• 
• 

Three Part Question

In [an otherwise healthy 18 month child presenting with acute diarrhoea] does the [introduction of yoghurt feeds] aid [recovery]?

Clinical Scenario

An 18 month old child presents to the Emergency Departmentwith diarrhoea following what sounds like an acute episode of gastroenteritis. She is not significantly dehydrated and can tolerate fluids orally. Mum is concerned as the child has an increasingly sore nappy area and because "things just go straight through her". You have heard that live yogourt and probiotics can be helpful and recommend this to the mother. When you mention this to your junior colleagues later they look at you sadly and shake their heads. Self-doubt sets in and you decide to look for the evidence to show them who knows best

Search Strategy

Ovid Medline 1950 - May 2007
[exp Diarrhea OR Diarrhea.mp OR Diarrhoea.mp] AND [Yogurt.mp OR Yogourt.mp]

Search Outcome

71 papers found of which 7 relevant to the clinical question

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Boudraa G 1990 Algeria	45 children aged 3 - 36 months with persistent diarrhoea. Fed milk or yogurt for 5 days	Controlled trial	5% weight loss or diarrhoea at 5 days	42% vs 14% (P < 0.05)	Small numbers
Isolauri E 1991 Finland	71 children aged 4 - 45 months given Lactobacillus casei sp strain CG, Gefilac 125 g fermented milk product bd. Lactobacillus casei sp strain CG freeze dried bd or pasteurised yogurt 125g bd	RCT	Duration of diarrhoea (days)	1.4 (0.8) vs 1.4(0.8) vs 2.4
Bhutta ZA 1992 Pakistan	73 children aged 6 - 36 months with persistent diarrhea given Khitchri (rice-lentil) diet supplemented with yoghurt or soy formula	Controlled trial	Paper awaited
Bourdraa G et al 2001 Algeria	112 children aged 3 - 24 months with acute acute watery diarrhea admitted to the hospital. infant formula (56) vs the same formula fermented with Lactobaccilus bulgaricus and strep thermophilus (56)	RCT	Success rate (cessation of diarrhea and appropriate weight gain at 7 days)	NSD
			persistent diarrhea at 2 says	65% vs 35%
Agarawal KN and Bhasin SK 2002 India	150 patients from hospital and community aged 6 months to 5 years. Fermented milk (Actimel) vs Indian Dahi vs ultra-heat-treated yoghurt	RCT	Decrease in mean duration of diarrhea	0.3 and 0.6 days in groups 1 and 2 vs group 3 (P<0.001)

Comment(s)

There arre a number of studies from around the world that address this issue. Most are small and many use different fermentation agents. The message is, however, consistent

Clinical Bottom Line

Fermented milk products reduce the duration of symptoms in infants with acute non-bloody diarrhoea

Level of Evidence

Level 2 - Studies considered were neither 1 or 3.

References

1. Boudraa G, Touhami M, Pochart P et al Effect of feeding youhurt versus milk in children with persistent diarrhoea J Paed Gastroenterology Nutr 1990;11:509-12
2. Isolauri E, Juntunen M, Rautanen T et al A human Lactobaccilus strain (Lactobaccilus casei sp strain CG) promotes recovery from acute diarrhea in children Pediatrics 1991;88:90-7
3. Bhutta ZA, Molla AM, Issani Z et al Nutitional management of persistent diarrhea: factors predicting clinical outcome Acta Paediatr Suppl 1992;381:144-8
4. Agarwal KN, Bhasin SK, Faridi MM et al Lactocaccilus casei in the control of acute diarrhea - a pilot study Indian Paediatr 2110;38:905-10
5. Boudraa G, Benbouabdellah M, Hachelaf W et al Effect of feeding yoghurt versus milk in children with acute diarrhea and carbohydrate malabsorption J paediatr Gastroenterol 2001;33:307-13
6. Agarwal KN and Bhasin SK Feasibility studies to control acute diarrhea in children by feeding fermented milk preparations Actimel and Indian Dahi European J Clin Nutrit 2002;56 Suppl 4:S56-9
7. Pashapour N and Sariyeh G Evaluation of yogurt effect on acute diarrhea in a 6 - 24 month-old hospitalized infants Turkisk J Paediatr 2006;48:115-8