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Abstract

  1. Top of page
  2. Abstract
  3. Objectives
  4. Relevance
  5. Participants
  6. Comparison
  7. Results
  8. Implications
  9. How Recent is the Evidence
  10. Research Gaps

This is a summary of a Cochrane review, published in this issue of EBCH, first published as: Gregorio GV, Gonzales MLM, Dans LF, Martinez EG. Polymer-based oral rehydration solution for treating acute watery diarrhoea. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD006519. DOI: 10.1002/14651858.CD006519.pub2. Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration


Objectives

  1. Top of page
  2. Abstract
  3. Objectives
  4. Relevance
  5. Participants
  6. Comparison
  7. Results
  8. Implications
  9. How Recent is the Evidence
  10. Research Gaps
  • This review aims to compare polymer-based oral rehydration solution (ORS) with glucose-based ORS for treating acute watery diarrhoea.

Relevance

  1. Top of page
  2. Abstract
  3. Objectives
  4. Relevance
  5. Participants
  6. Comparison
  7. Results
  8. Implications
  9. How Recent is the Evidence
  10. Research Gaps
  • Acute diarrhoea (three or more loose bowel movements in a 24-h period), is one of the principal causes of morbidity and mortality among children in low-income countries.

  • The incidence of diarrhoea is estimated to be 3.8 episodes per child per year for children less than 11 months of age and 2.1 episodes per child per year for children aged 1 to 4 years. The cause is mainly viral.

  • ORS was introduced in 1979 by the World Health Organization.

  • ORS consists of glucose, sodium, potassium, chloride, and citrate or bicarbonate.

  • The original ORS (also called ORS ≥ 310 or classic) and ORS ≤ 270 (also called hypoosmolar) were both shown to improve signs of dehydration.

  • While this glucose-based ORS is effective in replacing the fluid from acute diarrhoea, it neither reduces stool loss nor shortens the duration of illness.

  • Glucose polymer-based ORS (referred to as polymer-based ORS) may contain whole rice (amylopectins)—rice-based ORS or rice syrups (maltodextrins). In these polymer-based solutions, the glucose is slowly released after digestion and is absorbed in the small bowel, enhancing the reabsorption of water and electrolytes.

Participants

  1. Top of page
  2. Abstract
  3. Objectives
  4. Relevance
  5. Participants
  6. Comparison
  7. Results
  8. Implications
  9. How Recent is the Evidence
  10. Research Gaps
  • This review included 34 trials with 4214 participants. Twenty-seven trials were in children, five in adults and two in both children and adults.

Results

  1. Top of page
  2. Abstract
  3. Objectives
  4. Relevance
  5. Participants
  6. Comparison
  7. Results
  8. Implications
  9. How Recent is the Evidence
  10. Research Gaps
  • In a comparison of polymer-based ORS vs ORS ≤ 270 or ORS ≥ 310, polymer-based ORS:

    • ○ Led to decreased stool output (numeric data not available as there was significant heterogeneity; I2 = 100%).

    • ○ Resulted in significantly fewer unscheduled IVs (RR: 0.75; 95% CI: 0.59, 0.95).

  • In a comparison of polymer-based ORS vs glucose-based ORS, there was no significant difference in adverse events (vomiting, hyponatraemia, hypokalaemia and development of persistent diarrhoea); however, polymer-based ORS:

    • ○ Decreased both stool output and duration of diarrhoea (I2 = 100%).

    • ○ Resulted in significantly fewer unscheduled IVs (RR: 0.75; 95% CI: 0.58, 0.98).

  • In a comparison of polymer-based ORS (rice-based) vs glucose-based ORS, rice-based ORS:

    • ○ Significantly decreased duration of diarrhoea (MD: − 7.19; 95% CI: − 11.80, − 2.58).

    • ○ Led to decreased stool output (I2 = 100%).

    • ○ Resulted in significantly fewer unscheduled IVs (RR: 0.75; 95% CI: 0.58, 0.98).

Implications

  1. Top of page
  2. Abstract
  3. Objectives
  4. Relevance
  5. Participants
  6. Comparison
  7. Results
  8. Implications
  9. How Recent is the Evidence
  10. Research Gaps
  • Polymer-based ORS shows some advantages as it decreases the duration of diarrhoea and lowers the risk of unscheduled use of intravenous fluid, compared with a glucose-based ORS.

Research Gaps

  1. Top of page
  2. Abstract
  3. Objectives
  4. Relevance
  5. Participants
  6. Comparison
  7. Results
  8. Implications
  9. How Recent is the Evidence
  10. Research Gaps
  • Further research is needed to compare the efficacy of ORS ≤ 270 with a polymer-based ORS in reducing the total stool output, the total volume of ORS intake, the duration of diarrhoea, and the risk of unscheduled intravenous fluid therapy. There is also a need for more trials on the efficacy of wheat-based ORS.