Acute diarrhoea in expatriates in Bangladesh.

Acute diarrhoea in expatriates in Bangladesh SIR,-The study by Van Loon et al (Gut 1989; 30: 492-5) illustrates an important aspect of management of adult acute diarrhoea in expatriates in Bangladesh. We have completed a larger study of loperamide and dioralyte in the treatment of acute adult diarrhoea in servicemen in shore bases and ships visiting foreign ports. Criteria for diarrhoea were two or more loose stools in the previous 12 hours. Any underlying chronic bowel disease was an exclusion to entering the study. Subjects were randomised to four treatment groups: placebo, placebo+ dioralyte, loperamide, loperamide+dioralyte. The study was double blind with respect to loperamide and open with respect to dioralyte. Subjects were instructed to take two capsules (loperamide or placebo) immediately and one capsule after each further loose stool; those in the dioralyte groups took one sachet in water after each loose stool. The occurrence of vomiting, abdominal pain and loose stools were recorded on diary cards, as was their assessment of general well being. Of 397 subjects randomised in the study only 290 had fully complete diary cards but numbers of uncompleted cards were the same in each treatment group. The 290 cards were analysed for duration of the diarrhoea, severity of the diarrhoea, time of return to normal activity and general assessment of well being. Results were analysed by non-parametric methods using a Kruskal-Wallis test for multiple groups and Wilcoxon's rank-sum test for individual treatment differences. Duration of diarrhoea was shortest in those taking loperamide and dioralyte (mean 1-5 days) and this was significantly less than those on placebo alone (1 9) or placebo and dioralyte (1-9) (both p<0-01). The loperamide alone group (1 7) was not significantly different from the other groups. Overall the mean numbers of loose stools showed the same trend; loperamide and dioralyte was the best group (mean 4 9) and next was loperamide alone (mean 5 0). These were significantly less than the placebo and dioralyte group (7-4) although not different from placebo (6 5). Results of time of return to normal activity and general symptomatic well-being showed a trend towards a benefit from loperamide but these data failed to reach statistical significance. It is worth noting that Van Loon was studying the effect of loperamide on numbers of stools of patients who where all instructed to take dioralyte in addition. These findings are consistent with ours; the loperamide+ dioralyte group was …