Abstract
BackgroundThe current paradigm for treating toddler’s diarrhea comprises dietary modification and fluid restriction. Previous studies show that probiotics and proton-pump inhibitors (PPIs) or H2 blockers could control diarrhea associated with functional gastrointestinal disorders (FGIDs). This study aims to determine and compare the efficacy of a short course of oral ranitidine and a probiotic in the treatment of toddler’s diarrhea.MethodsThis study was a parallel-group randomized controlled trial (RCT). We sequentially enrolled 40 patients who met the eligibility criteria. We randomly assigned 20 patients to the oral ranitidine group, ten patients to the probiotic group, and ten patients to the placebo group. In the oral ranitidine group, patients received oral ranitidine (3 mg/kg/day) once daily for 10 days; in the probiotic and placebo groups, they were administered 5 to 10 billion colony-forming units (CFUs) per day of lyophilized Lactobacillus rhamnosus and 50 mg of once-daily oral vitamin C tablet respectively for 10 days. Stool frequency and consistency on the 10th day of the interventions were recorded as the primary outcomes. We used the Student’s t-test to determine if there were significant differences in the mean daily stool frequencies in the three intervention groups. A p-value < 0.05 was adopted as the level of statistical significance.ResultsIn the ranitidine group, stool frequency decreased significantly from an average of five per day on the first day to an average of approximately one per day on the 10th day of intervention (t = 10.462, p < 0.001). Additionally, stool consistency normalized on the 10th day of intervention. In the probiotic group, there was a significant reduction in stool frequency from an average of five per day on the first day to four per day on the 10th day (t = 2.586, p = 0.041), although stool consistency remained loose. However, stool consistency and frequency were not significantly affected in the placebo group (t = 1.964, p = 0.072).ConclusionOral ranitidine is more effective than probiotics in reducing stool frequency and normalizing stool consistency in toddler’s diarrhea. We recommend multi-center trials with appropriate study designs to confirm and validate this finding.Trial registrationISRCTN, ISRCTN10783996. Registered 8 April 2016-Registered retrospectively.
Highlights
The current paradigm for treating toddler’s diarrhea comprises dietary modification and fluid restriction
It has been classified as secretory diarrhea, osmotic diarrhea, inflammatory diarrhea and functional diarrhea
After two parents declined to participate in the trial, 40 participants were randomly assigned to the three intervention groups: 20 to oral ranitidine group, 10 to the probiotic group, and 10 to the placebo group
Summary
The current paradigm for treating toddler’s diarrhea comprises dietary modification and fluid restriction. Toddler’s diarrhea or ‘chronic non-specific diarrhea of childhood’ is a common cause of persistent loose stools in under-five children [1, 2]. It refers to ‘chronic diarrhea lasting more than three weeks in a toddler who has normal anthropometric parameters’ coupled with the absence of fluid and electrolyte imbalance or systemic signs like vomiting and pyrexia [2]. Diarrhea has been grouped into three types: short-duration watery diarrhea (lasting 7 to 14 days), persistent diarrhea (lasting 14 to 30 days), and chronic diarrhea (lasting more than 30 days). It has been classified as secretory diarrhea (involves active secretion of chloride or inhibition of sodium and chloride absorption with concomitant fluid loss), osmotic diarrhea (non-absorbable substrates such as sorbitol or solutes draw fluid into the gut lumen), inflammatory diarrhea (damage to the gut-mucosal lining or brush border results in decreased absorptive capacity of lost protein-rich fluids) and functional diarrhea (no underlying structural or biochemical cause to explain the symptom)
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