Diarrhea irritable bowel syndrome

Diarrhea is a common problem that is usually self-limiting and of short duration. Increased accumulations of small intestinal and colonic contents are known to be responsible for producing diarrhea. The former may be caused by increased intestinal secretion which may be enterotoxin-induced, eg, cholera and E. col] or hormone and dmg-induced, eg, caffeine, prostaglandins, and laxatives decreased intestinal absorption because of decreased mucosal surface area, mucosal disease, eg, tropical spme, or osmotic deficiency, eg, disaccharidase or lactase deficiency and rapid transit of contents. An increased accumulation of colonic content may be linked to increased colonic secretion owing to hydroxy fatty acid or bile acids, and exudation, eg, inflammatory bowel disease or amebiasis decreased colonic absorption caused by decreased surface area, mucosal disease, and osmotic factors and rapid transit, eg, irritable bowel syndrome. 

A laxative is most often prescribed for the short-term relief or prevention of constipation. Certain stimulant, emollient, and saline laxatives are used to evacuate the colon for rectal and bowel examinations. Fecal softeners or mineral oil are used prophylactically in patients who should not strain during defecation, such as after anorectal surgery or a myocardial infarction. Psyllium may be used in patients with irritable bowel syndrome and diverticular disease. Fblycarbophil may be prescribed for constipation or diarrhea associated with irritable bowel syndrome and diverticulosis. Mineral oil is... 

CHAPTER 18 / CONSTIPATION, DIARRHEA, AND IRRITABLE BOWEL SYNDROME 309... 

From Spruill WJ, Wade WE. Diarrhea, constipation and irritable bowel syndrome. In DiPiro JT, Talbert RL, Yee CC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 6th ed. New York McGraw-Hill, Inc 677-692, with permission. 

Noninfectious causes of acute diarrhea include drugs and toxins (Table 18-3), laxative abuse, food intolerance, irritable bowel syndrome (IBS), inflammatory bowel disease, ischemic bowel disease, lactase deficiency, Whipple s disease, pernicious anemia, diabetes mellitus, malabsorption, fecal impaction, diverticulosis, and celiac sprue. 

Chapter 18 Constipation, Diarrhea, and Irritable Bowel Syndrome... 

Rifaximin Rifamycin Antibiotic Gut bacteria Enteric infection Diarrhea, infectious Hepatic encephalopathy Small intestine bacterial overgrowth Inflammatory bowel disease Colonic diverticular disease Irritable bowel syndrome Constipation Clostridium difficile infection Helicobacter pylori infection Colorectal surgery Bowel decontamination, selective Pancreatitis, acute Bacterial peritonitis, spontaneous Nonsteroidal anti-inflammatory drug enteropathy... 

Okhuysen PC, Jiang ZD, Carlin L, Forbes C, DuPont HL Post-diarrhea chronic intestinal symptoms and irritable bowel syndrome in North American travelers to Mexico. Am J Gastroenterol 2004 99 1774-1778. 

Viramontes, B. E., Camilleii, M., McKinzie, S., Pardi, D. S., Burton, D., and Thomforde, G. M. (2001) Gender-related differences in slowing colonic transit by a 5-HT3 antagonist in subjects with diarrhea-predominant irritable bowel syndrome. Am. J. Gastroenterol. 96, 2671-2676. 

CamiUeri, M., Atanasova, E., Carlson, P. J., et al. (2002) Serotonin-transporter polymorphism. Pharmacogenetics in diarrhea-predominant irritable bowel syndrome. Gastroenterology. 123, 425 32. 

These drugs have weaker anticholinergic activity than atropine however, they have a significantly more expressed antispastic action. They are used for treating so-called irritable bowel syndrome and diarrhea. 

Only physicians who have enrolled in GlaxoSmithKline s Prescribing Program for Lotronex, based on their attestation of qualifications and acceptance of responsibilities, should prescribe alosetron (see Administration and Dosage). Alosetron is indicated only for women with severe diarrhea-predominant irritable bowel syndrome (IBS) who have failed to respond to conventional... 

Psyllium Useful in patients with irritable bowel syndrome and diverticular disease. Polycarbophil For constipation or diarrhea associated with conditions such as irritable bowel syndrome and diverticulosis acute nonspecific diarrhea. 

Caldarella MR Milano A, Laterza F et al. Visceral sensitivity and symptoms in patients with constipation- or diarrhea-predominant irritable bowel syndrome (IBS) effect of a low-fat intraduodenal infusion. Am J Gastroenterol 2005 100(2) 383-9. 

Dicyclomine Competitive antagonism at M3 receptors Reduces smooth muscle and secretory activity of gut Irritable bowel syndrome, minor diarrhea Available in oral and parenteral forms short t1/2 but action lasts up to 6 hours Toxicity Tachycardia, confusion, urinary retention, increased intraocular pressure Interactions With other antimuscarinics... 

Antidiarrheal agents may be used safely in patients with mild to moderate acute diarrhea. However, these agents should not be used in patients with bloody diarrhea, high fever, or systemic toxicity because of the risk of worsening the underlying condition. They should be discontinued in patients whose diarrhea is worsening despite therapy. Antidiarrheals are also used to control chronic diarrhea caused by such conditions as irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD). 

These compounds have been used for many centuries and still find use today in their original forms or through synthetic analogs. Conditions which respond to muscarinic antagonists include irritable bowel syndrome, ulcers, diarrhea, glaucoma, acute rhinitis in addition to some CNS disorders. For example, Lomitil is a prescription treatment for diarrhea which is composed of atropine and diphenoxylate (an opiod with similar effects). 

Three patients who had taken metformin for more than 2 years developed diarrhea (98). After withdrawal of metformin the diarrhea resolved within 1 month. A fourth patient developed diarrhea after taking metformin for 4 months, which stopped after withdrawal rechallenge with metformin 8 months later led to recurrence. Three of these patients had bowel disease (diverticulosis, irritable bowel syndrome, and diabetic neuropathy). 

Irritable bowel syndrome is an idiopathic chronic, relapsing disorder characterized by abdominal discomfort (pain, bloating, distention, or cramps) in association with alterations in bowel habits (diarrhea, constipation, or both). With episodes of abdominal pain or discomfort, patients note a change in the frequency or consistency of their bowel movements. 

Inhibition of 5-HT3 receptors in the gastrointestinal tract results in modulation of visceral afferent pain sensation and intestinal motility. Alosetron is a 5-HT3 antagonist that has been approved for the treatment of patients with severe irritable bowel syndrome with diarrhea (Figure 63-5). Three other 5-HT3 antagonists (ondansetron, granisetron, dolasetron) have been approved for the prevention and treatment of nausea and vomiting (see Antiemetics) however, their efficacy in the treatment of irritable bowel syndrome has not been determined. The relative differences between these 5-HT3 antagonists that determine their pharmacodynamic effects have not been well studied. 

Alosetron currently is approved for the treatment of women with severe irritable bowel syndrome in whom diarrhea is the predominant symptom ("diarrhea-predominant IBS"). Efficacy in men has not been established. In a dosage of 1 mg once or twice daily, it reduces IBS-related lower abdominal pain, cramps, urgency, and diarrhea. Approximately 50-60% of patients report adequate relief of pain and discomfort compared with 30-40% of patients treated with placebo. It also leads to a reduction in the mean number of bowel movements per day and improvement in stool consistency. This agent has not been evaluated for the treatment of other causes of diarrhea. 

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