“Feeding the gut”: The scientific basis for continued enteral nutrition during acute diarrhea

Abstract

The development of oral rehydration solutions for the treatment of diarrheal diseases stands as a monumental scientific achievement and perhaps the finest broadly applicable example of collaboration between basic and applied biomedical research. 1 Anonymous Water with sugar and salt [editorial]. Lancet. 1978; 2: 300-301 PubMed Google Scholar Laboratory and animal models in the 1950s and 1960s delineated the process of molecular cotransport across the gastrointestinal epithelia and paved the way for clinical studies that documented the persistence of this mechanism in diarrhea. 2 Hirschhorn N The treatment of acute diarrhea in children: an historical and physiological perspective. Am J Clin Nutr. 1980; 33: 637-663 PubMed Google Scholar After landmark studies in Dhaka and Calcutta demonstrated the efficacy of ORS in severe diarrhea such as cholera, 3 Nalin D Cash R Islam R et al. Oral maintenance therapy for cholera in adults. Lancet. 1968; 2: 370-372 Abstract PubMed Google Scholar , 4 Pierce N Banwell J Mitra R et al. Effect of intragastric glucose-electrolyte infusion upon water and electrolyte balance in Asiatic cholera. Gastroenterology. 1968; 55: 333-342 Abstract Full Text PDF PubMed Google Scholar trials confirming its efficacy in non-cholera diarrhea and in pediatric patients quickly followed. ORS was soon adopted by the World Health Organization and the United Nations Children's Fund as a major weapon in child survival programs, and, although recent attempts to improve the composition of ORS have been made, 5 Gore SM Fontaine O Pierce NF Impact of rice based oral rehydration solution on stool output and duration of diarrhoea: meta-analysis of 13 clinical trials. BMJ. 1992; 304: 287-291 Crossref PubMed Scopus (169) Google Scholar , 6 Anonymous Multicentre evaluation of reduced-osmolarity oral rehydration salts solution. International Study Group on Reduced-osmolarity ORS solutions. Lancet. 1995; 345: 282-285 Crossref PubMed Scopus (120) Google Scholar ORS continues to be the cornerstone for successful case management of diarrheal diseases.