management of acute diarrhea does not substantially reduce stool output, despite the fact that glu...
-
role of colonic short chain fatty acid transport in diarrhea
Annual Review of Physiology, 2010Co-Authors: Henry J BinderAbstract:Short-chain fatty acids (SCFA) are the major anion in stool and are synthesized from nonabsorbed carbohydrate by the colonic microbiota. Nonabsorbed carbohydrate are not absorbed in the colon and induce an osmotically mediated diarrhea; in contrast, SCFA are absorbed by colonic epithelial cells and stimulate Na-dependent fluid absorption via a cyclic AMP-independent process involving apical membrane Na-H, SCFA-HCO(3), and Cl-SCFA exchanges. SCFA production represents an adaptive process to conserve calories, fluid, and electrolytes. Inhibition of SCFA synthesis by antibiotics and administration of PEG, a substance that is not metabolized by colonic microbiota, both result in diarrhea. In contrast, increased production of SCFA as a result of providing starch that is relatively resistant to amylase digestion [so-called resistant starch (RS)] to Oral Rehydration Solution (RS-ORS) improves the efficacy of ORS and represents an important approach to improve the effectiveness of ORS in the treatment of acute diarrhea in children under five years of age.
-
a randomized controlled trial of glucose versus amylase resistant starch hypo osmolar Oral Rehydration Solution for adult acute dehydrating diarrhea
PLOS ONE, 2008Co-Authors: B S Ramakrishna, Graeme P Young, Venkataraman Subramanian, Vivek Mohan, Bendon K Sebastian, Michael J G Farthing, Henry J BinderAbstract:Background: Reduction of gross diarrhea rate in excess of that seen over time with intravenous therapy and appropriate antibiotics is not usually achieved by Oral glucose-electrolyte Rehydration therapy for cholera and cholera-like diarrheas. Methodology and Principal Findings: This prospective randomized clinical trial at a tertiary referral hospital in southern India was undertaken to determine whether amylase resistant starch, substituting for glucose in hypo-osmolar Oral Rehydration Solution, would reduce diarrhea duration and weight in adults with acute severe dehydrating diarrhea. 50 adult males with severe watery diarrhea of less than three days' duration and moderate to severe dehydration were randomized to receive hypo-osmolar ORS (HO-ORS) or HO-ORS in which amylase resistant high amylose maize starch 50g/L substituted for glucose (HAMS-ORS). All remaining therapy followed standard protocol. Duration of diarrhea (ORS commencement to first formed stool) in hours was significantly shorter with HAMS-ORS (median 19, IQR 10-28) compared to HO-ORS (median 42, IQR 24-50) (Bonferroni adjusted P, P-adj < 0.001). Survival analysis (Kaplan-Meier) showed faster recovery from diarrhea in the HAMS-ORS group (P < 0.001, log rank test). Total diarrhea fecal weight in grams (median, IQR) was not significantly lower in the HAMS-ORS group (2190, 1160-5635) compared to HO-ORS (5210, 2095-12190) (P-adj = 0.08). However, stool weight at 13-24 hours (280, 0-965 vs. 1360, 405-2985) and 25-48 hours (0, 0-360 vs. 1080, 55-3485) were significantly lower in HAMS-ORS compared to HO-ORS group (Padj = 0.048 and P = 0.012, respectively). ORS intake after first 24 hours was lower in the HAMS-ORS group. Subgroup analysis of patients with culture isolates of Vibrio cholerae indicated similar significant differences between the treatment groups. Conclusions: Compared to HO-ORS, HAMS-ORS reduced diarrhea duration by 55% and significantly reduced fecal weight after the first 12 hours of ORS therapy in adults with cholera-like diarrhea.
-
Zinc in the treatment of acute diarrhea : Current status and assessment
Gastroenterology, 2006Co-Authors: Kazi Mirajul Hoque, Henry J BinderAbstract:The improved treatment of acute diarrhea in children during the past 35 years has reduced its morbidity and mortality substantially. However, better therapy still is required. This article reviews the role of Oral Rehydration Solution in the treatment of acute diarrhea with particular attention to recent efforts to develop improved Oral Rehydration Solution formulations. One promising approach is the administration of Zinc (Zn). Based on its beneficial effects in infections, including pneumonia, Zn has been shown to be effective in the treatment of acute diarrhea in several randomized controlled trials including subsequent meta-analyses. Thus, an emerging body of clinical data indicates that Zn can be useful for treating acute diarrhea. However, only limited information is known about the mechanism(s) by which Zn reduces diarrhea. Recent studies have indicated that Zn acts as a K channel blocker of adenosine 3′,5′-cyclic monophosphate–mediated chlorine secretion, but may not affect either Ca 2+ - or guanosine 3′,5′-cyclic monophosphate–mediated chlorine secretion. These data provide a strong rationale for further trials testing its efficacy in specific clinical settings and for more detailed physiologic studies examining how Zn exerts its antidiarrheal effect.
-
amylase resistant starch plus Oral Rehydration Solution for cholera
The New England Journal of Medicine, 2000Co-Authors: B S Ramakrishna, S Venkataraman, Pugazhendhi Srinivasan, Pratap Dash, Graeme P Young, Henry J BinderAbstract: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 me...
M.j.g. Farthing - One of the best experts on this subject based on the ideXlab platform.
-
efficacy of a standard united kingdom Oral Rehydration Solution ors and a hypotonic ors assessed by human intestinal perfusion
Alimentary Pharmacology & Therapeutics, 2007Co-Authors: I B Hunt, Elizabeth J Elliott, M.j.g. FarthingAbstract:: Human triple-lumen intestinal perfusion was used to compare water and solute absorption from the Oral Rehydration Solution (ORS) most widely used in the United Kingdom and a new experimental hypotonic ORS (HYPO-ORS). HYPO-ORS (osmolality 210 mOsm/kg) promoted significantly greater water absorption than UK-ORS (7.03 +/- 1.1 vs 2.73 +/- 1.0 ml cm-1 h-1; P less than 0.01). HYPO-ORS produced net sodium and chloride absorption whereas the low sodium UK-ORS produced a net secretion of these ions. Bicarbonate absorption was also greater from HYPO-ORS although potassium and glucose absorption were similar from both Solutions. This study suggests that UK-ORS may not promote optimal water and solute absorption and that clinical studies with HYPO-ORS are indicated.
-
Oral Rehydration therapy.
Pharmacology & Therapeutics, 2002Co-Authors: M.j.g. FarthingAbstract:Abstract Oral Rehydration therapy (ORT) with glucose-electrolyte Solutions has been considered to be one of the greatest therapeutic advances of this century. ORT is effective in acute diarrheal disease of diverse etiology. The most widely used Oral Rehydration Solution (ORS) worldwide is that recommended by the World Health Organisation (Na 90, K 20, glucose 111 and citrate 10 mmol/L). Attempts to improve the efficacy of ORS have been made by using complex substrastes (rice and other cereals) in place of glucose, and by reducing osmolality by decreasing glucose and sodium concentrations in monomeric ORS. ORS may have wider applications in the management of patients with the short bowel syndrom and in post-surgical patients.
-
absorption of a hypotonic Oral Rehydration Solution in a human model of cholera
Gut, 1994Co-Authors: J B Hunt, Andrew V Thillainayagam, S Carnaby, P D Fairclough, M L Clark, M.j.g. FarthingAbstract:The development of Oral Rehydration Solutions (ORSs) has been one of the important therapeutic advances of this century. The optimal formulation, however, of ORSs for both cholera and other infective diarrhoeas is still debated. Part of the problem in developing ORSs has been the lack of adequate test systems for the assessment of new formulations before clinical trial. We have developed a jejunal perfusion, cholera toxin induced, secretory model in humans and have compared net water and solute absorption from a hypotonic ORS (HYPO-ORS: sodium 60 mmol/l, glucose 90 mmol/l, osmolality 240 mOsm/kg) and the British Pharmacopoeia recommended ORS (UK-ORS: sodium 35 mmol/l, glucose 200 mmol/l, osmolality 310 mOsm/kg) in six healthy volunteers. A plasma electrolyte Solution (PES) was also perfused in all subjects to confirm a secretory state. Only HYPO-ORS reversed sodium secretion to absorption (p < 0.01). Both ORSs promoted net water absorption but this was greatest with HYPO-ORS (p < 0.01). Glucose and potassium absorption rates were similar for both ORSs whereas chloride absorption mirrored sodium absorption and was greatest from HYPO-ORS (p < 0.05). These results, in a biologically relevant model of secretory diarrhoea, suggest it may be possible to achieve improved rates of Rehydration by the use of hypotonic ORS with mid range sodium concentrations.
-
water and solute absorption from a new hypotonic Oral Rehydration Solution evaluation in human and animal perfusion models
Gut, 1992Co-Authors: J B Hunt, Andrew V Thillainayagam, A F M Salim, S Carnaby, Elizabeth J Elliott, M.j.g. FarthingAbstract:Controversy continues regarding the optimal composition of glucose electrolyte Oral Rehydration Solutions for the treatment of acute diarrhoea. Four perfusion models (normal human jejunum, normal rat small intestine, cholera toxin treated secreting rat small intestine and rotavirus infected rat small intestine) have been developed and used to compare the efficacy of a hypotonic Oral Rehydration Solution with standard United Kingdom British National formulary and developing world Oral Rehydration Solutions (WHO). Despite obvious physiological and pathophysiological differences between these models there was general congruence in the water and solute absorption profiles of the different Oral Rehydration Solutions. Hypotonic Oral Rehydration Solution promoted significantly greater water absorption than other Oral Rehydration Solutions in all rat models (p < 0.001) but apparently increased water absorption failed to achieve significance in human jejunum. British National Formulary-Oral Rehydration Solution was unable to reverse net water secretion in both rotavirus and cholera toxin models. Net sodium absorption from hypotonic and WHO-Oral Rehydration Solutions was significantly greater than from the low sodium British National Formulary-Oral Rehydration Solutions (p < 0.001) except in the rotavirus model when absorption was similar to hypotonic-Oral Rehydration Solutions. These findings show that there is agreement in the apparent efficacy of Oral Rehydration Solutions in these animal and human perfusion models, and that improved water absorption with adequate sodium absorption may be achieved by reducing Oral Rehydration Solution osmolality.
Timo Vesikari - One of the best experts on this subject based on the ideXlab platform.
-
management of acute diarrhoea with low osmolarity Oral Rehydration Solutions and lactobacillus strain gg
Archives of Disease in Childhood, 1998Co-Authors: T Rautanen, Erika Isolauri, E Salo, Timo VesikariAbstract:Two hypotonic Oral Rehydration Solutions with osmolarities of 224 mosmol/l (Na + 60 mmol/l, glucose 84 mmol/l) and 204 mosmol/l (Na + 60 mmol/l, glucose 64 mmol/l), respectively, and Oral treatment with Lactobacillus GG were evaluated in a double blind trial in children aged 6–36 months hospitalised for acute diarrhoea. Early administration of Lactobacillus GG at the start of Oral Rehydration resulted in the shortest duration of diarrhoea, best weight gain, and fastest correction of acidosis. A reduced osmolarity Oral Rehydration Solution (224 mosmol/l) combined with early administration of Lactobacillus GG is an effective treatment for acute diarrhoea in young children; further reduction of osmolarity may not be beneficial.
-
randomised double blind study of hypotonic Oral Rehydration Solution in diarrhoea
Archives of Disease in Childhood, 1997Co-Authors: T Rautanen, Seija Kurki, Timo VesikariAbstract:A hypotonic (osmolality 224 mmol/l, sodium 60 mmol/l) Oral Rehydration Solution (ORS) was compared with an isotonic high glucose ORS (osmolality 304 mmol/l, sodium 60 mmol/l) in children with acute diarrhoea in a randomised double blind study. The stool output and hence the mean consumption of ORS for maintenance hydration was less (p = 0.036) in patients receiving hypotonic (69 ml/kg) than isotonic (97 ml/kg) ORS. Hypotonic ORS was more effective in patients with rotavirus positive than with rotavirus negative diarrhoea.
-
clinical experience with a hypotonic Oral Rehydration Solution in acute diarrhoea
Acta Paediatrica, 1993Co-Authors: T Rautanen, Sahib Elradhi, Timo VesikariAbstract:A hypotonic Oral Rehydration salts (ORS) Solution with total osmolality of 224 rnosmol/l was compared in an open clinical trial with an isotonic (osmolality 304 mosmol/l) ORS Solution for the treatment of dehydration due to acute diarrhoea. Both ORS Solutions had the same electrolyte composition with a Na+ concentration of 60 mmol/l. Children given the hypotonic ORS Solution (n= 103) passed significantly fewer diarrhoeal stools, and their diarrhoea and hospital stay were shorter than those of children given the isotonic ORS Solution (n= 135). We conclude that hypotonic ORS (“light” ORS) has clinical advantages over the standard ORS currently used in Finland.
Olivier Fontaine - One of the best experts on this subject based on the ideXlab platform.
-
a pilot test of the addition of zinc to the current case management package of diarrhea in a primary healthcare setting
Journal of Pediatric Gastroenterology and Nutrition, 2005Co-Authors: Nita Bhandari, Dilip Mahalanabis, Olivier Fontaine, Robert E Black, Sarmila Mazumder, Sunita Taneja, Brinda Dube, Maharaj K BhanAbstract:Zinc is recommended for the treatment of acute diarrhea in children but the effect of its introduction on drug and Oral Rehydration Solution use is unclear. Government care providers, private practitioners and community workers were trained to distribute zinc and Oral Rehydration Solution to children seeking care for diarrhea. Periodic surveys showed that village-based workers became a common source of diarrhea treatment and private practitioners were used less. Zinc was used in approximately half of the episodes; the prescription and use rates of Oral Rehydration Solution packets increased from 7% at baseline to 44.9% 6 months later. Reduction in use of drugs during diarrhea ranged from 34% for tablets to 64% for injections 6 months later. The cost of treatment to families declined significantly. These findings need confirmation in a randomized controlled trial.
-
scientific rationale for a change in the composition of Oral Rehydration Solution
JAMA, 2004Co-Authors: Christopher Duggan, Dilip Mahalanabis, Olivier Fontaine, Nathaniel F Pierce, Roger I Glass, Nur H Alam, M K Bhan, Mathuram SantoshamAbstract:Diarrheal diseases remain important causes of death and morbidity in developing countries with an estimated 1.5 billion episodes and 1.5 million to 2.5 million deaths each year among children younger than 5 years. Although the number of children currently dying from diarrhea continues to be unacceptably high it is substantially lower than the 5 million deaths per year estimated 20 years ago. A critical factor in this reduction in diarrhea deaths has been the widespread adoption of Oral Rehydration Solution (ORS) programs for the treatment and prevention of diarrhea-associated dehydration. Indeed ORS has been hailed as one of the most important medical advances of the past century at least in part because of its simplicity low cost and remarkable ease of use. Oral rehydation Solution works on the elegantly simple physiologic principle of solute cotransport across the gastrointestinal epithelium. Briefly landmark studies published in 1968 among patients with Vibrio cholera infections demonstrated that although the secretory nature of the diarrhea causes massive stool losses of water and electrolytes sodium-coupled glucose cotransport remains largely intact and continues to stimulate resorption of salt and water. Clinical trials documenting the efficacy of ORS soon followed in the 1970s and 1980s. (excerpt)
-
a double blind clinical trial comparing world health organization Oral Rehydration Solution with a reduced osmolarity Solution containing equal amounts of sodium and glucose
The Journal of Pediatrics, 1996Co-Authors: Mathuram Santosham, Christopher Duggan, Ibrahim Fayad, Maha Abu Zikri, Abeer Hussein, Akwasi Amponsah, Mohamed Hashem, Nermine El Sady, Olivier FontaineAbstract:Abstract OBJECTIVE: To compare the safety and efficacy of an Oral Rehydration Solution (ORS) containing 75 mmol/L of sodium and glucose each with the standard World Health Organization (WHO) ORS among Egyptian children with acute diarrhea. METHODS: One hundred ninety boys, ages 1 to 24 months, who were admitted to the hospital with acute diarrhea and signs of dehydration were randomly assigned to receive either standard ORS (311 mmol/L) or a reduced osmolarity ORS (245 mmol/L). Intake and output were measured every 3 hours. RESULTS: In the group treated with reduced osmolarity ORS, the mean stool output during the Rehydration phase was 36% lower (95% confidence interval, 1%, 100%) than in those treated with WHO ORS. The relative risk of vomiting during the Rehydration phase was significantly lower in children treated with reduced osmolarity ORS (relative risk, 2.4; 95% confidence interval, 1.2, 4.8). During the maintenance phase, stool output, mean intake of food and ORS, duration of diarrhea, and weight gain were similar in the treatment groups. The relative risk of treatment failure (need for unscheduled administration of intravenous fluids) was significantly increased in children receiving standard WHO ORS (relative risk, 7.9; 95% confidence interval, 1.1, 60.9). The mean serum sodium concentration at 24 hours was significantly lower in children receiving the reduced osmolarity ORS Solution (134 ± 6 mEq/L) than in children receiving the standard WHO ORS (138 ± 7 mEq/L) (p EDIATR 1996;128:45-51)
-
impact of rice based Oral Rehydration Solution on stool output and duration of diarrhoea meta analysis of 13 clinical trials
BMJ, 1992Co-Authors: S M Gore, Olivier Fontaine, Nathaniel F PierceAbstract:OBJECTIVE--To define the benefit of rice Oral Rehydration salts Solution in relation to the glucose based World Health Organisation Oral Rehydration salts Solution for treating and preventing dehydration in patients with severe dehydrating diarrhoea. DESIGN--Meta-analysis using data from 13 available randomised trials that compared these two formulations. SUBJECTS--The studies compared 1367 patients with cholera, severe cholera-like diarrhoea, or acute non-cholera diarrhoea. 668 received the standard WHO Solution and 699 the rice based Solution. INTERVENTION--Each trial report was reviewed to determine patient eligibility, the number of patients who were randomised and the number of these excluded from analysis, details of the randomisation procedure, and the precise timing of the outcome measurements. MAIN OUTCOME MEASURES--Stool output during the first 24 hours; weighted estimates of the difference in mean stool output between treatments. RESULTS--The rice Solution significantly reduced the rate of stool output during the first 24 hours by 36% (95% confidence interval 28 to 44%) in adults with cholera and by 32% (19 to 45%) in children with cholera. The rate of stool loss in infants and children with acute non-cholera diarrhoea was reduced by only 18% (6 to 30%). CONCLUSIONS--The benefit of rice Oral Rehydration salts Solution for patients with cholera is sufficiently great to warrant its use in such patients. The benefit is considerably smaller for children with acute, noncholera diarrhoea and should be more precisely defined before its practical value can be judged.
T Rautanen - One of the best experts on this subject based on the ideXlab platform.
-
management of acute diarrhoea with low osmolarity Oral Rehydration Solutions and lactobacillus strain gg
Archives of Disease in Childhood, 1998Co-Authors: T Rautanen, Erika Isolauri, E Salo, Timo VesikariAbstract:Two hypotonic Oral Rehydration Solutions with osmolarities of 224 mosmol/l (Na + 60 mmol/l, glucose 84 mmol/l) and 204 mosmol/l (Na + 60 mmol/l, glucose 64 mmol/l), respectively, and Oral treatment with Lactobacillus GG were evaluated in a double blind trial in children aged 6–36 months hospitalised for acute diarrhoea. Early administration of Lactobacillus GG at the start of Oral Rehydration resulted in the shortest duration of diarrhoea, best weight gain, and fastest correction of acidosis. A reduced osmolarity Oral Rehydration Solution (224 mosmol/l) combined with early administration of Lactobacillus GG is an effective treatment for acute diarrhoea in young children; further reduction of osmolarity may not be beneficial.
-
randomised double blind study of hypotonic Oral Rehydration Solution in diarrhoea
Archives of Disease in Childhood, 1997Co-Authors: T Rautanen, Seija Kurki, Timo VesikariAbstract:A hypotonic (osmolality 224 mmol/l, sodium 60 mmol/l) Oral Rehydration Solution (ORS) was compared with an isotonic high glucose ORS (osmolality 304 mmol/l, sodium 60 mmol/l) in children with acute diarrhoea in a randomised double blind study. The stool output and hence the mean consumption of ORS for maintenance hydration was less (p = 0.036) in patients receiving hypotonic (69 ml/kg) than isotonic (97 ml/kg) ORS. Hypotonic ORS was more effective in patients with rotavirus positive than with rotavirus negative diarrhoea.
-
clinical experience with a hypotonic Oral Rehydration Solution in acute diarrhoea
Acta Paediatrica, 1993Co-Authors: T Rautanen, Sahib Elradhi, Timo VesikariAbstract:A hypotonic Oral Rehydration salts (ORS) Solution with total osmolality of 224 rnosmol/l was compared in an open clinical trial with an isotonic (osmolality 304 mosmol/l) ORS Solution for the treatment of dehydration due to acute diarrhoea. Both ORS Solutions had the same electrolyte composition with a Na+ concentration of 60 mmol/l. Children given the hypotonic ORS Solution (n= 103) passed significantly fewer diarrhoeal stools, and their diarrhoea and hospital stay were shorter than those of children given the isotonic ORS Solution (n= 135). We conclude that hypotonic ORS (“light” ORS) has clinical advantages over the standard ORS currently used in Finland.