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Three Part Question

In [children with diarrhoea] is [diet contains banana] helps [reducing the symptoms]?

Clinical Scenario

While working in paediatric ED, you heard a paediatric colleague giving dietary advice to parents of a child with diarrhoea. He mentioned the use of banana in the diet to reduce the symptoms of diarrhoea. You wonder whether banana helps in recovery or not.

Search Strategy

Medline and Embase using National library of health interface

Medline: [exp diarrhea/ OR exp gastroenteritis/ OR diarrhoea.ti, ab OR diarrhea.ti, ab] AND [banana.ti, ab OR exp musa/] LIMIT to human AND English
Embase: [exp diarrhea/ OR exp gastroenteritis/ OR diarrhoea.ti, ab OR diarrhea.ti, ab] AND [banana.ti, ab OR exp musa/] LIMIT to human AND English.

Search Outcome

Medline 14, Embase 19 papers found till 11/08. Duplicate filtered 26 unique results found. After screening of abstracts and review of various articles, two were relevant to the clinical question.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Emery EA; Ahmad S; Koethe JD; Skipper A; Perlmutter S; Paskin DL April 1997. USA	31 critically ill tube fed patients randomized in to two groups. A-medical management 17 [51-87 years], B-banana flake management 14[41-78yrs]	Randomized Trial	Diarrhea score	Day7 16.50±12.12 vs. 2.00±3.46, over the course of treatment 25.41±9.76 vs. 21.64±7.81	Small numbers. No blinding
			% patients on last day without diarrhea	24% vs. 57%
			Cost per day	Banana $0.96 vs. loperamide $ 1.20 vs. kaolin $1.56 vs. cholestyramine $3.21
Rabbani GH. Sept 2001. Bangladesh.	62 boys [age 5-12 months] with persistent diarrhoea [>14 days] randomise into three treatment groups for 7 days: rice based banana [22], rice based pectin [19], and rice based diet alone	RCT double blinded	Stool weight	Day3-7, 50-60% reduction in stool weight[banana or pectin] p<0.01	Small numbers. Only boys included in the study. Poor data collection regarding stool pathogens.
			Stool consistency [formed stools]	Day3 59%vs55%vs15% Day 4:82% vs78% vs. 23% p<0.001
			Stool frequency	Decreased with banana or pectin (2±2 vs. 3±2 vs. 6±3) p<0.05
			Frequency of vomiting	Decreased with banana or pectin (3.6 ± 1.0 vs. 2.9±0.8 vs. 7.0±2.0) p<0.05
			Duration of diarrhoea	Decreased with banana or pectin 4.0±1.0 vs. 4.2±1.1 vs. 8.9±2.6; p<0.05

Comment(s)

NB Does banana have more pectin than other fruit? Banana contains pectin, which is fermented by colonic bacteria into short chain fatty acids (SCFA). These SCFA promote sodium and water absorption, exert a trophic effect on the colon by increasing blood flow, stimulating release of enteroglucagon. It also increases small intestinal permeability by decreasing lactulose-mannitol [L/M] ration in urine. No side effects including hyperkalemia were noted in these studies. Banana based feeding for children with an acute diarrhoeal illness could be further assessed.

Clinical Bottom Line

There are no published data that answer whether banana could be used to reduce diarrhoeal symptoms in an emergency department population.

References

1. Emery EA; Ahmad S; Koethe JD; Skipper A; Perlmutter S; Paskin DL Banana flakes control diarrhea in enterally fed patients. Nutrition in Clinical Practice, April 1997 April 1997, vol. /is. 12/2(72-5, 0884-5336
2. Rabbani GH; Teka T; Zaman B; Majid N; Khatun M; Fuchs GJ Clinical studies in persistent diarrhea: dietary management with green banana or pectin in Bangladeshi children Gastroenterology, September 2001 September 2001, vol. /is. 121/3(554-60), 0016-5085