Diarrhoea irritable bowel syndrome

Irritable bowel syndrome (DBS) is an exceedingly common condition in all societies, characterized by abdominal discomfort or pain in association with altered bowel habit or incomplete stool evacuation, bloating and constipation or diarrhoea, easily go undetected and do not show up with common tests such as blood tests or x-rays. The estimated prevalence in the community is about 10%. Irritable bowel syndrome and its variants, collectively called functional gastrointestinal disorders, constitute 40-50% of all the patients seen by gastroenterologists in Western countries. 

Yeo, A., Boyd, P., Lumsden, S., et al. (2004) Association between a functional polymorphism in the serotonin transporter gene and diarrhoea predominant irritable bowel syndrome in women. Gut. 53, 1452-1458. 

Loperamide and codeine are preferred to diphenoxylate in chronic diarrhoea, because they have less tendency to produce drug dependence. Long-term use of these drugs may aggravate irritable bowel syndrome. These drugs are used cautiously in attacks of colitis because there is increased risk of toxic megacolon. Also all these drugs should be used with caution in elderly because faecal impaction... 

Problems of conscipation, diarrhoea and irritable bowel syndrome are common. Infective diarrhoeal diseases are a significant cause of morbidity and mortality worldwide, especially in infants and children.The management of these conditions is reviewed. 

Diarrhoea is also part of some inflammatory disorders, such as irritable bowel syndrome, ulcerative colitis and Crohn s disease. These may best be relieved by treatment with corticosteroids and aminosalicylates. Diarrhoea is commonly associated with bacterial or other pathogenic infections (e.g. food poisoning) and these may require treatment with antibiotics or other antimicrobials. 

Kim, H.J., Camilleri, M., McKinzie, S., Lempke, M.B., Burton, D.D., Thomforde, G.M., and Zinsmeister, A.R. A randomized controlled trial of a probiotic VSL 3, on gut transit and symptoms in diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol. Ther., 17, 895, 2003. 

Several different types of active substances are found in the group of drugs for the treatment of diarrhoea. For Example pectins in apple, mucilage in marshmallow and tannins in tormentil. Peppermint and Asafoetida are considered to be effective in cases of irritable bowel syndrome. 

The inadequate intake of riboflavin seems to be the main cause for the deficiency of this vitamin, being common in populations whose diet lack dairy products and meat, and in anorexic individuals. Digestion and intestinal absorption disorders are other causes of disability, as observed in individuals with lactose intolerance, tropical sprue, coeliac disease and intestinal resection, as well as gastrointestinal and biliary obstruction. Other disorders such as diarrhoea, infectious enteritis and irritable bowel syndrome can cause poor absorption by increasing intestinal motility. Riboflavin deficiency also occurs in conditions such as chronic alcoholism, diabetes mellitus and inflammatory bowel diseases. 

Irritable bowel syndrome. Functional disorder characterized most commonly by cramping, abdominal pain, bloating, constipation and diarrhoea. Its symptoms can be controlled with diet, stress management and medications. 

Open-label studies An open-label extension study assessed the long-term safety, tolerability and efficacy of lubiprostone in 520 patients with constipation-predominant irritable bowel syndrome. Patients were orally administered lubiprostone (8 meg) twice daily for 36 weeks. The most common adverse events were diarrhoea (11%), nausea (11%), urinary tract infection (9%), sinusitis (9%) and abdominal distention (5.8%). No serious adverse events were considered as being treatment related. Seventeen patients discontinued lubiprostone due to a treatment-related adverse event, of which diarrhoea and nausea accoxmted for 1.2% and 0.6%, respectively [9. ... 

Alosetron hydrochloride. Adult dose 0.5-1 mg twice daily (severe diarrhoea, predominant irritable bowel syndrome in women). 

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