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Effect of diosmectite on intestinal permeability changes in acute diarrhea: a double-blind placebo-controlled trial
C Dupont1, J L Moreno, E Barau
1Département de Pédiatrie, Hôpital Saint Vincent de Paul, Paris, France.
Insights
Diosmectite improved intestinal absorption in children with acute diarrhea. The study found diosmectite enhanced mannitol absorption, a marker of intestinal absorptive area, suggesting a therapeutic benefit.
Area of Science:
- Gastroenterology
- Pediatrics
- Pharmacology
Background:
- Acute diarrhea is a common pediatric illness.
- Intestinal permeability is often altered during gastroenteritis.
- Diosmectite is a clay-based medication used for symptomatic treatment of diarrhea.
Purpose of the Study:
- To evaluate the effect of diosmectite on intestinal permeability in children with acute diarrhea.
- To assess changes in lactulose and mannitol absorption after diosmectite treatment.
Main Methods:
- A double-blind, placebo-controlled trial was conducted in 59 Gabonese children (5-35 months).
- Intestinal permeability tests (IPTs) measured urinary excretion of lactulose and mannitol.
- Tests were repeated after 2 days of treatment with either diosmectite or placebo.
Main Results:
- Initially, lactulose/mannitol ratios were similar between groups.
- After treatment, diosmectite significantly decreased the lactulose/mannitol ratio (p=0.02).
- Diosmectite enhanced mannitol absorption (+1.43%), while placebo showed a decrease (-0.47%; p=0.01).
Conclusions:
- Diosmectite appears to improve intestinal absorptive function during acute gastroenteritis.
- The drug enhances mannitol absorption, indicating a potential benefit for intestinal barrier function.
- Further research may elucidate the precise mechanisms of diosmectite's action on the intestinal mucosa.
Abstract:
The effect of diosmectite on intestinal permeability changes in acute diarrhea was measured during a double-blind placebo-controlled trial carried out in 59 Gabonese children aged 5-35 months. Intestinal permeability tests (IPTs), measuring the urinary elimination of orally administered lactulose and mannitol at a dosage of 1 g/10 kg each, were performed during the morning following admission and repeated 2 days later after treatment by diosmectite or placebo. During the first IPT, urine volume and lactulose and mannitol urinary recoveries were comparable in the diosmectite and in the placebo groups: 50 vs. 35.5 ml (median; p = 0.21), 1.01 vs. 1.27% (p = 0.35), and 2.20 vs. 2.87% (p = 0.12). As a result, the lactulose/mannitol (L/M) ratio was similar in the two groups: 44.44 vs. 35.33% (p = 0.98). During the second IPT, the urinary lactulose recovery decreased similarly in both groups (-0.18 vs. -0.29%; p = 0.76), whereas the urinary mannitol recovery exhibited opposite variations, the increase in the diosmectite group (+ 1.43%) contrasting significantly with the decrease in the placebo group (-0.47%; p = 0.01). When comparing the first and the second IPT, the decrease of the L/M ratio was significant in the diosmectite group (44.44 vs. 28.32%; p = 0.02) and not in the placebo group (35.33 vs. 48.23%; p = 0.91). During gastroenteritis, diosmectite appears to enhance absorption of mannitol, a marker of intestinal absorptive area.