Inflammatory bowel disease diarrhea

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. 

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. 

Inflammatory (or exudative) diarrhea results from changes to the intestinal mucosa that damage absorption processes and lead to an increase in proteins and other products in the intestinal lumen with fluid retention. The presence of blood or fecal leukocytes in the stool is indicative of an inflammatory process. The diarrhea of inflammatory bowel disease (e.g., ulcerative colitis) is inflammatory in nature. 

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... 

Burke DA, Axon ATR Adhesive Escherichia coli in inflammatory bowel disease and infective diarrhea. BMJ 1988 297 102-104. 

Loperamide is an opiate that is poorly absorbed from the G1 tract but still retains the ability to inhibit peristalsis It is useful in diarrheas that are just symptomatic and are not due to infection or organic pathology, such as inflammatory bowel disease. 

Rx Control and symptomatic relief of acute nonspecific diarrhea and of chronic diarrhea associated with inflammatory bowel disease. 

Inflammatory Bowel disease-. Decrease in rectal bleeding or diarrhea in conjunction wit h mucosal healing... 

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). 

Acarbose and miglitol have been reviewed (17,32,33). Their major adverse effects are flatulence, abdominal discomfort, diarrhea, and bloating, particularly at the start of therapy, which sometimes prevent further use. They should not be given to patients with intestinal obstruction, malabsorption, inflammatory bowel disease, or hepatic impairment. 

Acarbose is a glucopyranose derivative that acts by inhibiting intestinal a-gluco-sidase. This delays carbohydrate absorption and reduces the postprandial (1.5 hours after food) blood glucose levels and is used in combination with other sulfonyl-ureas. Acarbose may cause GI disturbances, flatulence, abdominal distortion, diarrhea, and pain. Acarbose should be avoided during pregnancy, as it affects the fetus. Acarbose is contraindicated in inflammatory bowel disease and hepatic dysfunction. 

Goldstein F, DiMarino AJ Jr. Diarrhea as a side effect of mesalamine treatment for inflammatory bowel disease. J Clin Gastroenterol 2000 31(l) 60-2. 

About half of aU patients given the usual dose of chenodeoxychohc acid, 15mg/kg/day, develop diarrhea, because the unabsorbed bile acid causes water to be secreted into the large bowel (9). The sjmptoms remit with dosage reduction and may not recur if the dose is then slowly increased again. It is best avoided in inflammatory bowel disease. 

The gastrointestinal toxicity of 5-fluorouracil is well documented and often dose-limiting. However, in a retrospective 10-year survey of gastrointestinal function in 19 patients who also had inflammatory bowel disease, although it did appear to increase the risk of exacerbation of diarrhea, it was not totally conclusive, as it was difficult to evaluate the contribution of other potentially causative factors, such as radiation (88). 

Oral budesonide has also been proposed to be beneficial in patients with subacute diarrhea. It has 90% first-pass removal in the liver, and so its systemic activity is low. Budesonide controls symptoms of diarrhea in most patients with inflammatory bowel disease. Preliminary data have suggested that the use of budesonide in patients with irinotecan-induced diarrhea could reduce the severity of symptoms. In addition, in a phase III trial budesonide 3 mg tds prevented irinotecan-induced diarrhea to a moderate extent. Budesonide is an option in patients who do not respond to high-dose oral loperamide (113). 

Inflammatory bowel disease is divided into two major gastrointestinal disorders ulcerative colitis (UC) and Crohn s disease. Both diseases are chronic and tend to be characterized by periods of exacerbations and remissions. Major differences between UC and Crohn s disease are differentiated by anatomic location and distribution. UC occurs in the colon and rectum, whereas Crohn s disease can occur throughout the gastrointestinal tract. UC tends to be continuous, diffuse, and mucosal Crohn s appears segmental, focal, and transmural. Fissures, strictures, abdominal masses, and pain are commonly associated with Crohn s. Classical symptoms of UC include chronic diarrhea with tenesmus, rectal bleeding, and abdominal pain. 

Diarrhea is frequent liquid stools in one or more bowel movement that is a symptom of an underlying cause such as microorganism, foods, malabsorption syndrome, or inflammatory bowel disease. Medication is administered to treat the underlying cause. For example, diarrhea caused by Escherichia coli is treated with fluoroquinolone, an antibiotic. 

Several quite different mechanisms can lead to diarrhea. In carbohydrate malabsorption, the presence of unabsorbed solutes in the bowel causes an osmotic diarrhea as water enters the bowel from the tissue. By contrast, the diarrhea of most laxative abuse and in VIPomas is due to active secretion of water and electrolytes into the bowel, which is described as secretory diarrhea. Inflammatory bowel diseases (ulcerative colitis and Crohn s disease) cause diarrhea as a consequence of the inflammatory process with loss of fluid into the bowel. 

Traveler s diarrhea is identified by multiple names depending on where the disease occurs, but all describes the clinical syndrome manifested by malaise, anorexia, and abdominal cramps followed by the sudden onset of diarrhea that incapacitates many travelers. In particular, an increased risk lies with North Americans and northern Europeans traveling to Latin America, southern Europe, Africa, and Asia. The highest risk is observed with patients with immunocompromised conditions, achlorhydria, or inflammatory bowel disease and people taking diuretics, digoxin, lithium, or insulin (because of the need for appropriate hydration). Overall, an estimated 20% to 50% of people traveling to high-risk areas will develop the illness. 

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