Starch containing formulations for diarrhoea therapy


      • Starch in oral rehydration solution.
      • Diarrhoea therapy using alpha-glucans.
      • Sodium absorption facilitated by alpha-glucans.


      Diarrhoea therapies in general include a number of approaches (depending on local practise and the cause of the diarrhoea) aimed at: (i) removing the cause (e.g. lactose in the diet); (ii) treating the cause of infection if present (e.g. antibiotics); (iii) reducing the effect of the cause (e.g. adsorbent); (iv) depressing gastric motility and secretions (e.g. various drugs); (v) probiotic bacteria with perhaps prebiotic energy sources and most importantly of all (vi) rehydration using rehydration salt solutions (oral rehydration therapy, ORT, using oral rehydration solutions, ORS). Glucose has been included in ORS formats for rapidly available energy since ORS formats were developed initially– but has the disadvantage of a high osmotic pressure. It is used in modern ORS formats to promote sodium absorption, however. The use of α-glucans (glucose containing oligo- or polysaccharides) in ORS formats is gaining ground in terms of utilisation for diarrhoea – a fairly recent approach to therapy in the western world. The use of different α-glucans in ORS formulations is discussed and strategies for the development further of therapies is investigated. This review is aimed at the scientific and medical communities.



      AMP (adenosine monophosphate), ORS (oral rehydration solution), ORT (oral rehydration therapy), SGLTs (sodium dependent glucose transporters), SCFAs (short chain fatty acids), WHO (World Health Organisation)
      To read this article in full you will need to make a payment


      1. World Health Organisation (WHO). 2017
        • Aranda-Michel J.
        • Giannella R.A.
        Acute diarrhoea: a practical review.
        Am J Med. 1999; 106: 670-676
        • Sweetser S.
        Evaluating the patient with diarrhoea: a case-based approach.
        Mayo Clin Proc. 2012; 87: 596-602
        • Faure C.
        Role of anti-diarrhoeal drugs as adjunctive therapies for acute diarrhoea in children.
        Int J Pediatr. 2013; (14 pages)612403
        • Banks M.
        • Farthing M.
        Acute diarrhoea: recommended management in general practice.
        Prescriber. 2006; 17: 55-64
        • Barrett J.
        • Brown M.
        Travellers' diarrhoea.
        Br Med J. 2016; 353: i1937
        • Duplessis C.A.
        • Gutierrez R.L.
        • Porter C.K.
        Review: chronic and persistent diarrhoea with a focus in the returning traveller.
        Trop Dis Travel Med Vaccines. 2017; 3: 1-17
        • Hill D.R.
        • Ryan E.T.
        Management of travellers' diarrhoea.
        Br Med J. 2008; 337: a1746
        • Barrett J.
        • Brown M.
        Diarrhoea in travellers.
        Med. 2018; 46: 24-29
        • Riddle M.S.
        • DuPont H.L.
        • Connor B.A.
        ACG clinical guideline: diagnosis, treatment, and prevention of acute diarrhoeal infections in adults.
        Am J Gastroenterol. 2016; 111: 602-622
        • Pietrusco R.G.
        Drug therapy reviews: pharmacotherapy of diarrhoea.
        Am J Hosp Pharm. 1979; 36: 757-767
        • Casburn-Jones A.C.
        • Farthing M.J.G.
        Management of infectious diarrhoea.
        Gut. 2004; 53: 296-305
        • Munos M.K.
        • Fischer-Walker C.L.
        • Black R.E.
        The effect of oral rehydration solution and recommended home fluids on diarrhoea mortality.
        Int J Epidemiol. 2010; 39: 75-87
        • Holzer P.
        Opioid receptors in the gastrointestinal tract.
        Regul Pept. 2009; 155: 11-17
        • Holzer P.
        Pharmacology of opioids and their effects on gastrointestinal function.
        Am J Gastroenterol Suppl. 2014; 2: 9-16
        • Sobczak M.
        • Sałaga M.
        • Storr M.A.
        • Fichna J.
        Physiology, signalling, and pharmacology of opioid receptors and their ligands in the gastrointestinal tract: current concepts and future perspectives.
        J Gastroenterol. 2014; 49: 24-45
        • Tester R.F.
        • Karkalas J.
        • Qi X.
        Starch – composition, fine structure and architecture.
        J Cereal Sci. 2004; 39: 151-165
        • Pérez S.
        • Bertoft E.
        The molecular structures of starch components and their contribution to the architecture of starch granules: a comprehensive review.
        Starch Staerke. 2010; 62: 389-420
        • Waterschoot J.
        • Gomand S.V.
        • Fierens E.
        • Delcour J.A.
        Production, structure, physicochemical and functional properties of maize, cassava, wheat, potato and rice starches.
        Starch Staerke. 2015; 67: 14-19
        • Qi X.
        • Tester R.F.
        Effect of native starch granule size on susceptibility to amylase hydrolysis.
        Starch Staerke. 2016; 68: 807-810
        • Qi X.
        • Tester R.F.
        Effect of composition and structure of native starch granules on their susceptibility to hydrolysis by amylase enzymes.
        Starch Staerke. 2016; 68: 811-815
        • Bertoft E.
        Understanding starch structure: recent progress.
        Agronomy. 2017; 7: 1-29
        • Qi X.
        • Tester R.F.
        Is starch or maltodextrin ‘glucose’?.
        Starch Staerke. 2018; (1700304)
        • Qi X.
        • Tester R.F.
        Heat and moisture modification of native starch granules on susceptibility to amylase hydrolysis.
        Starch Staerke. 2016; 68: 816-820
        • Allen S.J.
        • Martinez E.G.
        • Gregorio G.V.
        • Dans L.F.
        Probiotics for treating acute infectious diarrhoea (Review).
        Evid Base Child Health. 2011; 6: 1894-2021
        • Yang X.
        • Darko K.O.
        • Huanga Y.
        • He C.
        • Yang H.
        • He S.
        • et al.
        Resistant starch regulates gut microbiota: structure, biochemistry and cell signalling.
        Cell Physiol Biochem. 2017; 42: 306-318
        • Niba L.L.
        Resistant starch: a potential functional food ingredient.
        Nutr Food Sci. 2002; 32: 62-67
        • Cooke C.
        • Carr I.
        • Abrams K.
        • Mayberry J.
        Arrowroot as a treatment for diarrhoea in irritable bowel syndrome patients: a pilot study.
        Arq Gastroenterol. 2000; 37: 20-24
        • Rabbani G.H.
        • Teka T.
        • Zaman B.
        • Majid N.
        • Khatun M.
        • Fuchs G.J.
        Clinical studies in persistent diarrhoea: dietary management with green banana or pectin in Bangladeshi children.
        Gastroenterol. 2001; 121: 554-560
        • Gregorio G.V.
        • Gonzales M.L.M.
        • Dans L.F.
        • Martinez E.G.
        Polymer-based oral rehydration solution for treating acute watery diarrhoea (Review).
        Cochrane Database Syst Rev. 2016; 12: CD006519
        • Kühn J.
        • Finger F.
        • Bertuzzo E.
        • Borgeaud S.
        • Gatto M.
        • Rinaldo A.
        • et al.
        Glucose - but not rice-based oral rehydration therapy enhances the production of virulence determinants in the human pathogen Vibrio cholerae.
        PLoS Neglected Trop Dis. 2014; 8: e3347
        • Ramakrishna B.S.
        • Subramanian V.
        • Mohan V.
        • Sebastian B.K.
        • Young G.P.
        • Farthing M.J.
        • et al.
        A randomised controlled trial of glucose versus amylase resistant starch hypo-osmolar oral rehydration solution for adult acute dehydrating diarrhoea.
        PLoS One. 2008; 3: e1587
        • Binder H.J.
        • Brown I.
        • Ramakrishna B.S.
        • Young G.P.
        Oral rehydration therapy in the second decade of the twenty-first century.
        Curr Gastroenterol Rep. 2014; 16: 376
        • Binder H.J.
        Role of colonic short-chain fatty acid transport in diarrhoea.
        Annu Rev Physiol. 2010; 72: 297-313
        • Brandt K.G.
        • de Castro Antunes M.M.
        • da Silva G.A.P.
        Acute diarrhoea: evidence-based management.
        J Pediatr (Rio J). 2015; 91: S36-S43
        • Ramakrishna B.S.
        • Venkataraman S.
        • Srinivasan P.
        • Dash P.
        • Young G.P.
        • Binder H.J.
        Amylase-resistant starch plus oral rehydration solution for cholera.
        N Engl J Med. 2000; 342: 308-313
        • Donowitz M.
        • Alpers D.H.
        • Binder H.J.
        • Brewer T.
        • Carrington J.
        • Grey M.J.
        Translational approaches for pharmacotherapy development for acute diarrhoea.
        Gastroenterol. 2002; 142: e1-e9
        • Rao M.C.
        Oral rehydration therapy: new explanations for an old remedy.
        Annu Rev Physiol. 2004; 66: 385-417
        • Nutrition Information Centre University of Stellenbosch (NICUS)
        Diet and Diarrhoea: which supplements can be used in community acquired infectious diarrhoea in children?.
        S Afr Fam Pract. 2005; 47: 44-47
        • Hoque K.M.
        • Binder H.J.
        Zinc in the treatment of acute diarrhoea: current status and assessment.
        Gastroenterol. 2006; 130: 2201-2205
        • Raghupathy P.
        • Ramakrishna B.S.
        • Oommen S.P.
        • Ahmed M.S.
        • Priyaa G.
        • Dziura J.
        • et al.
        Amylase-resistant starch as adjunct to oral rehydration therapy in children with diarrhoea.
        J Pediatr Gastroenterol Nutr. 2006; 42: 362-368
        • McMahan Z.H.
        • DuPont H.L.
        Review article: the history of acute infectious diarrhoea management – from poorly focused empiricism to fluid therapy and modern pharmacotherapy.
        Aliment Pharmacol Ther. 2007; 25: 759-769
        • Kelly P.
        Infectious diarrhoea.
        Med. 2015; 43: 253-258
        • Thorens B.
        • Mueckler M.
        Glucose transporters in the 21st century.
        Am J Physiol Endocrinol Metab. 2010; 298: E141-E145
        • Augustin R.
        • Mayoux E.
        Mammalian sugar transporters.
        in: Szablewski L. Glucose homeostasis. InTech, 2014: 3-36