Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 29  |  Issue : 1  |  Page : 95-99

Bovine colostrum versus prebiotics in children with acute gastroenteritis


Department of Pediatrics, Faculty of Medicine, Menoufia University, Menoufia, Egypt

Date of Submission09-Nov-2014
Date of Acceptance06-Mar-2015
Date of Web Publication18-Mar-2016

Correspondence Address:
Mohammed S Mahmoud Abd El Bary
Meet El Ezz, Quesna, Menoufia
Egypt
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.178994

Rights and Permissions
  Abstract 

Objective
The aim of the study was to compare the effect of bovine colostrum with that of prebiotics in children with acute gastroenteritis.
Background
Gastroenteritis is a major global problem and affects infants in both developing and developed countries. Viral infection is the most common cause of gastroenteritis. Rotavirus is the most common virus causing gastroenteritis in children. It accounts for significant morbidity and mortality in children younger than 5 years of age. It is estimated that 3-5 billion cases of gastroenteritis occur globally on an annual basis, primarily affecting children and those in the developing world. It resulted in about 1.3 million deaths in children younger than 5 years as of 2008.
Patients and methods
Two hundred children aged 1-5 years were prospectively included in this study. They were divided into four groups: group 1 included 50 children who received prebiotics (lactobacillus LB) one sachet twice daily for 5 days along with traditional medications (oral rehydration salts (ORS), intravenous fluids, and symptomatic treatment). Group 2 included 50 children who received one sachet of the first 6 h bovine colostrum once daily for 5 days along with traditional medications. Group 3 included 50 children who received prebiotic and bovine colostrum plus traditional medications. Group 4 included 50 children who received traditional medications only. All patients were compared with respect to the following: hospital stay, number of diarrheal and vomiting attacks before and after treatment, intravenous fluid therapy before and after treatment, any other complication during the course of the disease (central nervous system and chest complications), laboratory investigations, and associated symptoms (fever, headache, anorexia, malaise).
Results
In this study we found that the group that received prebiotic and bovine colostrum had better results than the other groups in terms of duration of hospital stay, number of diarrheal and vomiting attacks, degree of dehydration, electrolyte disturbance, rehydration method, and associated complications. No significant difference was seen among the groups regarding pretreatment clinical status.
Conclusion
Early use of both bovine colostrum and prebiotics in children with acute gastroenteritis decreases the duration of hospital stay, the number of vomiting and diarrheal attacks, the degree of dehydration, intravenous fluid therapy, electrolyte disturbance, and associated complications.

Keywords: Acute gastroenteritis, bovine colostrum, lactobacillus LB, prebiotics


How to cite this article:
El Mashad GM, Abd El Naby SA, Mahmoud Abd El Bary MS. Bovine colostrum versus prebiotics in children with acute gastroenteritis. Menoufia Med J 2016;29:95-9

How to cite this URL:
El Mashad GM, Abd El Naby SA, Mahmoud Abd El Bary MS. Bovine colostrum versus prebiotics in children with acute gastroenteritis. Menoufia Med J [serial online] 2016 [cited 2019 Sep 20];29:95-9. Available from: http://www.mmj.eg.net/text.asp?2016/29/1/95/178994


  Introduction Top


Gastroenteritis is a medical condition that results in some combination of diarrhea, vomiting, abdominal pain, and cramping [1]. Colostrum is the fluid that new mothers' breasts produce during the first day or 2 after birth. It gives newborn infants a rich mixture of antibodies and growth factors that help them get a good start [2]. Although colostrum has been available since the first mammals walked the earth, it is relatively new as a nutritional supplement. Prebiotics are nondigestible food ingredients that stimulate the growth and/or activity of bacteria in the digestive system in ways claimed to be beneficial to health. They were first identified and named by Marcel Roberfroid in 1995 [3]. The aim of the study was to compare the effects of bovine colostrum and those of prebiotics in children with acute gastroenteritis. There are recent studies suggesting that prebiotics may act directly in the intestinal lumen to help protect the gut from infection, inflammation, and diarrhea [4]. The best example of this direct effect is the inhibition of pathologic bacteria adherence by certain oligosaccharides. Clinical research revealed that a high percentage of the antibodies and immunoglobulins present in colostrum are believed not to be absorbed but remain in the intestinal tract, where they attack disease-causing organisms before they penetrate the body and cause disease. The remainder is believed to be absorbed and distributed to assist in our internal defense processes. Thus, this is the combination of actions that is believed to make colostrum so unique and effective as an oral supplement [5].


  Patients and methods Top


Two hundred children aged 1-5 years (as diarrheal diseases cause more morbidity and mortality at this age range) were prospectively included in this study, which was conducted at the Pediatrics Department of Quesna Central Hospital between April 2013 and August 2013. Of the 200 infants, 110 were from rural areas and 90 were from urban areas. They were divided into four groups: group 1 included 50 children who received prebiotics (lactobacillus LB one sachet twice daily for 5 days) along with traditional medications (ORS, intravenous fluids, and symptomatic treatment). Group 2 included 50 children who received one sachet of the first 6 h bovine colostrum once daily for 5 days along with traditional medications. Group 3 included 50 children who received prebiotic and bovine colostrum along with traditional medications. Group 4 included 50 children who received traditional medications only. All patients were subjected to detailed medical history evaluation thorough clinical examination, with especial emphasis on duration of hospital stay, number of diarrheal and vomiting attacks before and after treatment, intravenous fluid therapy before and after treatment, any other complications during the course of the disease [central nervous system (CNS) and chest complications], laboratory investigations (serum Na and K), stool analysis, CBC, CRP serum urea and creatinine, and associated symptoms (fever, headache, anorexia, malaise).

Inclusion criteria

Infants and young children aged 1-5 years with acute diarrhea (lasting <14 days) due to gastroenteritis, alone or with vomiting, were eligible for inclusion in this study.

Exclusion criteria

  1. Age less than 1 year or more than 5 years.
  2. Chronic diarrhea and vomiting.
  3. Presence of disorders other than gastroenteritis that cause diarrhea or vomiting (e.g. specific food intolerance, inflammatory bowel disease, or protozoal gastroenteritis).
  4. Medical disorders that significantly alter the approach to fluid management, such as those with cardiac or renal failure.


Written informed consent was taken from mothers or from both parents for adding prebiotics and/or bovine colostrum as a line of treatment besides traditional treatment. Possible side effects or benefits were discussed and clarified. Contact numbers of the researcher were available for any enquiries.

Statistical analysis

Statistical analysis was carried out with statistical package for social the sciences (SPSS, version 16; SPSS Inc., Chicago, Illinois, USA). The various parameters were compared within subgroups as well as with controls. The independent t-test was performed for values that followed a normal distribution and the Mann-Whitney test for parameters that were non-normally distributed. P values less than 0.05 were considered significant and P values less than 0.01 were considered highly significant in all analyses.


  Results Top


No significant difference was seen among groups with regard to demographic data. Both the prebiotic and the bovine colostrum group had a significantly lower percentage of associated complications. No significant difference was seen among groups with respect to pretreatment clinical status. When considering the prebiotic and bovine colostrum groups together, the mean duration of hospital stay was 3.4 ± 1.0 days and the mean number of post-treatment diarrheal and vomiting attacks per day was 0 ± 0. In the prebiotic group, the mean duration of hospital stay was 4.4 ± 1.0 days and the mean number of post-treatment diarrheal and vomiting attacks per day was 1 ± 0. In the bovine colostrum group, the mean duration of hospital stay was 6.0 ± 1.4 days and the mean number of post-treatment diarrheal and vomiting attacks per day was 1 ± 1. In the traditional group, the duration of hospital stay was 7.8 ± 1.2 days, the mean number of post-treatment diarrheal attacks per day was 3 ± 0, and the mean number of post-treatment vomiting attacks per day was 2 ± 0 [Table 1],[Table 2],[Table 3],[Table 4] and [Table 5].
Table 1: Demographic data of the studied groups

Click here to view
Table 2: Pretreatment clinical status in the studied groups

Click here to view
Table 3: Post-treatment clinical outcomes in the studied groups

Click here to view
Table 4: Associated complications in the studied groups

Click here to view
Table 5: Post-treatment rehydration method in the studied groups

Click here to view



  Discussion Top


Gastroenteritis is inflammation of the gastrointestinal tract that involves both the stomach and the small intestine resulting in a combination of diarrhea and vomiting. The aim of the study was to compare the effect of bovine colostrum with that of prebiotics in children with acute gastroenteritis.

In this study there was no significant difference among the groups with respect to demographic data. These results are consistent with those of DeCamp et al. [6] use of antiemetic agents in acute gastroenteritis: a systematic review and meta-analysis, but in contrast to those of Grimwood and Forbes [7] 'acute and persistent diarrhea'.

In this study it was found that bovine colostrum decreased the duration of hospital stay to about 6 days in cases of acute attack, to 4 days in the group that received prebiotics, to 3 days in the group that received both colostrum and prebiotics, and to 8 days in the group that received only traditional medication.

These results are similar to those of Rawal et al. [8] who conducted a study on 605 children (1-8 years) having recurrent episodes of upper respiratory tract infections or diarrheal infections and who received bovine colostrum. They found that bovine colostrum was highly effective in reducing the hospitalization period compared with the placebo group.

It was found that prebiotics reduce the duration of hospital stay. These results are consistent with those of Waligora-Dupriet et al. [9], who showed the effect of oligofructose supplementation on gut microflora and well-being in young children attending a daycare center. A mean intake of 1.2 g/day of oligofructose for 6 months resulted in adequate growth and a reduction in daycare absenteeism.

In this study it was found that the frequency of diarrheal attacks was reduced to one attack per day in the group that received prebiotics, to one attack per day in the group that received bovine colostrum, to no attack per day in the group that received both prebiotics and bovine colostrum, and to three attacks per day in the group that received traditional medications. These results are consistent with those of Huppertz et al. [10] who conducted a study on 40 children with diarrhea caused by diarrheagenic Escherichia coli. They found that stool frequencies in the group treated with bovine colostrum were significantly reduced compared with those in the placebo group.

However, in the double-blind trial performed by Ylitalo et al. [11] on 135 children the researchers found that colostrum prepared by immunizing cows with a monkey form of rotavirus was not effective for treating rotavirus. The difference between these results may lie in the level and type of antibodies found in the particular colostrum used.

These results are also similar to those of the randomized controlled study performed by Bakker-Zierikzee et al. [12] who investigated the effect of the same prebiotic mixture on fecal serum immunoglobulin A (SIgA) secretion in infants. The prebiotic-supplemented infant formula (90% galacto-oligosaccharides/10% long-chain oligofructose) resulted in an enhanced secretion of fecal SIgA, which is considered to be associated with a significantly faster clearance of pathogenic bacteria and viruses from the intestine and decreased attacks of diarrhea.

However, in the study performed by Duggan et al. [13] on infants aged 6-12 months, 0.67 g/day oligofructose in combination with a cereal supplement had no effect on diarrhea.

In this study it was found that the frequency of vomiting attacks reduced to one episode per day in the group that received bovine colostrum, to one episode per day in the group that received prebiotics, to no episodes per day in the group that received both prebiotics and colostrum, and to two episodes per day in the group that received only traditional medication.

These results are consistent with those from a double-blind, placebo-controlled trial conducted by Sarker et al. [14] on 80 children with rotavirus diarrhea. The researchers found that hyperimmune colostrum (prepared by immunizing cows with rotavirus) reduced vomiting attacks and shortened the recovery time compared with those in the placebo group.

Further, it was found that prebiotics decreased the number of vomiting attacks. These results are consistent with those of a randomized double-blind study performed by Schmelzle et al. [15] on the nutritional efficacy and bifidogenicity of a new infant formula containing partially hydrolyzed protein, a high α-palmitic acid level, and nondigestible oligosaccharides. These studies show an effect on weight and length gain, crying, incidence of regurgitation, and vomiting.

However, in the study performed by Ben et al. [16] supplementation of milk formula with galacto-oligosaccharides improved intestinal microflora and fermentation in term infants, but showed no effect on weight and length gain, crying, incidence of regurgitation, and vomiting.

In this study it was found that the group that received bovine colostrum had a decrease in associated complications to only three cases of chest infection and no CNS infection, the group that received prebiotics had five cases of chest infection and only one case of CNS infection, the group that received both had two cases of chest infection and no cases of CNS infection, and the group that received only traditional medication had 10 cases of chest infection and three cases of CNS infection.

These results are consistent with those of a double-blind placebo-controlled study performed by Patiroðlu and Kondolot [17] on 31 IgA. The authors gave oral bovine colostrum or placebo on a random basis three times a day for 1 week and found that the bovine colostrum group had a lower infection severity score compared with those in the placebo group.

Further, it was found that prebiotics reduced associated complications. These results are consistent with those of Bruzzese et al. [18], who reported in an open trial a reduced incidence of both diarrhea and upper respiratory tract infections at the age of 9 months.

In this study it was found that both prebiotics and bovine colostrum decrease electrolyte disturbance in patients with acute gastroenteritis. These results are consistent with those of Casswall et al. [19], who performed a double-blind, placebo-controlled clinical trial in which they investigated the treatment of enterotoxigenic and enteropathogenic E. coli-induced diarrhea in children with bovine immunoglobulin milk concentrate from hyperimmunized cows. They found reduced vomiting and diarrheal attacks, and hyponatremia and hypernatremia. We also found that prebiotics decrease electrolyte disturbance. These results are consistent with those of Ashraf et al. [20], prebiotics in the treatment of shigellosis in children: a double-blind, randomized, controlled trial who found a reduction in intravenous fluid therapy and hypokalemia.

This study found increasing numbers of diarrheal attacks per day, but there was minimal dehydration. This is may be due to many factors such as the general condition of the child, amount of ORS taken per day, and breastfeeding [21].

In this study we found increasing numbers of vomiting attacks per day to be associated with hypokalemia and hyponatremia. This may be because excessive vomiting leads to loss of acids, which leads to hypokalemia and consequently hyponatremia, which may be due to the increasing numbers of diarrheal attacks per day with vomiting.


  Conclusion Top


Early use of both bovine colostrum and prebiotics in children with acute gastroenteritis leads to a greater decrease in the duration of hospital stay, number of attacks of vomiting and diarrhea, degree of dehydration, intravenous fluid therapy, electrolyte disturbance, and associated complications compared with prebiotics alone and bovine colostrum alone.


  Acknowledgements Top


Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Szajewska H, Dziechciarz P. Gastrointestinal infections in the pediatric population. Curr Opin Gastroenterol 2010; 26 :36-44.  Back to cited text no. 1
    
2.
Macfarlane GT, Steed H, Macfarlane S. Bacterial metabolism and health-related effects of galacto-oligosaccharides and other prebiotics. J Appl Microbiol 2008; 104 :305-344.  Back to cited text no. 2
    
3.
Marcus N, Mor M, Amir L, Mimouni M, Waisman Y. The quick-read C-reactive protein test for the prediction of bacterial gastroenteritis in the pediatric emergency department. Pediatr Emerg Care 2007; 23 :634-637.  Back to cited text no. 3
    
4.
Roller M, Rechkemmer G, Watzl B. Prebiotic insulin enriched with oligofructose in combination with the bifidobacteria and prebiotic supplements. Pediatr Res 2004; 51 :750-755.  Back to cited text no. 4
    
5.
Prosser C, Stelwagen K, Cummins R, Nager AL, Wang VJ. Reduction in heat induced gastrointestinal hyperpermeability in rats by bovine colostrum and goat mile powders. J Appl Physiol 2004; 96 :650-654.  Back to cited text no. 5
    
6.
DeCamp LR, Byerley JS, Doshi N, Podas T, Johnson W. Use of antiemetic agents in acute gastroenteritis: a systematic review and meta-analysis. Arch Pediatr Adolesc Med 2008; 162 :858-865.  Back to cited text no. 6
    
7.
Grimwood K, Forbes DA. Acute and persistent diarrhea. Pediatr Clin North Am 2009; 56 :1343-1361.  Back to cited text no. 7
    
8.
Rawal P, Gupta V, Thapa BR. Role of colostrum in gastrointestinal infections. Indian J Pediatr 2008; 75 :917-921.  Back to cited text no. 8
    
9.
Waligora-Dupriet AJ, Campeotto F, Nicolis I, Bonet A, Soulaines P, Dupont C, Butel MJ. Effect of oligofructose supplementation on gut microflora and well-being in young children attending a day care centre. Int J Food Microbiol 2007; 113 :108-113.  Back to cited text no. 9
    
10.
Huppertz HI, Rutkowski S, Busch DH, Eisebit R, Lissner R, Karch H. Bovine colostrum ameliorates diarrhea in infection with diarrheagenic Escherichia coli, shiga toxin-producing E. coli, and E. coli expressing intimin and hemolysin. J Pediatr Gastroenterol Nutr 1999; 29 :452-456.  Back to cited text no. 10
    
11.
Ylitalo S, Uhari M, Rasi S, Pudas J, Leppäluoto J. Rotaviral antibodies in the treatment of acute rotaviral gastroenteritis. Acta Paediatr 1998; 87 :264-267.  Back to cited text no. 11
    
12.
Bakker-Zierikzee AM, Tol EA, Kroes H, Alles MS, Kok FJ, Bindels JG. Faecal SIgA secretion in infants fed on pre- or probiotic infant formula. Pediatr Allergy Immunol 2006; 17 :134-140.  Back to cited text no. 12
    
13.
Duggan C, Penny ME, Hibberd P, Gil A, Huapaya A, Cooper A, et al. Oligofructose-supplemented infant cereal: 2 randomized, blinded, community-based trials in Peruvian infants. Am J Clin Nutr 2003; 77 :937-942.  Back to cited text no. 13
    
14.
Sarker SA, Casswall TH, Mahalanabis D, Alam NH, Albert MJ, Brössow H, et al. Successful treatment of rotavirus diarrhea in children with immunoglobulin from immunized bovine colostrum. Pediatr Infect Dis J 1998; 17 :1149-1154.  Back to cited text no. 14
    
15.
Schmelzle H, Wirth S, Skopnik H, Case CL, Sekine K. Randomized double-blind study of the nutritional efficacy and bifidogenicity of a new infant formula containing partially hydrolyzed protein, a high beta-palmitic acid level, and non digestible oligosaccharides. J Pediatr Gastroenterol Nutr. 2003; 36 :343-351.  Back to cited text no. 15
    
16.
Ben XM, Zhou XY, Zhao WH, Yu WL, Pan W, Zhang WL, et al. Supplementation of milk formula with galacto-oligosaccharides improves intestinal micro-flora and fermentation in term infants. Chin Med J (Engl). 2004; 117 :927-931.  Back to cited text no. 16
    
17.
Patiroðlu T, Kondolot M. The effect of bovine colostrums on viral upper respiratory tract infections in children with immunoglobulin A deficiency. Clin Respir J 2013; 7 :21-26.  Back to cited text no. 17
    
18.
Bruzzese E, Volpicelli M, Squaglia M, Huet F, Van DP, Ligo M, et al. Impact of prebiotics on human health. Dig Liver Dis 2006; 38 :S283-S287.  Back to cited text no. 18
    
19.
Casswall TH, Sarker SA, Faruque SM, Weintraub A, Albert MJ, Fuchs GJ, et al. Treatment of enterotoxigenic and enteropathogenic Escherichia coli-induced diarrhoea in children with bovine immunoglobulin milk concentrate from hyperimmunized cows: a double-blind, placebo-controlled, clinical trial. Scand J Gastroenterol 2000; 35 :711-718.  Back to cited text no. 19
    
20.
Ashraf H, Mahalanabis D, Mitra AK. Prebiotics in the treatment of shigellosis in children: a double-blind, randomized, controlled trial. Acta Paediatr 2001; 90 :1373-1378.  Back to cited text no. 20
    
21.
Dennehy PH. Viral gastroenteritis in children. Pediatr Infect Dis J 2011; 30 :63-64.  Back to cited text no. 21
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


This article has been cited by
1 Bovine Colostrum in the Treatment of Acute Diarrhea in Children: A Double-Blinded Randomized Controlled Trial
Sana Hosny Barakat,Marwa Ahmed Meheissen,Omneya Magdy Omar,Doaa Ali Elbana
Journal of Tropical Pediatrics. 2019;
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Patients and methods
Results
Discussion
Conclusion
Acknowledgements
References
Article Tables

 Article Access Statistics
    Viewed1261    
    Printed16    
    Emailed0    
    PDF Downloaded165    
    Comments [Add]    
    Cited by others 1    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]