Evaluation of Gelatin Tannate Against Symptoms of Acute Diarrhea in Pediatric Patients

The health benefits of dietary polyphenols on pediatric intestinal diseases: Mechanism of action, clinical evidence and future research progress

Pediatric intestinal development is immature, vulnerable to external influences and produce a variety of intestinal diseases. At present, breakthroughs have been made in the treatment of pediatric intestinal diseases, but there are still many challenges, such as toxic side effects, drug resistance, and the lack of more effective treatments and specific drugs. In recent years, dietary polyphenols derived from plants have become a research hotspot in the treatment of pediatric intestinal diseases due to their outstanding pharmacological activities such, as anti-inflammatory, antibacterial, antioxidant and regulation of intestinal flora. This article reviewed the mechanism of action and clinical evidence of dietary polyphenols in the treatment of pediatric intestinal diseases, and discussed the influence of physiological characteristics of children on the efficacy of polyphenols, and finally prospected the new dosage forms of polyphenols in pediatrics.

Endogenous humoral determinants of vascular endothelial dysfunction as triggers of acute poisoning complications

The vascular endothelium is not only the semipermeable membrane that separates tissue from blood but also an organ that regulates inflammation, vascular tone, blood clotting, angiogenesis and synthesis of connective tissue proteins. It is susceptible to the direct cytotoxic action of numerous xenobiotics and to the acute hypoxia that accompanies acute poisoning. This damage is superimposed on the preformed state of the vascular endothelium, which, in turn, depends on many humoral factors. The probability that an exogenous toxicant will cause life-threatening dysfunction of the vascular endothelium, thereby complicating the course of acute poisoning, increases with an increase in the content of endogenous substances in the blood that disrupt endothelial function. These include ammonia, bacterial endotoxin, indoxyl sulfate, para-cresyl sulfate, trimethylamine N-oxide, asymmetric dimethylarginine, glucose, homocysteine, low-density and very-low-density lipoproteins, free fatty acids and products of intravascular haemolysis. Some other endogenous substances (albumin, haptoglobin, haemopexin, biliverdin, bilirubin, tetrahydrobiopterin) or food-derived compounds (ascorbic acid, rutin, omega-3 polyunsaturated fatty acids, etc.) reduce the risk of lethal vascular endothelial dysfunction. The individual variability of the content of these substances in the blood contributes to the stochasticity of the complications of acute poisoning and is a promising target for the risk reduction measures. Another feasible option may be the repositioning of drugs that affect the function of the vascular endothelium while being currently used for other indications.

Effect of Two Mucoprotectants, Gelatin Tannate and Xyloglucan plus Gelatin, on Cholera Toxin-Induced Water Secretion in Rats

Background: Newer antidiarrheal agents include the mucoprotectants gelatin tannate and xyloglucan. Methods: Rat models of cholera toxin (CT)-induced water secretion were used to evaluate the mucoprotective effects of gelatin tannate, xyloglucan, and related compounds. Results: Oral pretreatment for 4 days with gelatin tannate (250 and 500 mg/kg/day), but not tannic acid or gelatin (both 125 mg/kg/day), blocked CT-induced intestinal water secretion. CT-induced intestinal water secretion was also attenuated by oral xyloglucan 12.5 mg/kg + gelatin 125 mg/kg (6 h pre-CT) and gelatin 250 mg/kg (12 h pre-CT), and by local (intra-jejunal loop) administration of gelatin, gelatin tannate and xyloglucan concomitantly with CT. Conclusions: Gelatin tannate and xyloglucan + gelatin attenuated CT-induced intra-loop water secretion in this experimental model, supporting previous evidence that their mechanisms of mucosal protection are closely related to their chemical structures, which confer film-forming properties via the formation of mucoadhesive films.

Gut Barrier in Critical States of the Body

The intestinal barrier (IB) is a system of diffusion barriers separating the intestinal chyme and blood. The aim of the review is to identify the role of IB dysfunction in the formation of critical states of the body and to substantiate ways to prevent these states. Toxic substances produced by normal intestinal microflora are characterized. The involvement of endotoxin and ammonia in the pathogenesis of sepsis, acute circulatory disorders, secondary acute pulmonary lesions, and acute cerebral insufficiency is shown. Approaches to protect the IB in critical states of the body are proposed.

Secondary Dysfunction of the Intestinal Barrier in the Pathogenesis of Complications of Acute Poisoning

The last decade has been marked by an exponential increase in the number of publications on the physiological role of the normal human gut microbiota. The idea of a symbiotic relationship between the human organism and normal microbiota of its gastrointestinal tract has been firmly established as an integral part of the current biomedical paradigm. However, the type of this symbiosis varies from mutualism to parasitism and depends on the functional state of the host organism. Damage caused to the organism by external agents can lead to the emergence of conditionally pathogenic properties in the normal gut microbiota, mediated by humoral factors and affecting the outcome of exogenous exposure. Among the substances produced by symbiotic microbiota, there are an indefinite number of compounds with systemic toxicity. Some occur in the intestinal chyme in potentially lethal amounts in the case they enter the bloodstream quickly. The quick entry of potential toxicants is prevented by the intestinal barrier (IB), a set of structural elements separating the intestinal chyme from the blood. Hypothetically, severe damage to the IB caused by exogenous toxicants can trigger a leakage and subsequent systemic redistribution of toxic substances of bacterial origin. Until recently, the impact of such a redistribution on the outcome of acute exogenous poisoning remained outside the view of toxicology. The present review addresses causal relationships between the secondary dysfunction of the IB and complications of acute poisoning. We characterize acute systemic toxicity of such waste products of the normal gut microflora as ammonia and endotoxins, and demonstrate their involvement in the formation of such complications of acute poisoning as shock, sepsis, cerebral insufficiency and secondary lung injuries. The principles of assessing the functional state of the IB and the approaches to its protection in acute poisoning are briefly considered.

Comparison of safety, effectiveness and serum inflammatory factor indexes of Saccharomyces boulardii versus Bifidobacterium triple viable in treating children with chronic diarrhea: a randomized trial

BACKGROUND

Diarrhea is common in children under 5 years of age and is an important public health problem in China. CD is the main obstacle to the growth and development of children, which brings a great burden to individuals, families and society. The objective of this work is to study the efficacy and safety of Saccharomyces boulardii versus Bifidobacterium triple viable in the treatment of CD in children.

METHODS

From October 2018 to October 2020, a total of 161 children aged 2-8 years hospitalized with CD were randomly allocated into S. boulardii group, Bifidobacterium triple viable group and control group. After 14 days of treatment, the curative effect and recovery time of the three groups were evaluated. The levels of serum interleukin (IL)-6, IL-7 and tumor necrosis factor-alpha (TNF-α) before and after the treatment were valuated and compared among the three groups, together with clinical efficacy and safety.

RESULTS

The recovery time of the Bifidobacterium triple viable group was significantly shorter than that of S. boulardii group (P<0.05). The marked effective rate and total effective rate of the Bifidobacterium triple viable group were significantly higher than those of the control group (P<0.05); the total effective rate of the S. boulardii group was significantly higher than that of the control group (P<0.05). The improvement in the levels of IL-6, IL-7 and TNF-α in the Bifidobacterium triple viable group was greater than that in the control group; the improvement in IL-6 and IL-7 levels in the Bifidobacterium triple viable group was greater than that in the S. boulardii group; the improvement in IL-6 and IL-7 levels in the S. boulardii group was greater than that in the control group, and the differences were statistically significant (P<0.05).

CONCLUSIONS

The efficacy of Bifidobacterium triple viable and S. boulardii in the treatment of children with CD was better than that of conventional treatment. The treatment effect for Bifidobacterium triple viable was more significant, and it was proved to be safe, to shorten the course of disease, and have clinical relevance.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2100046444.

Randomized, placebo-controlled trial of xyloglucan and gelose for the treatment of acute diarrhea in children

BACKGROUND

Oral rehydration is the main treatment of acute diarrhea in children. This study was undertaken to evaluate the efficacy and safety of xyloglucan and gelose (agar-agar) plus oral rehydration solution (ORS) compared with placebo and ORS for reduction of acute diarrhea symptoms in children.

METHODS

In a randomized, double-blind, placebo-controlled trial, children with acute gastroenteritis received xyloglucan/gelose plus ORS (n = 50) or placebo plus ORS (n = 50) for 5 days. Demographic, clinical, anthropometric and laboratory parameters were recorded and analyzed.

RESULTS

Xyloglucan/gelose plus ORS reduced the total number of type 7 and 6 stools on the Bristol Stool Form scale (p = 0.040 and p = 0.015, respectively, compared to placebo plus ORS), and had a rapid onset of action, evident 6 hours post-treatment. Xyloglucan/gelose plus ORS also improved associated clinical symptoms (apathy, vomiting, flatulence, and blood in stool). compared with placebo plus ORS. Except for a generalized rash of unknown causality in a patient receiving placebo plus ORS, all other adverse events (dehydration, n = 7, cough, n = 1, exacerbation of vomiting, n = 1) were deemed unrelated to study medication.

CONCLUSIONS

Xyloglucan/gelose plus ORS was effective and safe in treating acute diarrhea in children.

Medical devices that look like medicines: safety and regulatory concerns for children in Europe

INTRODUCTION

Medical devices (MedDevs) and medicines are assessed (and monitored) differently before and after launch. There are products for repeated oral ingestion that are marketed in the European Union as MedDevs.

OBJECTIVES AND METHODS

To illustrate the consequences of these differences in assessment, we compared the leaflet information of three MedDevs with the standards for medicines and with published evidence at launch. As examples, gelatin tannate (GT), its combination with tyndalised probiotics (TP) (GTTP) for diarrhoea and a gel containing hyaluronic acid (HA)/chondroitin sulfate (CS)/poloxamer (Pol407) (HACSPol) for gastro-oesophageal reflux disease were examined.

RESULTS

Applying standards for medicines, product composition is insufficiently defined in the MedDev leaflet (eg, plant origin, polymerisation grade, dose and ratio of the relevant constituents). As no age limit is mentioned in the leaflets, all 3 products allow use in children from birth onwards, although published clinical documentation in children was poor (GT) or lacking (GTTP and HACSPol). MedDev leaflets do not mention adverse events (AEs), while literature search suggests safety concerns such as tannic acid (TA) cytotoxicity, potentially more diarrhoea/AEs with TP, use of doses higher than established safe (TA and HA) and lack of chronic toxicity studies for oral Pol407. None refers to interactions with medicines, although some ingredients may affect medicine absorption.

CONCLUSION

Although these MedDevs require repeated oral intake as do medicines, their assessment and monitoring differ significantly from the standards for medicines. Compared with medicines, MedDevs for repeated oral use are poorly labelled and rely on very limited clinical information at market release.

Gelatin tannate versus other antidiarrheal medication in children with acute gastroenteritis: a retrospective, observational study

AIM

To evaluate the effectiveness and safety of gelatin tannate (GT) for acute gastroenteritis (AGE) in children.

MATERIALS & METHODS

In this retrospective, observational study, children admitted for AGE received GT ± oral rehydration solution (ORS; n = 46) or other antidiarrheal medications ± ORS (n = 46). Number and consistency of stools were recorded.

RESULTS

Children were aged 6 months to 7.9 years. GT ± ORS reduced diarrhea duration (29.0 vs 45.4 h, p < 0.0001) and normalized stool consistency at 72 h in significantly more patients (87.0 vs 30.4%; p = 0.026) compared with other antidiarrheal medications ± ORS. Differences in favor of GT were apparent from 12 h onward.

CONCLUSION

GT is more effective than conventional treatment for managing AGE in children.

Efficacy of gelatin tannate for acute diarrhea in children: a systematic review and meta-analysis

AIM

To investigate by meta-analysis the efficacy of gelatin tannate (GT), a mucosal barrier protector, in children with acute gastroenteritis.

METHODS

A comprehensive literature search was conducted. Studies were selected according to PICO: Participants: children aged 0-12 years with acute diarrhea; Intervention: GT; Comparison: oral rehydration solution and/or placebo; Outcomes: diarrhea-related outcomes.

RESULTS

Three published randomized controlled trials were identified of pediatric diarrhea treated with GT (n = 203) or control (n = 204). GT significantly (p < 0.01) reduced stool frequency at 12 h in two randomized controlled trials. A significant treatment effect (risk ratio = 0.74; p < 0.01) in favor of GT was found for the exploratory composite outcome of 'diarrhea or liquid stools at 24 h' in three studies. Risk ratios in a single study which reported the percentage of patients with liquid stools at 12, 24 and 48 h favored GT at all time points. No significant differences were found between GT and control for patients with diarrhea at 12 or 24 h or for duration of diarrhea.

CONCLUSION

GT improved stool frequency and stool consistency in children with acute diarrhea, although further well-controlled studies would be useful to confirm a beneficial treatment effect.

Gelatine tannate in the management of acute gastroenteritis in children: a randomised controlled trial

OBJECTIVE

To assess the efficacy of gelatine tannate (a complex of tannic acid with astringent and anti-inflammatory properties, and a protective gelatine) for the treatment of acute gastroenteritis (AGE) in children.

DESIGN

Randomised, double-blind, placebo-controlled trial. Intention-to-treat analysis.

SETTING

Two paediatric hospitals in Warsaw.

PARTICIPANTS

Children younger than 5 years of age with AGE, defined as a change in stool consistency to a loose or liquid form (according to the Bristol Stool Form Scale or Amsterdam Stool Form Scale) and/or an increase in the frequency of evacuations (≥3 in 24 hours), lasting for no longer than 5 days.

INTERVENTIONS

Seventy-two children were assigned to receive gelatine tannate (n=36) or placebo (n=36) in addition to standard rehydration therapy. The gelatine tannate was administered at an age-dependent dose (250-500 mg), and both study products were taken four times per day for 5 days.

PRIMARY AND SECONDARY OUTCOME MEASURES

The main outcome measure was duration of diarrhoea. Secondary outcomes included the need for intravenous rehydration, need for hospitalisation of outpatients, number of watery stools per day, vomiting, weight gain, adverse events, recurrence of diarrhoea, severity of diarrhoea according to the Vesikari Scale and use of concomitant medications.

RESULTS

Sixty-four children (89%) completed the intervention and were included in the analysis. The duration of diarrhoea after randomisation was similar in the gelatine tannate and placebo groups (75.6±27.8 vs 75.5±29.0 hours, respectively, mean difference 0.1 hours, 95% CI -14.1 to 14.3 hours). There was no significant difference between groups in the number of watery stools per day throughout the study period. There were also no differences in any other secondary outcome measures between groups.

CONCLUSION

In children with AGE younger than 5 years of age, gelatine tannate was ineffective as an adjunct to rehydration therapy.

TRIAL REGISTRATION NUMBER

NCT02280759.