Smectite in Acute Diarrhoea
Date First Published:
August 19, 2005
Last Updated:
October 11, 2005
Report by:
Zui-Shen Yen, Emergency Physician (National Taiwan University Hospital)
Search checked by:
Mei-Shu Lai, National Taiwan University Hospital
Three-Part Question:
In [children with acute diarrhoea] is [the use of smectite with oral rehydration solution better than oral rehydration solution alone] at [shortening the duration of diarrhoea] ?
Clinical Scenario:
A 12-month-old boy with acute diarrhea is brought to the emergency department by his parents. He tolerates oral rehydration solution well but his parents still worry very much about his frequent loose stools. You wonder if the use of smectite would provide any additional benefit.
Search Strategy:
Medline 1966-August 2005, Embase 1966-August 2005, and The Cochrane Library, Issue 3, 2005.
Search Details:
Medline: {(dioctahedral$.mp OR smect$.mp) AND (exp diarrhea OR exp gastroenteritis OR diarrh$.mp)} LIMIT to human AND English. Embase: {(diactahedral* OR smect*) AND ('diarrhea'/exp OR 'gastroenteritis'/exp OR diarrh*)} LIMIT to human AND English. Cochrane Library: "smectite".
Outcome:
Altogether 21 papers were found, of which five were considered to be original research of high quality (randomised controlled trials) and relevant to the topic of interest. These five paper are shown in the table
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Management of Lithuanian children's acute diarrhoea with Gastrolit solution and dioctahedral smectite. Narkeviciute I, Rudzeviciene O, Leviniene G, Mociskiene K, Eidukevicius R. 2002 Lithuania | 54 patients (age 6-48 months) with acute diarrhoea randomised to dioctahedral smectite (DS)+oral rehydration solution (ORS) or ORS | PRCT | Duration of diarrhoea (hours) | Significantly shorter duration of diarrhoea in the DS+ORS group (42.3±24.7 vs. 61.8±33.9, p=0.019) | Small number of patients Randomisation by birthday No blinding |
| Smectite in the treatment of acute diarrhea: a nationwide randomized controlled study of the Italian Society of Pediatric Gastroenterology and Hepatology (SIGEP) Guarino A, Bisceglia M, Castellucci G, et al. 2001 Italy | 804 patients (age 3months–5year) with acute diarrhoea randomised to DS+ORS or ORS | PRCT | Duration of diarrhoea (hours) | Significantly shorter duration of diarrhoea in the DS+ORS group (96±21 vs. 119±23, p<0.001) | Incomparable baseline data No intention-to-treat analysis No blinding |
| Control randomized study of rehydration/rehydration with dioctahedral smectite in ambulatory Thai infants with acute diarrhea. Lexomboon U, Harikul S, Lortholary O. 1994 Thailand | 66 patients (age 1-24 months) with acute diarrhoea randomised to DS+ORS or ORS | PRCT | Cure rate at 72 hours | Significantly higher cure rate in the DS+ORS group at 72 hours after the treatment (71% vs. 34%, p<0.01) | Small number of patients Unclear randomisation No blinding |
| Smectite in acute diarrhea in children: a double-blind placebo-controlled clinical trial. Madkour AA, Madina EM, el-Azzouni OE, Amer MA, el-Walili TM, Abbass T. 1993 Egypt | 90 boys (age 3-24 months) with acute diarrhoea randomised to DS+ORS or ORS | PRCT | Duration of diarrhoea (hours) | Significantly shorter duration of diarrhoea in the DS+ORS group (54.1±2.35 vs. 72.9±1.98, p<0.001) | Small number of patients |
| Total number of diarrhoeal stools | Significant smaller number of total diarrhoeal stools in the DS+ORS group (11.3±0.48 vs. 13.8±0.45, p<0.001) | ||||
| Control study of oral rehydration solution (ORS)/ORS + dioctahedral smectite in hospitalized Thai infants with acute secretory diarrhea. Vivatvakin B, Jongpipatvanich S, Harikul S, Eksaengri P, Lortholary O. 1992 Lithuania | 62 patients (age 1-24 months) with acute diarrhoea randomised to DS+ORS or ORS | PRCT | Duration of diarrhoea (hours) | Significantly shorter duration of diarrhoea in the DS+ORS group (43.3±25.1 vs. 84.7±48.5, p=0.005) | Small number of patients Unclear randomisation No blinding |
Author Commentary:
Dioctahedral smectite is a natural adsorbent clay formed of fine sheets of aluminomagnesium silicate. Smectite has been found to adsorb viruses, bacteria, bacterial toxins, thus protecting the intestinal mucosa. Most clinical studies were relatively small and only one was obviously blinded. However, they consistently showed the efficacy of smectite in reducing the duration of diarrhoea. In children with acute diarrhoea rehydrated with oral rehydration solution, smectite may shorten the duration of diarrhoea by about 20% to 50%. There was no significant side effects observed. Considering safety, tolerance and antidiarrhoeal activity of smectite, it's worth a try to use smectite in the treatment of acute diarrhoea in children.
Bottom Line:
Oral smectite appears to be effective at shortening the duration of diarrhoea in children with acute diarrhoea rehydrated with oral rehydration solution.
References:
- Narkeviciute I, Rudzeviciene O, Leviniene G, Mociskiene K, Eidukevicius R.. Management of Lithuanian children's acute diarrhoea with Gastrolit solution and dioctahedral smectite.
- 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)
- Lexomboon U, Harikul S, Lortholary O.. Control randomized study of rehydration/rehydration with dioctahedral smectite in ambulatory Thai infants with acute diarrhea.
- Madkour AA, Madina EM, el-Azzouni OE, Amer MA, el-Walili TM, Abbass T.. Smectite in acute diarrhea in children: a double-blind placebo-controlled clinical trial.
- Vivatvakin B, Jongpipatvanich S, Harikul S, Eksaengri P, Lortholary O.. Control study of oral rehydration solution (ORS)/ORS + dioctahedral smectite in hospitalized Thai infants with acute secretory diarrhea.