Efficacy of glutamine supplementation on the outcome of children admitted with persistent diarrhea to Mulago Hospital

Abstract

Background: Globally, 1.8 million children die annually as a consequence of diarrhea most of these being due to persistent diarrhea. Persistent diarrhea contributes to about 50% of all diarrhea–related mortality even though it represents only about 10% of diarrhea episodes. Most of the mortality and morbidity due to persistent diarrhea is a consequence of the prolonged intestinal injury with consequent increased intestinal permeability, delayed intestinal regeneration and translocation of bacteria into the blood stream. The WHO guidelines attempt to address these problems by recommending nutritional modification, micronutrient supplementation and antibiotic use for the concomitant infections. Glutamine a nonessential amino acid has positive trophic effect on the intestinal mucosa, decrease of intestinal permeability and improvement of intestinal absorption. Glutamine has been shown to improve diarrhea secondary to nelfinavir and chemotherapy use. Where Glutamine was used in ORS, it showed a reduction in the duration of acute diarrhea in children. There is scarcely any published data on the effect of glutamine on persistent diarrhea among children. Objective: To assess the efficacy of oral glutamine supplementation on the proportion of children aged 2 to 60 months who failed to improve while admitted with persistent diarrhea to Mulago hospital. Study design: It was a randomized phase III clinical trial. Methods: One hundred thirty eight children(138) aged 2 months to 60 months with persistent diarrhea presenting to Acute Care Unit were recruited consecutively after consent from care takers. The patients were randomized to receive either standard treatment or standard treatment with Glutamine supplement. Stool analysis was done and the participants were followed up for 12 days. The primary outcome measure was proportion of children who failed to improve compared to those on standard treatment. The secondary outcome measure was the duration of diarrhea in hours from the start of the intervention until the child met the criteria for improvement or cessation of follow up. Study results: One hundred thirty eight children were enrolled into the study. Each treatment arm had 69 participants. The difference in the proportions of children who failed to improve from persistent diarrhea in the glutamine arm compared to standard treatment arm (control) was not statistically significant. (P =0.12). The duration of persistent diarrhea in the treatment arm was 5.0 days (IQR 4-7) versus 5.0 days (IQR 4-7) in the control arm and was not statistically significant (P=0.52). Conclusion: Glutamine supplementation had no effect on the outcome of children admitted with persistent diarrhea.