Editor's Choice

Abstract

Eating marshmallows reduces ileostomy output: A randomised crossover trial. Clarebrough E, Guest G, Stupart D. 1 The management of the high output ileostomy remains a challenge – the review by Baker et al in this journal in 2011 remains one of our most downloaded and most cited papers. Some treatments undoubtedly have an excellent evidence base, whereas others have become ingrained within the everyday practice of our specialty but are based on little more than anecdote and folklore. Critically appraising the information given to patients with ostomies for their accuracy is every bit as important as the readability. When evidence is lacking to support the statements made, what should we do? Clarebrough et al have provided the answer – perform the study to answer the question and help eliminate uncertainty. Marshmallows (and related gelatin containing products) have often been advocated by stoma care nurses, gastroenterologists and colorectal surgeons alike. Clarebrough et al designed a randomised crossover trial to assess the effect of marshmallows on stoma output. Importantly, they assessed not only the volume of stoma output but also the patient centred outcomes of number of bag changes and subjective questionnaire assessment of qualitative effluent changes and acceptability for future use. Marshmallows did reduce stoma output, albeit only by a median of 75 ml and the clinical utility of this is uncertain. Perhaps more importantly marshmallows reduced the number of bag changes per day from a median of six to five. What may perturb some is that only seven out of the 28 patients who completed the trial were taking regular antidiarrhoeal medication. Regular loperamide may be far more effective than marshmallow ingestion and better for dental health too. The relatively low proportion of patients taking loperamide may reflect differences in healthcare systems. Nevertheless, we may now have greater confidence when giving dietary advice to reduce stoma output to patients with ileostomies.