The Addition of High Amylase Resistant Starch to Reduce Stool Output in Patients with Short Bowel Syndrome

Introduction: Malabsorptive diarrhoea and dehydration complicating short bowel syndrome (SBS) are difficult to manage despite medical therapy and dietary manipulation. Dietary supplementation with High Amylase Resistant Starch (HARS) has been demonstrated to reduce diarrhoea from a number of causes including gastroenteritis[1][3] and cholera.[2] We hypothesised that the addition of HARS would decrease stool output via the production of short chain fatty acids and a resultant increase in colonic water reabsorption. This pilot study aimed to determine whether the addition of HARS reduced diarrhoea in patients with SBS. Methods: Participants with SBS with colon in continuity consuming oral diet were recruited from the intestinal rehabilitation clinic at the Austin Hospital, Melbourne. The study involved a 2 week crossover trial. Each participant completed the control (usual diet) followed by the intervention (addition of 50 g HARS to usual diet) for 1 week each. Total daily stool weight and number of bowel actions per day were compared between groups using paired t-tests. Results: Eight adults (58% male, mean age 55.7) were recruited. Five of the 8 participants completed the trial. The length of residual small bowel ranged from 20-120 cm. Total daily stool weight was reduced in all participants when consuming HARS (Figure 1). Mean daily stool output was significantly decreased 1049 ± 519 g/d to 804 ± 585 g/d (p = 0.023). The number of bowel actions per day were not significantly different (p = 0.6) but were overall numerically reduced in the majority of subjects post-intervention with HARS (Figure 2).FigureFigureConclusion: These preliminary data suggest that dietary supplementation of HARS in patients with short bowel syndrome (with colon in continuity) reduces stool output. HARS is a soluble tasteless powder which can be easily and inexpensively incorporated into the diet and may have the potential to decrease reliance on intravenous nutrition or hydration. Further adequately powered trials are required to confirm the effect of HARS on nutrition and hydration status. This study was funded by a grant received from the Austin Medical Research Foundation. Austin Health Medical Research Foundation. References: 1. Raghupathy P, Ramakrishna B, Oommen S, Ahmed M, Priyaa G, Dziura J, Young G, Binder J. 2006. Amylase-Resistant Starch as adjunct to oral rehydration therapy in children with diarrhea. Journal of pediatric gastroenterology 42:362-368. 2. Ramakrishna B et al. Amylase resistant starch plus oral rehydration solution for cholera. NEJM 2000; 342:308-13. 3. Rabbani et al. Green Banana reduces clinical severity of childhood shigellosis. Pediatr Infect Dis J. 2009;28: 420-425.