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Anti-Diarrheal Effects of Diosmectite in the Treatment of Acute Diarrhea in Children

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Abstract

Acute diarrhea caused by an infectious organism is highly prevalent, particularly in developing countries, and is usually self-limiting. The condition is a major contributor to the global disease burden and is associated with a significant economic cost. The disease is common in children aged <5 years. It occurs as the result of exposure to a diarrheogenic agent that alters intestinal absorption and/or secretion, resulting in an increase in the volume of water that enters the colon beyond that which can be absorbed. Diarrhea almost always occurs by one or more of four mechanisms: disruption of osmotic forces in the intestine; disruption of normal secretory processes; disruption of epithelial cells or the epithelial tight junctions; or motility disorders.

Oral rehydration therapy (ORT) is central to the management of acute diarrhea, and is sufficient to prevent complications due to dehydration in most patients while the disease runs its course. However, ORT has no effect on the duration of the disease or frequency of bowel motions, and any agent that could meet these needs would therefore be a useful addition to ORT.

Diosmectite is a natural aluminomagnesium silicate clay with a lamellar, non-fibrous crystalline structure that gives it strong adsorbent properties. Its mechanisms of action are not yet fully understood, but are probably multiple. Diosmectite reduces inflammation, modifies mucus rheologic properties, inhibits mucolysis, and adsorbs bacteria, bacterial enterotoxins, viruses and other potentially diarrheogenic substances.

A number of studies have shown that diosmectite reduces the duration of diarrhea and decreases the frequency of bowel motions after 2 days of treatment in children with mild-to-moderate acute diarrhea. Two recent trials have indicated a reduction in stool output with diosmectite. Because of its very favorable safety profile, with no serious adverse effects, diosmectite is frequently used, mainly in European countries but also in Asia and Africa. Diosmectite should be used as an adjunct, not an alternative, to ORT and, when needed, to antibacterial therapy.

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References

  1. Alam NH, Ashraf H. Treatment of infectious diarrhea in children. Pediatr Drugs 2003; 5(3): 151–65

    Google Scholar 

  2. Gadewar S, Fasano A. Current concepts in the evaluation, diagnosis and management of acute infectious diarrhea. Curr Opin Pharmacol 2005 Dec; 5(6): 559–65

    Article  PubMed  CAS  Google Scholar 

  3. Thapar N, Sanderson IR. Diarrhoea in children: an interface between developing and developed countries. Lancet 2004 Feb; 363(9409): 641–53

    Article  PubMed  Google Scholar 

  4. Field M. Intestinal ion transport and the pathophysiology of diarrhea. J Clin Invest 2003 Apr; 111(9): 931–43

    PubMed  CAS  Google Scholar 

  5. Dalby-Payne J, Elliott E. Gastroenteritis in children. Clin Evid 2004 Dec; 12: 443–54

    PubMed  Google Scholar 

  6. Provisional Committee on Quality Improvement: Subcommittee on Acute Gastroenteritis. Practice parameter: the management of acute gastroenteritis in young children. Pediatrics 1996 Mar; 97(3): 424–36

    Google Scholar 

  7. Wilson MJ. Clay mineralogical and related characteristics of geophagic materials. J Chem Ecolog 2003 Jul; 29(7): 1525–47

    Article  CAS  Google Scholar 

  8. Dies J, Miralles L, Tarrasa F, et al. Thermoluminescence response of calcic bentonite subjected to conditions of high nuclear waste underground storage. Radiat Prot Dosimetry 2002; 100(1–4): 389–94

    Article  PubMed  CAS  Google Scholar 

  9. Fioramonti J, Fargeas MJ, Bueno L. Action of T-2 toxin on gastrointestinal transit in mice: protective effect of an argillaceous compound. Toxicol Lett 1987 May; 36(3): 227–32

    Article  PubMed  CAS  Google Scholar 

  10. Guarino A, Bisceglia M, Castellucci G, et al. Smectite in the treatment of acute diarrhea: a nationwide randomized controlled study of the Italian; Society of Pediatric Gastroenterology and Hepatology (SIGEP) in collaboration with primary care physicians. J Pediatr Gastroenterol Nutr 2001 Jan; 32(1): 71–5

    Article  PubMed  CAS  Google Scholar 

  11. Madkour AA, Madina EM, El-Azzouni OE, et al. Smectite in acute diarrhea in children: a double-blind, placebo-controlled clinical trial. J Pediatr Gastroenterol Nutr 1993 Aug; 17(2): 176–81

    Article  PubMed  CAS  Google Scholar 

  12. Vivatvakin B, Jongpipatvanich S, Harikul S, et al. Control study of oral rehydration solution (ORS)/ORS+dioctahedral smectite in hospitalized Thai infants with acute secretory diarrhea. Southeast Asian J Trop Med Public Health 1992 Sep; 23(3): 414–9

    PubMed  CAS  Google Scholar 

  13. Lexomboon U, Harikul S, Lortholary O. Control randomized study of rehydration/rehydration with dioctahedral smectite in ambulatory Thai infants with acute diarrhea. Southeast Asian J Trop Med Public Health 1994 Mar; 25(1): 157–62

    PubMed  CAS  Google Scholar 

  14. Narkeviciute I, Rudzeviciene O, Leviniene G, et al. Management of Lithuanian children’s acute diarrhea with Gastrolit solution and dioctahedral smectite. Eur J Gastroenterol Hepatol 2002 Apr; 14(4): 419–24

    Article  PubMed  CAS  Google Scholar 

  15. Gilbert B, Lienhardt A, Palomera S, et al. The efficacy of smectite in acute infantile diarrhea, compared to a placebo and loperamide [in French]. Ann Pediatr (Paris) 1991 Nov; 38(9): 633–6

    CAS  Google Scholar 

  16. Lachaux A, Danzon A, Collet JP, et al. Acute infantile diarrhoea: role of treatment with smectite as complement to rehydration. Randomised double-blind study. Int Rev Pediatr 1986; 163: 29–31

    Google Scholar 

  17. Zong S, Chao YM, Qu Y, et al. Study on Smecta therapy for acute diarrhea in infants [in Chinese]. J Tianjing Med Univ 1997; 3: 60–3

    Google Scholar 

  18. Osman GAH, Mahomoud SAR, El-Shakankiry HM, et al. An adsorbent! Role in the management of acute diarrhea in infants and children. Ain Shams Med J 1992; 13: 10,11 and 12665-76

    Google Scholar 

  19. Szajewska H, Dziechciarz P, Mrukowicz J. Meta-analysis: smectite in the treatment of acute infectious diarrhea in children. Aliment Pharmacol Ther 2006 Jan; 23(2): 217–27

    Article  PubMed  CAS  Google Scholar 

  20. Dupont C, Kok Foo JL, Garnier P, et al. Oral diosmectite reduces stool output and diarrhea duration in children with acute watery diarrhea [online]. Available from URL: http://www.cghjournal.org/inpress [Accessed 2009 Feb 24]

  21. Berkes J, Viswanathan VK, Savkovic SD, et al. Intestinal epithelial responses to enteric pathogens: effects on the tight junction barrier, ion transport, and inflammation. Gut 2003 Mar; 52(3): 439–51

    Article  PubMed  CAS  Google Scholar 

  22. Droy-Lefaix MT, Bueno L. Inflammatory cascade and diarrhea: a new approach. Acta Endoscopica 2003; 33(5): 773–80

    Article  Google Scholar 

  23. Hecht G, Savkovic SD. Review article: effector role of epithelia in inflammation: interaction with bacteria. Aliment Pharmacol Ther 1997 Dec; 11Suppl. 3: 64–8

    PubMed  Google Scholar 

  24. Jung HC, Eckmann L, Yang S-K, et al. A distinct array of proinflammatory cytokines is expressed in human colon epithelial cells in response to bacterial invasion. J Clin Invest 1995 Jan; 95(1): 55–65

    Article  PubMed  CAS  Google Scholar 

  25. Amieva MR. Important bacterial gastrointestinal pathogens in children: a pathogenesis perspective. Pediatr Clin North Am 2005 Jan; 52(3): 749–77

    Article  PubMed  Google Scholar 

  26. Dong Y, Zeng CQ, Ball JM, et al. The rotavirus enterotoxin NSP4 mobilizes intracellular calcium in human intestinal cells by stimulating phospholipase C-mediated inositol 1,4,5-trisphosphate production. Proc Natl Acad Sci U S A 1997 Apr; 94(8): 3960–5

    Article  PubMed  CAS  Google Scholar 

  27. Gonzalez R, de Medina FS, Martinez-Augustin O, et al. Anti-inflammatory effect of diosmectite in hapten-induced colitis in the rat. Br J Pharmacol 2004 Mar; 141(6): 951–60

    Article  PubMed  CAS  Google Scholar 

  28. Moré J, Benazet F, Fioramonti J, et al. Effects of treatment with smectite on gastric and intestinal glycoproteins in the rat: a histochemical study. Histochem J 1987 Dec; 19(12): 665–70

    Article  PubMed  Google Scholar 

  29. Droy MT, Drouet Y, Geraud G, et al. Spinnability: a new approach to intestinal stress and its therapy [in French]. Gastroenterol Clin Biol 1985; 9 (12 Pt 2): 119–21

    PubMed  CAS  Google Scholar 

  30. Rateau JG, Morgant G, Droy-Priot MT, et al. A histological, enzymatic and water-electrolyte study of the action of smectite, a mucoprotective clay, on experimental infectious diarrhea in the rabbit. Curr Med Res Opin 1982; 8(4): 233–41

    Article  PubMed  CAS  Google Scholar 

  31. Leonard A, Droy-Lefaix MT, Allen A. Pepsin hydrolysis of the adherent mucus barrier and subsequent gastric mucosal damage in the rat: effect of diosmectite and 16, 16 dimethyl prostaglandin E2. Gastroenterol Clin Biol 1994; 18(6–7): 609–16

    PubMed  CAS  Google Scholar 

  32. Brouillard MY, Rateau JG. Adsorption potency of 2 clays, smectite and kaolin on bacterial enterotoxins: in vitro study in cell culture and the intestine of newborn mice [in French]. Gastroenterol Clin Biol 1989 Jan; 13(1): 18–24

    PubMed  CAS  Google Scholar 

  33. Weese JS, Cote NM, deGannes RV. Evaluation of in vitro properties of di-tri-octahedral smectite on clostridial toxins and growth. Equine Vet J 2003 Nov; 35(7): 638–41

    Article  PubMed  CAS  Google Scholar 

  34. Martirosian G, Rouyan G, Zalewski T, et al. Dioctahedral smectite neutralization activity of Clostridium difficile and Bacteroides fragilis toxins in vitro. Acta Microbiol Pol 1998; 47(2): 177–83

    PubMed  CAS  Google Scholar 

  35. Clark KJ, Sarr AB, Grant PG, et al. In vitro studies on the use of clay, clay minerals and charcoal to adsorb bovine rota virus and bovine coronavirus. Vet Microbiol 1998 Oct; 63(2–4): 137–46

    Article  PubMed  CAS  Google Scholar 

  36. Mahraoui L, Heyman M, Plique O, et al. Apical effect of diosmectite on damage to the intestinal barrier induced by basal tumour necrosis factor. Gut 1997 Mar; 40(3): 339–43

    PubMed  CAS  Google Scholar 

  37. Fioramonti J, Droy-Lefaix MT, Bueno L. Changes in gastrointestinal motility induced by cholera toxin and experimental osmotic diarrhea in dogs: effects of treatment with an argillaceous compound. Digestion 1987; 36(4): 230–7

    Article  PubMed  CAS  Google Scholar 

  38. Dupont C, Moreno JL, Barau E, et al. Effect of diosmectite on intestinal permeability changes in acute diarrhea: a double-blind placebo-controlled trial. J Pediatr Gastroenterol Nutr 1992 May; 14(4): 413–9

    Article  PubMed  CAS  Google Scholar 

  39. USAID, UNICEF, World Health Organization. Diarrhoea treatment guidelines [online]. Available from URL: http://whqlibdoc.who.int/publications/2005/a85500.pdf [Accessed 2009 Feb 2]

  40. European Patent Office. European patent application [online]. Available from URL: https://publications.european-patient-office.org/PublicationServer/getpdf.jsp?cc=EP&pn=1747775&ki=A1

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Acknowledgements

The preparation of this manuscript was supported by Ipsen, France. Editorial assistance for the development of this manuscript was provided by John McKeogh, Wolters Kluwer Health Medical Communications. C. Dupont has received honoraria for lectures, for the current review, and for previous clinical trials with Ipsen. B. Vernisse has no conflicts of interest that are directly relevant to the content of this review.

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  1. Service de Néonatologie, Hôpital Saint-Vincent-de-Paul, Université Paris Descartes, 82 avenue Denfert-Rochereau, 75674, Paris Cedex 14, France

    Christophe Dupont

  2. Cabinet d’Hépato-Gastro-Entérologie, Saint Germain en Laye, France

    Bernard Vernisse

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Correspondence to Christophe Dupont.

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Dupont, C., Vernisse, B. Anti-Diarrheal Effects of Diosmectite in the Treatment of Acute Diarrhea in Children. Pediatr-Drugs 11, 89–99 (2009). https://doi.org/10.2165/00148581-200911020-00001

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