Chronic diarrhea medical therapy: Difference between revisions

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==Overview==
==Overview==
[[Antidiarrheal]] drugs can be broadly defined as agents that minimize the [[symptoms]] of diarrhea by improving stool [[Consistency (statistics)|consistency]], reducing stool [[frequency]], or reducing [[Human feces|stool weight]]. [[Chronic diarrhea]] is a common symptom of many conditions. In order to appropriately treat [[chronic diarrhea]], the underlying causes must be identified and treated and, in most cases, the [[chronic diarrhea]] will resolve.<ref name="pmid7605866">{{cite journal| author=Schiller LR| title=Review article: anti-diarrhoeal pharmacology and therapeutics. | journal=Aliment Pharmacol Ther | year= 1995 | volume= 9 | issue= 2 | pages= 87-106 | pmid=7605866 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7605866  }} </ref>


==Medical Therapy==
==Medical Therapy==
{{familytree/start}}
For the treatment of the most common causes of [[chronic diarrhea]], please click below:
{{familytree | | | A01 | | | A01= Adults with chronic diarrhea (> 4 weeks)}}
*'''Inflammatory diarrhea'''
{{familytree | | | |!| | | | }}
**[[Crohn's disease medical therapy#Medical Therapy|Crohn's disease]]
{{familytree | | | B01 | | | B01=<div style="float: left; text-align: left; height: 36em; width: 30em; padding:1em;"> '''Characterize the symptoms:'''<br>
**[[Ulcerative colitis medical therapy#Medical Therapy|Ulcerative colitis]]
❑ Onset (congenital, abrupt or gradual) <br> ❑ Pattern (continuous or intermittent) <br> ❑ Duration <br> ❑ Stool characteristics (watery, bloody or fatty) <br> ❑ [[Fever]] <br> ❑ [[Abdominal pain]] <br> ❑ [[Weight loss]] <br> ❑ Fecal incontinence
**[[Tuberculosis medical therapy#Medical Therapy|Tuberculosis]]
----
**[[Strongyloidiasis medical therapy#Medical Therapy|Strongyloidiasis]]
'''Obtain a detailed history:'''<br>
**[[Ischemic colitis medical therapy#Medical Therapy|Ischemic colitis]]
❑ Aggravating factors ([[diet]] or [[stress]]) <br> ❑ Over-the-counter drugs or use of prescription <br> ❑ Previous evaluations (objective records, radiograms or [[biopsy]] specimens) <br> ❑ Radiation therapy or surgery <br> ❑ Factitious diarrhea (eating disorders, laxative ingestion, [[secondary gain]] or [[malingering]]) <br> ❑ Systemic disease ([[cancer]], [[diabetes]], [[HIV]], [[hyperthyroidism]]) <br>
 
----
*'''Watery diarrhea'''  
'''Elicit the epidemiological factors:'''<br>
**[[Celiac disease medical therapy#Medical Therapy|Celiac sprue]]
❑ Travel before the onset of illness <br>
**[[Chronic pancreatitis medical therapy#Medical Therapy|Chronic pancreatitis]]
❑ Exposure to contaminated food or water <br>
**[[Lactose intolerance medical therapy#Medical Therapy|Lactose intolerance]]
❑ Illness in other family members </div>}}
**[[Whipple's disease medical therapy#Medical Therapy|Whipple's disease]]
{{familytree | | | |!| | | }}
**[[Cholera medical therapy#Medical Therapy|Cholera]]
{{familytree | | | C01 | | | C01=<div style="float: left; text-align: left; height: 29em; width: 30em; padding:1em;"> '''Examine the patient:'''<br>
**[[Giardiasis medical therapy#Medical Therapy|Giardiasis]]
'''Assess the volume status:''' <br>
**[[Hyperthyroidism medical therapy#Medical Therapy|Hyperthyroidism]]
❑ General condition <br>
**[[Addison's disease medical therapy#Medical Therapy|Addison's disease]]
❑ Thirst <br>
 
❑ [[Pulse]] <br>
*'''Fatty diarrhea'''
❑ [[Blood pressure]] <br>
**[[Celiac disease medical therapy#Medical Therapy|Celiac disease]]
❑ Eyes <br>
**[[Pancreatic insufficiency#Treatment|Pancreatic insufficiency]]
❑ Mucosa
**[[Small bowel bacterial overgrowth syndrome#Treatment|Small bowel bacterial overgrowth syndrome]]
----
 
'''Perform a general physical exam:'''<br>
Below are some of the [[drugs]] that can be used in the symptomatic treatment of chronic [[diarrhea]] and their mechanisms of action. Some [[drugs]] have numerous mechanisms of action and can thus be found under more than one section. It is important to know that these [[drugs]] are used for the [[symptomatic]] treatment of chronic [[diarrhea]]. In order to appropriately treat chronic [[diarrhea]], the underlying cause of the [[disease]] must be identified.<ref name="pmid7605866">{{cite journal| author=Schiller LR| title=Review article: anti-diarrhoeal pharmacology and therapeutics. | journal=Aliment Pharmacol Ther | year= 1995 | volume= 9 | issue= 2 | pages= 87-106 | pmid=7605866 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7605866  }} </ref>
❑ Skin ([[flushing]], [[rash]]es or dermatographism) <br> ❑ Oral cavity (ulcers) <br> ❑ Cardiovascular system (murmur)<br> ❑ Respiratory system (wheezing) <br> ❑ [[Thyroid]] (mass) <br> ❑ [[Abdomen]] ([[ascites]], [[hepatomegaly]], mass or tenderness) <br> ❑ Anorectal ([[Abscess]], blood, [[fistula]] or sphincter competence) <br> ❑ Extremities ([[edema]]) </div>}}
 
{{familytree | | | |!| | | | }}
'''Inhibitors of intestinal transit time'''
{{familytree | | | D01 | | | | D01=<div style="float: left; text-align: left; height: 12em; width: 30em; padding:1em;"> '''Order routine laboratory tests:'''
*[[Opiates]]
❑ [[CBC|CBC and differential]] <br> ❑ [[ESR]] <br> ❑ [[Serum electrolytes]]<br> ❑ Total serum [[protein]] and [[albumin]] <br> ❑ [[Thyroid function tests]] <br> ❑ [[Urinalysis]] <br>
**[[Loperamide]]
</div>}}
**[[Eluxadoline]]
{{familytree | | | |!| | | | }}
**[[Diphenoxylate]]
{{familytree | | | D10 | | | | D10= <div style="float: left; text-align: left"> '''Start altered diet:'''<br> ❑ Stop lactose products <br> ❑  Avoid alcohol and high osmolar supplements <br> ❑ Drink 8-10 large glasses of clear fluids (fruit juices, soft drinks etc) <br> ❑ Eat frequent small meals (rice, potato, banana, pastas etc) <br>
**[[Difenoxin]]
----
**[[Codeine]]
❑ '''Start [[oral rehydration therapy]] or [[intravenous fluids]] depending on the hydration status'''</div>}}
**[[Opium]]
{{familytree | | | |!| | | | | }}
**[[Paregoric]]
{{familytree | | | D02 | | | | | D02 = '''Any specific obvious diagnosis through history and examination?'''}}
**[[Morphine]]
{{familytree | |,|-|^|-|.| | }}
*Encephalinase inhibitor
{{familytree | D03 | | D04 | | D03= <div style="float: left; text-align: left; width: 30em; padding:1em;">Yes </div>| D04=<div style="float: left; text-align: left; width: 30em; padding:1em;">No </div>}}
**[[Racecadotril]]
{{familytree | |!| | | |!| | }}
*[[5-HT3 receptor antagonist|5-HT3-receptor antagonist]]
{{familytree | D05 | | |!| | D05= <div style="float: left; text-align: left; height: 22em; width: 30em; padding:1em;"> '''Chronic infection (outbreaks or endemic areas)'''<br> ❑ Trial of oral [[metronidazole]] 500 mg TID for 5 days for protozoal diarrhea<br> ❑ Oral [[ciprofloxacin]] 500 mg BD X 3 days for enteric bacterial diarrhea
**[[Alosetron]]
-----
*[[Alpha-2 adrenergic receptor|α2-Adrenergic agonist]]
'''Medication induced:''' <br>
**[[Clonidine]]
❑ Discontinuation of the drug
*[[Somatostatin]] and analogs
-----
**[[Octreotide]]
'''Irritable bowel syndrome''' (chronic abdominal pain and altered bowel habits in the absence of any organic disorder)<br>
**[[Lanreotide]]
❑ Trial of antispasmodic agents (oral [[dicyclomine]] 20 mg QID),OR <br>
**[[Pasireotide]]
❑ [[Tricyclic antidepressant|TCA's]]([[amitriptyline]] 10-25 mg OD), OR <br>
*[[Calcium channel blocker]]
❑ [[SSRI]] ([[fluoxetine]] 20-40 mg OD), OR <br>
**[[Nifedipine]]
❑ [[Rifaximin]]</div>}}
 
{{familytree | |!| | | |!| | }}
'''Pro-absorptive agents'''
{{familytree | E01 | | |!| | E01= No resolution of the diarrhea}}
*[[Glucose]], [[amino acids]]
{{familytree | |`|-|v|-|'| | }}
**[[Oral rehydration therapy|Oral rehydration solution]]
{{familytree | | | F01 | | | F01=<div style="float: left; text-align: left; line-height: 150% "> '''Order stool analysis:'''<br>
*[[Α2 agonist|α2-Adrenergic agonist]]
❑ [[Diarrhea laboratory findings#Fecal Weight|Stool weight]] <br> ❑ [[Diarrhea laboratory findings#Stool Osmotic Gap|Stool electrolytes and fecal osmotic gap]] <br> ❑ [[Diarrhea laboratory findings#Fecal pH|Stool pH]] <br> ❑ [[Diarrhea laboratory findings#Occult Blood|Fecal occult blood testing]] <br> ❑ [[Diarrhea laboratory findings#White Blood Cells|Stool WBC's]] <br> ❑ Stool fat: [[Diarrhea laboratory findings#Fecal Fat Concentration and Output|Quantitative]] / [[Diarrhea laboratory findings#Sudan Stain for Fat|Sudan stain]] <br> ❑ [[Diarrhea laboratory findings#Analysis for Laxatives|Laxative screen]] </div>}}
**[[Clonidine]]
{{familytree/end}}
 
This management is as per the American Gastroenterological Association guidelines for the evaluation and management of chronic diarrhea.<ref name="pmid10348831">{{cite journal| author=| title=American Gastroenterological Association medical position statement: guidelines for the evaluation and management of chronic diarrhea. | journal=Gastroenterology | year= 1999 | volume= 116 | issue= 6 | pages= 1461-3 | pmid=10348831 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10348831  }} </ref>
'''Antisecretory drugs'''
<br>
*[[Somatostatin]] and analogs
**[[Octreotide]]
**[[Lanreotide]]
**[[Pasireotide]]
*[[Enterocyte]] apical membrane [[chloride channel]] inhibitors
**[[Crofelemer]]
*[[Berberine]]
*[[Calcium channel blockers]]
**[[Nifedipine]]
*[[Calmodulin]] inhibitors
**[[Chlorpromazine]]
**[[Trifluoperazine]]
*[[Calcium-sensing receptor|Calcium-sensing receptor ligands]]
*[[Nicotinic acid]]
*[[Lithium]]
*[[Zinc]]
*[[Bismuth]]
*[[Non-steroidal anti-inflammatory drug|Nonsteroidal antiinflammatory drugs]]
*[[Corticosteroids]]
*[[Teduglutide]]
 
'''Intraluminal agents'''
*[[Adsorbent|Adsorbents]]
**Clays
*Bile acid-binding resins
**[[Cholestyramine]]
**[[Colestipol]]
**[[Colesevelam]]
*[[Fiber]]


==References==
==References==
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[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Gastroenterology]]
[[Category:Pediatrics]]

Latest revision as of 20:57, 29 July 2020

Chronic diarrhea Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Chronic diarrhea from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]

Overview

Antidiarrheal drugs can be broadly defined as agents that minimize the symptoms of diarrhea by improving stool consistency, reducing stool frequency, or reducing stool weight. Chronic diarrhea is a common symptom of many conditions. In order to appropriately treat chronic diarrhea, the underlying causes must be identified and treated and, in most cases, the chronic diarrhea will resolve.[1]

Medical Therapy

For the treatment of the most common causes of chronic diarrhea, please click below:

Below are some of the drugs that can be used in the symptomatic treatment of chronic diarrhea and their mechanisms of action. Some drugs have numerous mechanisms of action and can thus be found under more than one section. It is important to know that these drugs are used for the symptomatic treatment of chronic diarrhea. In order to appropriately treat chronic diarrhea, the underlying cause of the disease must be identified.[1]

Inhibitors of intestinal transit time

Pro-absorptive agents

Antisecretory drugs

Intraluminal agents

References

  1. ↑ 1.0 1.1 Schiller LR (1995). "Review article: anti-diarrhoeal pharmacology and therapeutics". Aliment Pharmacol Ther. 9 (2): 87–106. PMID 7605866.


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