Diosmectite, a globally accepted treatment for gastrointestinal conditions, demonstrates efficacy and safety in managing chronic diarrhoea.
The following article is a summary of a CPD-accredited article available here: https://acinoedudoc.com/
Diosmectite, a natural colloidal clay, is widely used globally for various gastrointestinal conditions, including acute diarrhoea in both children and adults, as well as adjunct treatment with oral rehydration solution.
Diosmectite is used in the symptomatic treatment of chronic functional diarrhoea and pain associated with functional bowel diseases in adults. Numerous randomised controlled trials and meta-analyses have demonstrated its efficacy, attributing its benefits to its potent coating properties on the gastrointestinal mucosa, thanks to its leaflet structure and high plastic viscosity.
Pharmacological studies have elucidated diosmectite's mechanisms of action, which include stabilising mucus and protecting the gastrointestinal mucosa against aggressive agents like hydrochloric acid and bile acids. Diosmectite also exhibits high adsorption capacity against enterotoxins, bacteria, and viruses, decreases inflammation mediators, reinforces intestinal mucosa barrier, and restores epithelial barrier defects induced by proinflammatory cytokines. Moreover, it reduces hypersensitivity to colorectal distension, making it effective in treating chronic functional diarrhoea and diarrhoea-predominant irritable bowel syndrome (IBS) when administered at doses of 3g three times a day for 2-8 weeks.
Given the prevalence of chronic diarrhoea associated with microbiota alterations, researchers sought to assess diosmectite's impact on the gut microbiome during long-term use. A prospective, open-label, non-comparative, multi-center international study administered diosmectite 3g three times a day over five weeks to evaluate its effect on elemental impurities and the bowel microbiota composition in subjects with chronic functional diarrhoea.
The study confirmed diosmectite's clinical benefit in reducing overall Bristol Stool Scale (BSS) scores, particularly in cases of more severe baseline symptoms. Despite its efficacy in improving transit, there was no observed alteration in the microbiota composition even at the highest resolution attained by complete shotgun sequencing-based metagenomic gene scans. This contrasts with treatments for other chronic conditions like type-2 diabetes or neuropsychological disorders, where drug-microbe interactions can significantly alter the microbiota.
The lack of impact on the microbiota suggests that diosmectite can be safely administered for extended periods (up to five weeks in the study) without causing microbiota-mediated gut symptoms such as bowel distension or intestinal inflammation. However, further investigations are warranted to assess potential modulation of microbiome functions through assessments of gene expression (metatranscriptome) or metabolome. Nonetheless, the study's findings highlight diosmectite's safety and efficacy in chronic diarrhoea management, providing reassurance for its long-term use in clinical practice.
Conclusion
In conclusion, diosmectite demonstrates efficacy and safety in managing acute and chronic gastrointestinal transit disorders. Its long-term administration in chronic diarrhoea does not appear to adversely impact the intestinal microbiota composition, as evidenced by this study's findings. Thus, diosmectite stands as a viable treatment option for chronic diarrhoea without posing risks associated with microbiota-mediated gut symptoms.
