Does resistant starch reduce diarrhoea and improve nutrition and quality of life in people with short bowel syndrome

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Short bowel syndrome (SBS) is defined as having insufficient bowel to absorb the necessary nutrition and hydration to maintain weight / sustain growth. The aetiology of short bowel syndrome can be either congenital (in children) or as a result of massive surgical resections. The prevalence of SBS in Australia is not known however it is estimated there are 220 patients on home parenteral nutrition in Australia for which SBS is a major indication. Despite the low prevalence of the condition these patients are complex to manage due to chronic diarrhoea, dehydration, macro and micronutrient deficiencies and electrolyte disturbances. Many rely on home enteral or parenteral nutrition or intravenous fluid and thus have to manage the complications associated with these forms of nutrition support. Despite medical therapy, oral rehydration solutions and a modified diet, the diarrhoea and malabsorption experienced in people with SBS is difficult to manage. This is not only debilitating but may also mean people who suffer from this condition are reliant on intravenous nutrition or hydration, therapies which are associated with a poor quality of life. High Amylase Resistant Starch (HARS) is a form of starch that occurs naturally in food. It is available as a supplement and is frequently added to foods by the food industry to increase fibre content. HARS has no taste and is usually undetectable in food or drinks. HARS has been shown to decrease diarrhoea from a variety of causes including gastroenteritis and cholera. A pilot trial completed at Austin Health showed that adding 50g/d of HARS to the diet of people with SBS significantly reduced the total amount of diarrhoea per day and showed a trend towards a decreased number of bowel actions per day. Larger trials are needed to confirm this effect and determine if there are any improvements in the person’s ability to absorb nutrition / hydration as well as their quality of life. We aim to recruit 50 people with SBS across Australia and supplement their diet with 50g of HARS each day for 2 months. Stool frequency and weight, urine output, body weight, handgrip strength and quality of life will be measured. The end of trial results will be compared to the participant’s baseline results (before they started taking the starch). This study aims to determine if supplementation of HARS to the usual diet of people with short bowel syndrome will reduce the diarrhoea (frequency of bowel actions and improve stool consistency), nutrition/hydration status and quality of life. It is hypothesized that the addition of 50g per day of HARS to the usual diet of people with short bowel syndrome will decrease the amount of diarrhea they experience and in turn improve their nutritional and hydration status as well as quality of life. Any therapy which can improve the quality of life of an individual with a chronic potentially life threatening condition has huge implications for the individual.

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