Abstract
Context: Chronic nonspecific diarrhea in children, also known as toddler's diarrhea, is a frequently encountered disorder in clinical practice. It tends to cause significant parental anxiety and frustration leading to frequent health care visits.
Objective: We investigated the usefulness of sacrosidase (Sucraid®) in children with toddler's diarrhea. The primary outcome was the proportion of patients who responded to sacrosidase supplementation. Secondary outcome measures included safety and potential adverse effects.
Population: Children 1 to 6 years of age with a current history of toddler's diarrhea (≥ 3 loose stools per day for ≥ 3 months) were enrolled in a prospective trial from our outpatient specialty clinic. Exclusion criteria included a history consistent with infection, inflammation, malnutrition or the use of motility altering agents. Patients were also excluded if they had abnormal screening tests including the presence of anemia, elevated inflammatory markers, positive celiac disease antibodies or infectious stool studies.
Design: Baseline defecation patterns (stool frequency and consistency) were obtained using daily diaries filled by caregivers over 1 week prior to any intervention. Patients with baseline defecation patterns that satisfied the definition of toddler's diarrhea (≥ 3 stools daily) were placed on sacrosidase supplementation with all snacks and meals. Caregivers filled similar daily diaries for 2 weeks. We defined clinical response as a decrease in daily stool frequency by 50% and/or a decrease of ≥ 2 points on the stool consistency scale while on sacrosidase supplementation.
Results: Between September 2005 and July 2006, 37 children presented for evaluation of diarrhea, of which 20 were eligible for the study. Of those eligible, 12 were enrolled (average age 31.6 months, range 41 to 23 months). One subject was excluded from analysis for noncompliance and three subjects were not kept in the study due to normal defecation patterns in the baseline period. Four of the remaining eight patients (50%) who finished the study were clinical responders. In the responder group, the average daily stool frequency decreased from 5.2 to 1.9 and the stool consistency scale decreased from a mean of 4.5 to 2.5 points. In the non-responder group, the average daily stool frequency and stool consistency remained unchanged. There were no complications reported.
Conclusions: Sacrosidase supplementation demonstrated a potential benefit in children with toddler's diarrhea by decreasing defecation frequency and improving stool consistency. This may be due to excessive sucrose in children's diet or to unrecognized partial sucrase deficiency. A larger scale study with longer patient follow up is needed to further assess the benefit of such an intervention.
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Hattar, L., Bishop, W. & Rahhal, R. 43 Sacrosidase in the Treatment of Chronic Nonspecific Diarrhea in Children.. Pediatr Res 60, 497 (2006). https://doi.org/10.1203/00006450-200610000-00065
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DOI: https://doi.org/10.1203/00006450-200610000-00065