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Medication Induced Constipation And Diarrhea. Practical Gastroenterology. 32(5): 12-28. May 2008.
This article reviews the problems of constipation and diarrhea that occur as a side effect of medication use. The authors note that medication-induced constipation and diarrhea are frequent side effects that contribute to the costs of health care for evaluation and management and also contribute to patient morbidity. The diagnosis is often delayed due to poor association of symptom onset with the use of a medication. The authors define constipation; discuss its epidemiology, economic impact, and risk factors; consider diagnostic and treatment issues; and discuss the treatment of constipation in the setting of chronic opioid use. The next section covers the definition and mechanisms of medication-induced diarrhea, antibiotic-associated diarrhea, diarrhea associated with protease inhibitors, and chemotherapy-induced diarrhea. The authors conclude by encouraging health care providers to have a high index of suspicion when patients present with constipation or diarrhea and to obtain a detailed medication history of all medications taken in the past 2 months; this approach can avoid multiple diagnostic tests. High-risk patient populations for medication-induced diarrhea or constipation include the elderly, nursing home or long-term care residents, patients with chronic pain, those with prolonged hospitalization, and those being treated with broad spectrum antibiotics. 3 figures. 2 tables. 35 references.
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BRAT Diet for Acute Diarrhea in Children: Should It Be Used?. Practical Gastroenterology. 31(6): 60, 65-68. June 2007.
This article considers the use of one type of diet often prescribed during acute diarrhea in children, the BRAT diet, which consists of bananas, rice, applesauce, and toast (or tea). The authors note that although many studies support the importance of enteral nutrition in recovery from diarrhea, there are few data concerning the effectiveness of specific food types. They review the limited data that address the safety and efficacy of diets with bananas, rice, and other dietary components in treating diarrhea. In addition, they review the nutritional content of this restrictive diet and find it lacking in energy, fat, and several micronutrients. The selection of a single type of restrictive diet, such as the BRAT diet, during diarrhea can impair nutritional recovery and lead to severe malnutrition. They conclude that prompt feeding during an acute episode of diarrhea and avoiding unnecessarily restrictive diets is the recommended dietary therapy during acute diarrhea. 1 figure. 1 table. 22 references.
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Constipation, Diarrhea, Hemorrhoids and Fecal Incontinence. IN: Pregnancy in Gastrointestinal Disorders. 2nd ed. Bethesda, MD: American College of Gastroenterology. 2007. pp 4-9.
This chapter about constipation, diarrhea, hemorrhoids, and fecal incontinence is from a monograph that presents updated information about pregnancy in women with gastrointestinal disorders. The authors note that the pathophysiology of these common alterations in bowel patterns may be specific to hormonal and structural changes that occur during pregnancy and as a result of delivery. The chapter focuses on bringing readers up to date on the research in the area covered, the recommended treatments, and patient management concerns, notably issues of maternal and fetal safety. Specific topics include drug therapy, the use of dietary and behavioral modification to manage constipation, the etiology of diarrhea during pregnancy, oral rehydration for acute diarrhea, symptoms of hemorrhoids, the use of surgical hemorrhoidectomy, problems with diagnosing fecal incontinence, and treatment for fecal incontinence. The authors conclude that disturbances in bowel function are common in pregnancy and are often responsive to conservative medical therapy. 3 tables. 20 references.
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Diarrhea. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2007. 6 p.
Diarrhea is defined as loose, watery stools. A person with diarrhea typically passes stool more than three times a day. Acute diarrhea is a common problem that usually lasts 1 or 2 days and goes away on its own without special treatment. Prolonged diarrhea persisting for more than 2 days may be a sign of a more serious problem and poses the risk of dehydration. This fact sheet describes the causes of diarrhea, associated symptoms, diarrhea in children, the signs of dehydration, how to know when to contact a health care provider regarding diarrhea, diagnostic tests that may be used to help find the cause of the diarrhea, treatment options, and current research efforts in this area. Treatment for diarrhea involves replacing lost fluid and electrolytes. Depending on the cause of the problem, a person might also need medication to stop the diarrhea or to treat an infection. One sidebar offers suggestions for preventing traveler's diarrhea when traveling outside of the United States. The contact information for two resource organizations is provided: the American Gastroenterological Association and the International Foundation for Functional Gastrointestinal Disorders. The fact sheet concludes with a brief description of the National Digestive Diseases Information Clearinghouse.
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Managing Bowel Dysfunction. Bethesda, MD: National Institutes of Health Clinical Center. June 2007. 20 p.
This patient education fact sheet reviews the management of bowel dysfunction, defined as problems with the frequency, consistence, and/or ability to control the bowel movements. People may have trouble with their bowel movements due to many factors including medications, diseases or treatments for diseases, stress, or a change in eating or exercise patterns. The fact sheet reviews the physiology of the male and female digestive systems, normal bowel function, and the diagnosis of bowel problems with laboratory tests, radiologic or ultrasonic examination, special procedures, and fecal occult blood sampling. The fact sheet describes the causes, treatment, and prevention of bowel dysfunctions, including constipation, diarrhea, and fecal incontinence. A section considers specialized surgical procedures for bowel dysfunctions, including colostomy or ileostomy. Practical tips and strategies for everyday activities, meal planning, skin care, and exercise are provided; three sample menus are included. The fact sheet concludes with a brief glossary of relevant terms. 5 figures. 3 tables.
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MNT for Clostridium Difficile Disease. Today’s Dietitian. 9(9): 38-40. September 2007.
This article explores the use of medical nutrition therapy (MNT) for Clostridium difficile (C. difficile) disease, a bacterial infection that causes diarrhea and other more serious intestinal conditions including colitis. C. difficile can be acquired from a carrier and spread through direct or indirect contact with contaminated surfaces or airborne spores; individuals taking antibiotics are particularly at risk of becoming infected. In most cases, treatment of C. difficile infections requires discontinuing the problematic antibiotic along with administration of fluids and electrolytes. Relapse and recurrence are relatively common and can be more severe than the original infection. The author focuses on the use of diet strategies to help treat and manage C. difficile infections, including small frequent feedings with fluids between meals and replacement of electrolytes by including high-sodium soups and fruits juices. The author includes a section about recommended prevention strategies such as careful use of antibiotics, stringent handwashing policies, careful isolation of patients already infected with C. difficile, and disinfection of any objects that may be contaminated. A final section of the article considers the use of probiotics and prebiotics; probiotics are bacteria intended to assist the body’s naturally occurring gut flora in reestablishing themselves. 5 references.
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Post infectious Irritable Bowel Syndrome: Clinical Aspects, Pathophysiology, And Treatment. Practical Gastroenterology. 31(9 Suppl): 18-24. September 2007.
This article on postinfectious irritable bowel syndrome (PI-IBS) is from a special supplement issue of Practical Gastroenterology on the topic of IBS. The supplement reports on the proceedings of a meeting in September 2005 of a group of gastroenterologists who gathered to develop a shared understanding of the data regarding the role of intestinal bacteria in IBS. IBS is characterized by bloating, abdominal pain, flatulence, and altered bowel function, including diarrhea and constipation. In this article, the author focuses on the clinical aspects, pathophysiology, and treatment of PI-IBS, which is defined as new onset of IBS after an acute episode of infectious diarrhea. The author hypothesizes that chronic mucosal inflammation, immunologic changes, and biochemical alterations triggered by microbial infection may be involved in mechanisms leading to persistent intestinal symptoms. The differential diagnosis of PI-IBS involves ruling out other conditions that may cause prolonged diarrhea, including persistent enteric infection, co-infection, and malabsorption or food intolerance. Treatment often focuses on symptom relief, but the prevention and early treatment of acute bacterial illness with antimicrobials such as rifaximin may be important for reducing the risk of PI-IBS development, particularly in international travelers. 4 tables. 39 references.
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Rifaximin as Acute Therapy and Maintenance Treatment for Functional Gastrointestinal Symptoms. Gastroenterology and Hepatology. 3(1): 9. January 2007.
This article is from a continuing education supplement that offers case studies that demonstrate the potential use of antibiotic therapy in the management of patients with functional gastrointestinal disorders. The cases provide examples of the pathogenic role of bacteria in irritable bowel syndrome (IBS) and suggest that treatment strategies that affect gut bacteria and the respective host responses to these pathogens might alleviate symptoms in patients with functional gastrointestinal symptoms. This article describes the case of a 55-year-old Caucasian woman who presented with a 10-year history of functional gastrointestinal symptoms, including mild diarrhea, severe constipation, abdominal pain, bloating, and gas. Symptoms were exacerbated by certain carbohydrates and alleviated only by not eating. A diagnosis of Rome II-positive, alternating-form irritable bowel syndrome (IBS) was determined. Based on clinical symptoms, the patient was administered oral rifaximin 400 milligrams twice daily for 10 days. Following completion of rifaximin treatment, probiotic therapy and tegaserod 2 milligrams daily were administered as maintenance therapy. At 3 months follow-up, the patient had not experienced symptom recurrence. The author briefly discusses the implications of this case study. 4 references.
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Rifaximin: Recent Advances in Gastroenterology and Hepatology. Gastroenterology and Hepatology. 3(6): 474-483. June 2007.
This article reviews data that have been presented at medical meetings or published in medical journals since the publication of a 2006 review of rifaximin in this journal. Rifaximin is an antibiotic that was initially developed to treat bacteria-related diarrhea, but its uses have increased as the understanding of the role of enteric bacteria has advanced. The author presents data that suggest rifaximin may be useful in several enteric conditions, including Clostridium difficile-associated diarrhea, cryptosporidial diarrhea, Helicobacter pylori-associated gastritis, inflammatory bowel disease (IBD), pouchitis, traveler’s diarrhea, diverticular disease, hepatic encephalopathy, small intestinal bacterial overgrowth, and irritable bowel syndrome. For each condition, the author reviews the related research, focusing on administration and dosage, as well as patient selection. The author concludes that rifaximin may be beneficial as monotherapy or in combination with other agents for the treatment of multiple enteric conditions. 2 figures. 5 tables. 72 references.
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Understanding Irritable Bowel Syndrome. Baltimore, MD: AGA Institute. 2007. 4 p.
This brochure from the American Gastroenterological Association (AGA) provides an overview of irritable bowel syndrome (IBS), a common disorder of the intestine that leads to crampy pain, gassiness, bloating, and changes in bowel habits, including constipation and diarrhea. The brochure reviews the lifestyle impact of IBS and outlines the causes and triggers of the condition, which can include problems with colonic motility, an oversensitive gastrointestinal tract, certain foods, hormones associated with the menstrual cycle, and emotional conflict or stress. The brochure describes how IBS is diagnosed, the relationship between IBS and more serious problems, and treatment options, including the role of a healthy diet, dietary fiber, small meals, and the role of medicines in relieving IBS symptoms. Another section explores the interplay between diet, stress, and IBS. A final section summarizes the basic information presented in the brochure. One illustration presents the organs of the digestive system labeled in a simple line drawing. Readers are referred to the AGA website at www.gastro.org/patient for more information about digestive health and to find a local AGA member physician. 6 figures.
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Diarrhea. IN: Nilsson, K.R.; Piccini, J.P., eds. Osler Medical Handbook. Philadelphia, PA: Saunders. 2006. pp. 456-466.
Diarrhea is defined as a change in bowel habits with abnormally loose stools, usually associated with an excessive frequency of defecation and more than 200 grams of stool per day. This chapter on diarrhea is from a handbook that provides the essentials of diagnosis and treatment, as well as the latest in evidence-based medicine, for residents working bedside, in-patient care. The chapter begins with a presentation of essential Fast Facts and concludes with Pearls and Pitfalls useful to the practicing internist. The body of the chapter is divided into sections: Epidemiology, Clinical Presentation, Diagnosis, and Management. Specific topics covered in this chapter include the mechanisms through which diarrhea can develop, including decreased rate of intestinal nutrient and salt absorption, net electrolyte secretion, rapid intestinal transit, and the ingestion of poorly absorbable substances; the classification of diarrhea as acute or chronic; the causes of and treatments for acute diarrhea; the causes of chronic diarrhea and its classification into watery, inflammatory, or dry types; and the differences between secretory and osmotic watery diarrhea. The chapter concludes with a list of references, each labeled with a 'strength of evidence' grade to help readers determine the type of research available in that reference source. 2 figures. 3 tables. 22 references.
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Functional Bowel Disorders. IN: Drossman, D.A., ed. Rome III: The Functional Gastrointestinal Disorders. 3rd ed. McLean, VA: Degnon Associates, Inc. 2006. pp. 487-555.
This chapter on functional bowel disorders is from a lengthy reference book that presents the Rome III criteria for functional gastrointestinal disorders (FGIDs), a classification system based on the assumption and premise that for each disorder there are identifiable symptom clusters that emerge across clinical and population groups. The authors of this chapter define functional bowel disorders as FGIDs with symptoms attributable to the middle or lower gastrointestinal tract. These disorders include irritable bowel syndrome (IBS), functional bloating, functional constipation, functional diarrhea, and unspecified functional bowel disorder. In each of these categories, the authors provide a definition and discuss epidemiology, symptoms, nomenclature and classification, clinical evaluation, physiological features, and treatment strategies. Specific topics include gastrointestinal motor disturbances, visceral hypersensitivity, postinfectious IBS, history of physical or sexual abuse, food intolerance, drug therapy, measurements of colonic transit, fiber supplementation and bulk laxatives, osmotic laxatives, and unspecified functional bowel disorder. The chapter concludes with a list of recommendations for future research in functional bowel disorders. 4 tables. 464 references.
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Guidelines for Prevention, Surveillance, Diagnosis and Treatment in the New Era of More Virulent Strains of Antibiotic-Associated Diarrhea (AAD), Clostridium Difficile-Associated Disease [or] Diarrhea (CDAD) and Clostridium Difficile Colitis (CDAC). Practical Gastroenterology. 30(6): 65-82. June 2006.
Clostridium difficile-associated diseases, which usually affected hospital patients, are now becoming more prevalent in cases of relatively healthy adults, some of whom have not even been hospitalized. This article describes the methods of prevention, early diagnosis, and prompt aggressive treatment which are critical in managing Clostridium difficile-associated diarrhea (CDAD) and colitis (CDAC). The authors stress that a very important method of controlling outbreaks of C. difficile-associated disease must be interventions on the prevention and use of antimicrobial agents implicated as risk factors for the disease. After reviewing the relevant research, the authors describe ten recommendations for managing CDAD and CDAC, particularly in the health care setting. The recommendations are in the areas of minimizing all antibiotics, avoidance of high-risk antibiotics, strict patient care and quarantine, and having a high index of suspicion for CDAD in patients who develop diarrhea, especially after gastrointestinal surgery. These interventions have been shown to be cost-effective and successful in improving antibiotic prescribing to hospital inpatients, and have also been shown to reduce antimicrobial resistance and hospital-acquired infections. 62 references.
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Nutrition Strategies for Managing Diarrhea. Digestive Health Matters. 15(2): 6-7. Summer 2006.
Persistent or recurring diarrhea is a symptom of many different digestive disorders. This article presents nutrition strategies that may be useful for readers coping with mild, short-term diarrhea. Readers are advised to consult a physician to obtain a diagnosis and specific treatment for more serious diarrhea. The author discusses the role of diet, certain foods that may produce loose stools, dietary supplements that can worsen symptoms, and foods and supplements that may help to control diarrhea. Each section lists specific foods and supplements. The author concludes by summarizing the general recommendations: identify foods and fluids that cause problems for the individual, drink adequate fluids apart from meal times, include foods with sodium and potassium, and eat less and more often.
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Viral Gastroenteritis. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2006. 4 p.
Viral gastroenteritis is an intestinal infection that can be caused by several viruses. Viral gastroenteritis is highly contagious and causes millions of cases of watery diarrhea each year. Most people recover from viral gastroenteritis without any complications. However, dehydration can be a problem for people who cannot drink enough fluids to replace what is lost through vomiting and diarrhea. This fact sheet describes viral gastroenteritis and its management, addressing the symptoms of this illness; the causes of gastroenteritis, which can include rotaviruses, adenoviruses, caliciviruses, and astroviruses; risk factors and transmission of these viruses; diagnosis, which is usually based on a physical examination and the patient’s symptoms, but may involve a stool test as well; and treatment strategies, which focus on reducing symptoms and preventing dehydration. Transmission is usually through unwashed hands, close contact with an infected person, or food and beverages that contain the virus. The symptoms of dehydration are excessive thirst, dry mouth, dark yellow urine or scant urine, decreased tears, severe weakness or lethargy, and dizziness or lightheadedness. Infants, young children, the elderly, and people with weak immune systems have a higher risk of developing dehydration due to vomiting and diarrhea. Prevention is the only way to avoid viral gastroenteritis. A final section refers readers to the Centers for Disease Control and Prevention at www.cdc.gov or 1–800–311–3435 and describes the goals and activities of the National Digestive Diseases Information Clearinghouse. 1 figure.
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Celiac Disease in Children with Diarrhea Is More Frequent Than Previously Suspected. Journal of Pediatric Gastroenterology and Nutrition. 40(3): 309-311. March 2005.
Celiac disease (CD, characterized by gluten intolerance) may be missed or diagnosed late in children with chronic diarrhea. This article reports on a study that estimated the frequency of CD among pediatric patients with chronic diarrhea based on serologic and pathologic examinations. During a 6-year period, all patients with chronic diarrhea of more than 6 weeks referred to the authors' clinic were included (n = 825); a control group of 825 patients was also enrolled in the study. CD was diagnosed in 54 (6.5 percent) of the diarrhea patients and in 7 (0.8 percent) of the controls. After 6 months of a gluten-free diet, 48 (88.8 percent) patients had significant improvement in symptoms and, of these, 41 (76.1 percent) were totally asymptomatic. Repeat endoscopy was performed in 42 patients after 6 months of the gluten-free diet and 40 (95.2 percent) showed improvement in histologic findings. The authors conclude that routine testing for CD may be indicated in all patients being evaluated for chronic diarrhea. 15 references.
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Managing Diarrhea. Digestive Health Matters. 14(3): 14-15. Fall 2005.
This article describes strategies that can be used to manage diarrhea, defined as the too frequent and often urgent passage of loose stools. The author notes that symptoms of anything more than mild, short-term diarrhea should be brought to the attention of a health care provider. Sometimes diagnosis is impossible or delayed, there is persistent diarrhea during or despite specific treatment, or the patient has intermittent diarrhea as part of irritable bowel syndrome (IBS). The author describes how to manage the symptom of diarrhea until the underlying disease is brought under control. Topics included are the signs of dehydration; the importance of rehydration; diet causes and treatments; the use of a bulking agent (psyllium); the use of over-the-counter (OTC) drugs including bismuth, codeine, and loperamide; the use of prescription drugs including codeine phosphate, diphyenoxylate, and cholestyramine; and guidelines for using the drugs. The author concludes by cautioning readers not to ignore diarrhea and concomitant hydration. 2 references.
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Medication for Inflammatory Bowel Disease. Toronto, Canada: Crohn’s and Colitis Foundation of Canada. 8 p.
This brochure reviews some of the medications that may be used for inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis. After an introductory section that briefly summarizes these diseases, the booklet describes medications used to reduce inflammation in the gastrointestinal tract; medications used to reduce symptoms of the disease, such as diarrhea and cramps; and medications used to treat complications. Specific drugs discussed include sulfasalazine; 5-aminosalicylate, also known as mesalamine, mesalazine, and olsalazine; glucocorticosteroids, including prednisone, hydrocortisone, betamethasone, tixocortol, and budensonide; immunosuppressive agents, including azathioprine, 6-mercaptopurine, methotrexate, and cyclosporine A; antibiotics, including metronidazole, ciprofloxacin, ampicillin, cefazolin, gentamicin, and tobramycin; new biological therapies, including infliximab; antidiarrheal drugs, including Loperamide, codeine, diphenoxylate, tincture of opium, and paregoric; bulk-formers, primarily natural fiber sources; bile salt binders, i.e., cholestyramine, used for Crohn’s disease only; and nicotine, which is sometimes used for ulcerative colitis. For each drug, the brochure notes synonyms, how the drug is prescribed, how it works, possible side effects, and the different forms, if any, the drug comes in. The remainder of the article considers medications for other symptoms and problems, complications of IBD that may require therapy, alternative therapies, and conventional therapies. The contact information and mission of the Crohn’s and Colitis Foundation of Canada are noted. A form to join the organization or contribute money to its causes is included. 1 figure.
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What I Need to Know About Diarrhea. Bethesda, MD: National Digestive Diseases Information Clearinghouse, 2005. 19 p.
Diarrhea is a change in the bowel movements where the person passes unusually loose stools. This brochure explains diarrhea, its causes, and how it can be managed. Written in nontechnical language, the brochure covers a definition of diarrhea, other symptoms that accompany diarrhea, the risk factors and causes of diarrhea, traveler's diarrhea, how to know when to consult a health care provider, diagnostic tests to confirm the condition or determine the cause of the problem, and treatment options. Diarrhea is caused by bacteria, viruses, parasites, some foods or medicines, or diseases that affect the digestive system. Diarrhea becomes dangerous when the person becomes dehydrated, so the main treatment for diarrhea is replacing lost fluids. A health care provider should be called about strong pain in the abdomen or rectum, a fever, blood in the stool, signs of dehydration, or severe fever for more than 3 days (1 day in children). The booklet includes a summary of the information provided, a list of resources where readers can get more information, and a list of acknowledgements. A final section briefly describes the goals and work of the National Digestive Diseases Information Clearinghouse (NDDIC). The brochure is illustrated with line drawings designed to clarify the concepts discussed in the text. 12 figures.
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Diet and Diarrhea. Ostomy Quarterly. 41(2): 52. Winter 2004.
The ileoanal reservoir procedure is common for patients who must have their colon removed. The reservoir (pouch) is formed from the small intestine and provides a storage place for stool in the absence of the colon. With the colon gone, large quantities of fluid are lost with the stool. Bowel movements may be ten or more times a day. This brief article helps readers with ileoanal pouches to understand how dietary changes may help them decrease the number of bowel movements they experience each day. Some of the foods reported to help slow pouch output are yogurt, applesauce, tapioca, bananas, potatoes without the skin, and cheese. The author discusses the causes of diarrhea, the importance of replacing fluid and electrolytes lost during diarrhea, concerns about sugar consumption, the use of oral rehydration solutions, dietary fiber, potassium-rich foods, and experimenting with one's own diet (including the use of a food diary for accurate recordkeeping).
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How Do J-Pouches Work?. Ostomy Quarterly. 41(2): 49. Winter 2004.
Continent bowel diversions are made by creating internal pouches, or reservoirs. Pouches created in the pelvic area (j-pouch, pull-through) are 'reconnected' to allow the normal route of evacuation. This brief article helps readers understand how j-pouches work. The author reviews the normal physiology of the small intestine and colon to describe why the pouch is so vital (to store and concentrate stool). The author explains peristalsis (of the small intestine) and the process of elimination by gravity rather than with the muscles of the rectum. Practical toileting strategies are also provided. 1 figure.
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Neonatal Enteropathies: Defining the Causes of Protracted Diarrhea of Infancy. Journal of Pediatric Gastroenterology and Nutrition. 38(1): 16-26. January 2004.
This article reviews the underlying causes of chronic diarrhea beginning early in life. The authors note that infectious and post-infectious enteropathies and food sensitive or allergic enteropathy account for the majority of cases. Recent attention has focused on characterized defined entities which cause protracted diarrhea in infants and young children. Disorders of intestinal ion transport usually present at birth, following a pregnancy complicated by polyhydramnios. Intestinal mucosal biopsies show normal architect with intact villus-crypt axis. Neonatal enteropathies, by contrast, are characterized by blunting of the villi. These include microvillus inclusion disease, tufting enteropathy, autoimmune enteropathy, and IPEX syndrome. The article focuses on these four conditions. 5 figures. 1 table. 75 references.
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Acute Diarrhea in Children. Flourtown, PA: American Society for Pediatric Gastroenterology, Hepatology and Nutrition. 2003. 1 p.
Acute diarrhea is one of the most common illnesses in children and a common reason for doctor visits. The most common causes of acute diarrhea are viruses, bacteria and parasites, food poisoning, medications (especially antibiotics), food allergies, enzyme deficiencies (as in lactose intolerance), and toxic substances. This brief fact sheet considers acute diarrhea (defined as lasting less than one week) in children. The fact sheet defines the condition, then discusses its incidence (how common it is), the causes of the condition, diagnostic tests used to identify and confirm the problem, and treatment options. Acute diarrhea stops when the body clears the infection or toxic causing the problem. Most viruses and bacteria do not require treatment with antibiotics. If the diarrhea persists for longer than one or two weeks, stool and blood tests will help determine the most likely cause of the problem and can guide treatment strategies. Children with acute diarrhea should continue to eat their regular diet, unless the diarrhea is severe or accompanied by vomiting. In that case, replacement fluid mineral drinks are recommended. For more information, readers are encouraged to visit www.naspghan.org (the web site of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition).
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Approach to the Patient with Diarrhea. In: Textbook of Gastroenterology. 4th ed. [2-volume set]. Hagerstown, MD: Lippincott Williams and Wilkins. 2003. p. 844-894.
This chapter on the approach to patients with diarrhea is from a lengthy, two-volume textbook that integrates the various demands of science, technology, expanding information, good judgment, and common sense into the diagnosis and management of gastrointestinal patients. Topics include general epidemiology, general definition, pathophysiology of diarrhea, a definition of acute diarrhea, acute infectious diarrheas, prolonged infectious diarrheas, nosocomial diarrheas, runner's diarrhea, chronic diarrheas, steatorrhea (malabsorptive diseases), watery diarrheas, true secretory diarrheas, inflammatory diarrheas, the clinical evaluation of chronic diarrhea, and antidiarrheal therapy. 11 figures. 16 tables. 574 references.
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Diarrhea. In: Bonci, L. American Dietetic Association Guide to Better Digestion. Hoboken, NJ: John Wiley and Sons, Inc. 2003. p. 173-183.
Coping with a gastrointestinal disorder, whether it is irritable bowel syndrome (IBS), gas (flatulence), constipation, heartburn, or another condition, can be embarrassing and debilitating. While medical treatments and prescriptions can offer relief, one of the most important ways patients can help themselves is in their dietary choices. This chapter on diarrhea is from a book that describes how patients can self-manage their digestive disorders through dietary choices. In this chapter, the author first defines diarrhea, then discusses the varying symptoms of the condition, diagnostic considerations, treatment options, the impact of dietary choices on diarrhea (including the BRAT diet), foods that may produce loose stools, foods that may help control diarrhea, and dietary and herbal supplements that are not used to help with digestive disorders but that may have gastrointestinal side effects such as diarrhea. Treatment for diarrhea is designed to decrease the frequency of bowel movements, prevent dehydration, and prevent electrolyte loss (sodium and potassium, particularly). 2 figures.
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Diarrhea: Steps to Recovery. San Bruno, CA: StayWell Company. 2003. [2 p.].
This patient education brochure describes diarrhea and its treatment. Written in nontechnical language, the brochure first defines diarrhea as bowel movements that occur more frequently or are more watery than usual. Symptoms of diarrhea include looser, more watery stools than normal, more frequent stools than normal, more urgent need to pass stool, and pain or spasms in the digestive tract. Things that may irritate the digestive tract and lead to diarrhea include harmful bacteria or viruses or medications. Certain foods can cause diarrhea in some people; stress and anxiety can lead to diarrhea in others. Diagnosis will include the patient's medical history and some diagnostic tests such as stool sample testing and sigmoidoscopy. Treatment of the diarrhea depends on its cause. Diarrhea caused by infection needs to be treated by eradicating the underlying infection. Other treatment options can include an increase in drinking fluids, prescription medications, fasting, and following the BRAT (bananas, rice, applesauce, toast) diet. The brochure reminds readers to contact their health care provider if they have severe pain, high fever or bloody stool, or symptoms of dehydration. One section of the brochure illustrates and describes the physiology of normal bowel movements and what happens in diarrhea. The last page of the brochure summarizes the recommendations for recovering from diarrhea. The brochure is illustrated with full color line drawings. 6 figures.
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Small Intestine: Infections with Common Bacterial and Viral Pathogens. In: Textbook of Gastroenterology. 4th ed. [2-volume set]. Hagerstown, MD: Lippincott Williams and Wilkins. 2003. p. 1530-1560.
This chapter on infections of the small intestine is from a lengthy, two-volume textbook that integrates the various demands of science, technology, expanding information, good judgment, and common sense into the diagnosis and management of gastrointestinal patients. In this chapter, the authors focus on the major bacterial and viral pathogens that infect the small intestine. Whether by toxin-mediated effects or direct destruction of intestinal epithelial cells, these microbial pathogens have devised ways to disrupt the normal fluid handling capabilities of the intestinal tract and cause diarrhea. In general, the diarrhea caused by infection with a small bowel pathogen is characterized by high-volume, less frequent bowel movements, whereas lower-volume and more frequent bowel movements are associated with colonic diarrhea. Topics covered include food poisoning and common source outbreaks, traveler's diarrhea, bacterial infection, viral pathogens, and therapeutic considerations. Specific organisms discussed include Clostridium perfringens, Listeria monocytogenes, Escherichia coli, Salmonella, Yersinia, Vibrio (including Vibrio cholera), Aeromonas, Plesiomonas, Edwardsiella, rotavirus, Norwalk and Norwalk-like caliciviruses, astrovirus, and enteric adenovirus. Treatment options discussed include oral rehydration therapy (ORT), antimicrobial therapy, antidiarrheal drugs, and enteric vaccines. 5 tables. 368 references.
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Acute Diarrhea in Adults. In: Edmundowicz, S.A., ed. 20 Common Problems in Gastroenterology. New York, NY: McGraw-Hill, Inc. 2002. p. 159-176.
Acute diarrhea is an increase in stool liquidity or a decrease in consistency, often associated with an increase in stool frequency and volume compared with the patient's usual bowel habits. Diarrhea persisting beyond 4 weeks is regarded as chronic. This chapter on acute diarrhea in adults is from a book that focuses on the most common gastroenterological problems encountered in a primary practice setting. The chapter is organized to support rapid access to the information necessary to evaluate and treat most patients with this problems. Topics include definition and epidemiology; the general approach to patients with acute diarrhea; key history and physical examination points; ancillary tests, including stool examination, stool ova (eggs) and parasite examination; infectious agents, including viral diarrheas, bacterial diarrhea, toxin-induced diarrhea, inflammatory diarrhea due to invasive organisms, parasitic diseases, hospital-acquired diarrhea, traveler's diarrhea, diarrhea in the immunocompromised host, medications as a cause of diarrhea, idiopathic inflammatory bowel disease (IBD), diarrhea in runners, alcohol-induced diarrhea, and the emergence of new diarrheal syndromes and pathogens; patient management, including fluid and electrolyte replacement and food restriction; medications, including adsorbents, antimotility agents, antimicrobials, and antiemetics; patient education; and emerging concepts and controversies. The chapter includes an outline for quick reference, the text itself, a diagnostic and treatment algorithm, and selected references. 1 figure. 9 tables. 25 references.
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Bacterial Food Poisoning. Practical Gastroenterology. 26(10): 14-15, 19-20, 23. October 2002.
Despite the advances of modern civilization, food poisoning still remains a common cause of gastrointestinal illness, with an estimated 76 million persons annually experiencing foodborne illness in the United States. This article reviews the current thinking on bacterial food poisoning. The authors note that the two basic mechanisms in which illness can be transmitted through food are through a bacterial toxin or through bacterial invasion. These can result in either symptoms of nausea and vomiting or a diarrhea-predominant illness. The authors present and discuss brief vignettes, including a nausea and vomiting case and a diarrhea and dysentery case; and then discuss the differences in blood and non-bloody diarrheal syndromes. The authors conclude that most cases of foodborne illness are never reported to the Centers for Disease Control (CDC) and are usually treated by primary care physicians. Most cases are self-limited and do not require antimicrobial therapy. 1 figure. 10 references.
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Budesonide Treatment for Collagenous Colitis: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial. Gastroenterology. 123(4): 978-984. October 2002.
Collagenous colitis is an idiopathic (of unknown cause) microscopic colitis characterized by chronic watery diarrhea, a typical subepithelial collagen layer, and lymphoplasmacellular infiltration. This article reports on a randomized, double-blind, placebo-controlled multicenter study that investigated the effect of budesonide on symptoms and histology in patients with collagenous colitis. Patients with chronic diarrhea and histologically proven collagenous colitis were randomized to receive either oral budesonide 9 milligrams per day for 6 weeks, or placebo; 45 patients were available for per protocol analysis. The rate of clinical remission was significantly higher in the budesonide group than in the placebo group. Histologic improvement was observed in 14 patients of the budesonide group (60. 9 percent) and in 1 patient of the placebo group (4.5 percent). Two patients in the budesonide group (7.7 percent) and 1 patient in the placebo group (4.0 percent) discontinued treatment prematurely because of side effects. The authors conclude that oral budesonide (Entocort capsules) is an effective and safe treatment modality for patients with collagenous colitis. Long-term follow up of these patients is necessary to investigate whether clinical and histologic remission is sustained. 2 figures. 5 tables. 34 references.
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Compliance, Tone and Sensitivity of the Rectum in Different Subtypes of Irritable Bowel Syndrome. Neurogastroenterology and Motility. 14(3): 241-247. June 2002.
Irritable bowel syndrome (IBS) consists of various subtypes; it is unknown whether these subtypes share a common pathophysiology. Evaluation of motor and sensory function of the rectum using a barostat may help to explore a common pathophysiological background or differences in pathophysiology in subtypes of BIS. This article reports on a study in which authors evaluated compliance, tone, and sensitivity of the rectum, in both fasting state and postprandially (after a meal), using a computerized barostat in 15 patients with diarrhea-predominant IBS (IBSD), 14 patients with constipation-predominant IBS (IBSC), and 12 healthy controls. Rectal compliance was decreased in both IBS groups compared with controls. The perception of urge was increased only in IBSD patients, whereas pain perception was significantly increased in both IBS groups. Spontaneous adaptive relaxation was decreased in IBSD patients. Postprandially, rectal volume decreased significantly in the controls and in IBSD patients, but not in IBSC patients. In conclusion, both rectal motor and sensory characteristics are different between IBSD and IBSC patients. Therefore, testing of rectal visceroperception, adaptive relaxation, and the rectal response to a meal may help distinguish groups of patients with different subtypes of IBS. 5 figures. 2 tables. 23 references.
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Diarrhea. In: Feldman, M.; Friedman, L.S.; Sleisenger, M.H. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 7th ed. [2-volume set]. St. Louis, MO: Saunders. 2002. p. 131-153.
Diarrhea is a symptom of many conditions and thus the evaluation and management of diarrhea can be complex. This chapter on diarrhea is from a comprehensive and authoritative textbook that covers disorders of the gastrointestinal tract, biliary tree, pancreas, and liver, as well as the related topics of nutrition and peritoneal disorders. Topics include a definition of diarrhea; pathophysiology and mechanisms of diarrhea, including osmotic diarrhea, secretory diarrhea, and complex diarrhea; clinical classification; acute versus chronic diarrhea; differential diagnosis of diarrhea; evaluation of the patient with diarrhea; chronic watery diarrhea; chronic fatty diarrhea; chronic inflammatory diarrhea; nonspecific treatment of diarrhea; and highlights of selected diarrheal syndromes, including diarrhea in irritable bowel syndrome (IBS), microscopic colitis syndrome, postsurgical diarrhea, diarrhea in hospitalized patients, bile acid-induced diarrhea, factitious diarrhea, idiopathic secretory diarrhea, and diarrhea of obscure origin. The chapter includes a mini-outline with page citations, full-color illustrations, and extensive references. 9 figures. 8 tables. 175 references.
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Diarrhea. In: Reisman, A.B.; Setevens, D.L., eds. Telephone Medicine: A Guide for the Practicing Physician. Philadelphia, PA: American College of Physicians. p. 123-142.
This chapter on diarrhea is from a reference book for practicing physicians who are providing information for their patients over the telephone. The author notes that most episodes of acute diarrhea are self-limited and do not require or result in physician assistance. The chapter summarizes key points, then outlines an approach to diagnosing acute diarrhea and its sequelae in the adult patient. Topics include epidemiology, utility of early telephone evaluation, traveler's diarrhea, the general approach to the telephone evaluation, determining whether the patient is dehydrated, invasive versus noninvasive diarrhea, how to determine which patients need to be seen immediately (emergency room) and which patients can wait a few days to be seen (physician's office), recommended fluid intake, recommended anti-diarrheal medications, what to tell the patient, and what to document. The author notes that although most patients with acute diarrhea improve with symptomatic treatment at home, the physician needs to identify patients at high risk for complications such as severe dehydration, sepsis, and death. Physicians must also identify those requiring non-urgent referral for evaluation for underlying programs, such as colon cancer or inflammatory bowel disease. Finally, aggressive home treatment with the proper medications and appropriate fluids will lead to rapid symptomatic improvement in many patients and may prevent progression to severe dehydration. A patient care diagnostic algorithm is provided. 1 figure. 8 tables. 11 references.
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Diarrhea: Differentiating the Acute from the Chronic. Patient Care. p.52-56. July, 2002.
Diarrhea is a response of the bowel to infection, drugs, foods, or disease. Three factors can lead to the passage of unformed stools: an increase in intestinal fluid and electrolyte secretion (osmotic or secretory diarrhea), malabsorption of intraintestinal contents (due to damaged intestinal lining of the small bowel), and altered intestinal motility (dysmotility diarrhea). Proceeding directly to empiric or supportive therapy is often more practical than attempting to identify the cause of loose stools in some patients. This article focuses on differentiating acute and chronic diarrhea and how to determine which patients require diagnostic testing. Topics include the evaluation of acute and chronic diarrhea, and therapy for acute diarrhea. Stool examinations for ova and parasites may be indicated in patients when the illness originated during travel to high-risk areas or when illness persists longer than 2 weeks. Preventing dehydration is a major goal of therapy, and either over the counter (OTC) preparations or home remedies are often effective. Antibiotic therapy is generally not necessary for acute diarrheal episodes except when treatable parasites or some bacterial agents are known to cause the infection. 1 figure. 1 table. 4 references.
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Diarrhea: Differentiating the Acute from the Chronic. Patient Care. 36(9): 52-56. July , 2002.
This article assists general practice physicians in differentiating acute and chronic diarrhea, in evaluating both acute and chronic diarrhea, and in treating acute diarrhea. The authors note that proceeding directly to empiric or supportive therapy is often more practical than attempting to identify the cause of loose stools in some patients. Diarrhea present for less than a 2 week period is considered acute. Stool examinations for ova and parasites may be indicated in patients when the illness originated during travel to high-risk areas or when illness persists longer than 2 weeks. Preventing dehydration is a major goal of therapy, and either over the counter (OTC) preparations or home remedies are often effective. Antibiotic therapy is generally not necessary for acute diarrheal episodes. For chronic diarrhea, a physical examination often reveals important information about weight loss, fluid depletion, and signs of systemic illness. Possible causes include osmotic and secretory disorders, malabsorption syndromes, motility disorders, infections, and inflammatory bowel disease (IBD). 2 tables. 4 references.
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Efficacy of Probiotic Use in Acute Diarrhea in Children: A Meta-Analysis. Digestive Diseases and Sciences. 47(11): 2625-2634. November 2002.
This article reports on a study undertaken to review the effectiveness of probiotic use in reducing the duration of increased stool output in children with acute diarrheal illness. Studies eligible for review were limited to trials of probiotic therapy in otherwise healthy children less than 5 years old with acute-onset diarrhea. The main outcome variable was difference in diarrhea duration between treatment and control groups. The meta-analysis of 18 eligible studies suggests that coadministration of probiotics with standard rehydration therapy reduces the duration of acute diarrhea by approximately 1 day. In subsequent analyses limited to studies of hospitalized children, to double-blinded trials, and to studies evaluating lactobacilli, the pooled estimates were similar. The authors conclude that bacterial probiotic therapy shortens the duration of acute diarrheal illness in children by approximately one day. 2 figures. 1 table. 48 references.
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Escherichia Coli as a Cause of Diarrhea. Journal of Gastroenterology and Hepatology. 17(4): 467-475. April 2002.
Escherichia coli is the best known member of the normal microbiota of the human intestine and a versatile gastrointestinal pathogen (cause of disease). This article explores the role of E. coli as a cause of diarrhea. The varieties of E. coli that cause diarrhea are classified into named pathotypes, including enterotoxigenic, enteroinvasive, enteropathogenic, and enterohemorrhagic. Individual strains of each pathotype possess a distinct set of virulence-associated characteristics that determine the clinical, pathological and epidemiological features of the diseases they cause. In the article, the authors summarize the key distinguishing features of the major pathotypes of diarrhea-genic E. coli. Knowledge of the pathogenic mechanisms of these bacteria has led to the development of rational interventions for the treatment and prevention of E. coli induced diarrhea. The mainstay of antidiarrheal therapy is oral rehydration with sugar and electrolyte solutions. Importantly, patients suspected of being infected with these bacteria should not be treated with antibiotics because these may enhance toxin synthesis or promote its release from the bacteria with a consequent increased risk of hemorrhagic colitis. 4 figures. 4 tables. 59 references.
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Infectious Diarrhea and Bacterial Food Poisoning. In: Feldman, M.; Friedman, L.S.; Sleisenger, M.H. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 7th ed. [2-volume set]. St. Louis, MO: Saunders. 2002. p. 1864-1913.
This chapter on infectious diarrhea and bacterial food poisoning is from a comprehensive and authoritative textbook that covers disorders of the gastrointestinal tract, biliary tree, pancreas, and liver, as well as the related topics of nutrition and peritoneal disorders. Topics include changes in normal flora caused by diarrhea; classification of bacterial diarrhea; toxigenic diarrheas, including cholera, other vibrios, Aeromonas, Plesiomonas shigelloides, and Escherichia coli; invasive pathogens, including Shigella, nontyphoidal Salmonellosis, typhoid fever, Campylobacter, and Yersinia; viral diarrhea, including that due to rotavirus, calicivirus, enteric andenovirus, astrovirus, and torovirus; traveler's diarrhea, including microbiology, epidemiology, clinical features, and prevention; diarrhea in the elderly; diagnosis of infectious diarrheal disease; treatment of infectious diarrhea, including with fluid therapy, diet, antimicrobial drugs, and nonspecific therapy; tuberculosis of the gastrointestinal tract; and bacterial food poisoning, including that from Clostridium perfringers, Saphylococcus auerus, Listeria, Bacillus cereus, botulism, and Bacillus anthracis. The chapter includes a mini-outline with page citations, illustrations, and extensive references. 8 figures. 16 tables. 329 references.
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Meta-Analysis: The Effect of Probiotic Administration on Antibiotic-Associated Diarrhoea. Alimentary Pharmacology and Therapeutics. 16(8): 1461-1467. August 2002.
Antibiotic-associated diarrhea can be attributed in part to imbalances in intestinal microflora. Therefore, probiotic preparations are used to prevent the diarrhea. However, although several trials have been conducted, no conclusive evidence has been found to the efficacy of different preparations, e.g. Lactobacillus spp. and Saccharomyces spp. This article reports on a meta-analysis of the data in the literature on the efficacy of probiotics in the prevention of antibiotic-associated diarrhea. Twenty-two studies matched the inclusion criteria. Only seven studies (881 patients) were homogeneous. The results suggest a strong benefit of probiotic administration on antibiotic-associated diarrhea, but further data are needed. The authors conclude that the evidence for beneficial effects is still not definitive. Published studies are flawed by the lack of a placebo design and by peculiar population features. 2 figures. 3 tables. 39 references.
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Miscellaneous Colitides. In: Corman, M.L.; Allison, S.I.; Kuehne, J.P. Handbook of Colon and Rectal Surgery. Philadelphia, PA: Lippincott Williams and Wilkins. 2002. p.855-898.
This chapter on miscellaneous colitides is from a handbook that addresses the entire range of diseases affecting the colon, rectum, and anus. The authors discuss a number of inflammatory conditions of the bowel that, generally speaking, are either infectious or noninfectious. The common denominator for all of these illnesses is an association with the symptom of diarrhea. The authors caution that although most diarrheal conditions are self-limiting (in Western countries), an acute onset of diarrheal disease may be the initial presentation of an underlying disorder that mandates thorough gastrointestinal investigation. Topics include eosinophilic gastroenteritis or colitis; microscopic colitis; collagenous colitis; neutropenic enterocolitis, ileocecal syndrome, and typhlitis; diversion colitis, disuse colitis, and starvation colitis; disinfectant colitis (pseudolypomatosis); corrosive colitis; NSAID (nonsteroidal antiinflammatory drugs) induced colitis; toxic epidermal necrolysis; bacterial infections; viral infections; fungal infections; and parasitic infections. 27 references.
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Serotonin-Transporter Polymorphism Pharmacogenetics in Diarrhea-Predominant Irritable Bowel Syndrome. Gastroenterology. 123(2): 425-432. August 2002.
Irritable bowel syndrome (IBS) affects approximately 15 percent of adults, causes abdominal pain, discomfort, and altered bowel habits, and predominantly affects women. This article reports on a study of the use of serotonin (5HT) receptor antagonists in women with diarrhea- predominant IBS (DIBS). 5HT undergoes reuptake by a transporter protein (SERT). In the study, 30 patients (15 men, 15 women) with DIBS received 1 milligram twice a day of alosetron for 6 weeks; colonic transit was measured by scintigraphy at baseline and at the end of treatment. Results showed that SERT polymorphisms tended to be associated with colonic transit response; there was a greater response in those with long homozygous than heterozygous polymorphisms. Age, gender, and duration of IBS were not significantly different in the three groups (long, short, heterozygous). The authors conclude that genetic polymorphisms at the SERT promoter influence response to a 5HT antagonist in DIBS and may influence benefit to risk ratio with this class of compounds. 3 figures. 1 table. 57 references.
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Travel Risks: Update on Traveler's Diarrhea and Other Common Problems. Consultant. 42(14): 1778-1784. December 2002.
This article updates physicians on traveler's diarrhea and other common travel-related problems. The author notes that patients can greatly reduce the risk of traveler's diarrhea by drinking only bottled water and eating only hot foods prepared in sanitary conditions or peelable fruits and vegetables. Antibiotic prophylaxis for traveler's diarrhea is no longer routinely recommended; this approach should be reserved for patients who may have to consume food and beverages of questionable safety, those with reduced immunity, and those likely to experience serious consequences of illness. Adequate hydration is the first step in treating traveler's diarrhea. Drug therapy (loperamide or fluoroquinolones in adults and bismuth subsalicylate or azithromycin in children) can ameliorate symptoms and speed recovery. The article also discusses motion sickness, altitude sickness, travel medicine kits, and contraindications to air travel. 5 tables. 18 references.
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Tropical Malabsorption and Tropical Diarrhea. In: Feldman, M.; Friedman, L.S.; Sleisenger, M.H. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 7th ed. [2-volume set]. St. Louis, MO: Saunders. 2002. p. 1842-1853.
Malabsorption of dietary nutrients by the small intestine has special relevance for people living in the tropics and subtropics. The causes of intestinal malabsorption differ from those commonly seen in the industrialized world, and the clinical impact is often substantially greater because many persons in the developing world, particularly infants and young children, often exist in a state of borderline undernutrition. Tropical malabsorption can be caused either by specific causes, such as infections of known etiology and inflammatory and neoplastic disorders, or nonspecific conditions, such as tropical enteropathy and tropical sprue, for which the etiology has not been determined. This chapter on tropical malabsorption and tropical diarrhea is from a comprehensive and authoritative textbook that covers disorders of the gastrointestinal tract, biliary tree, pancreas, and liver, as well as the related topics of nutrition and peritoneal disorders. Topics include specific causes of tropical malabsorption, including intestinal infection, celiac sprue, lymphoma, severe undernutrition, and primary hypolactasia; nonspecific tropical malabsorption; the definition, epidemiology, pathophysiology, and theories of pathogenesis of tropical enteropathy; and the definition, historical aspects, epidemiology, clinical features, pathology, pathophysiology, pathogenesis, diagnosis, treatment, and prevention of tropical sprue. The chapter includes a mini-outline with page citations, illustrations, and extensive references. 7 figures. 2 tables. 171 references.
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Chronic Diarrhea: Differential Diagnosis and Management. Consultant. 41(1): 53-57. January 2001.
Diarrhea that lasts longer than 4 weeks is considered chronic. This article reviews the differential diagnosis and management of patients with chronic diarrhea. Physicians are advised to first examine the patient for signs of fluid and nutritional depletion. Patients should be asked about exacerbating and alleviating factors, diet, drug use, recent travel, abdominal pain, weight loss, and stool characteristics. Blood in the diarrhea may implicate malignancy or chronic inflammatory bowel disease; food particles or oil in the stool may indicate maldigestion or malabsorption. Fecal leukocytes suggest inflammation, and eosinophilia is seen with neoplasms, allergy, collagen vascular diseases, parasitic infestation, and colitis. Stool analysis for fecal weight, osmotic gap, fat, occult blood, pH, and laxative abuse is often important in making the diagnosis. A 24 hour stool collection weighing less than 200 grams suggests incontinence, irritable bowel syndrome (IBS), or rectal disease, but not true diarrhea. Stool weight of more than 500 grams is rare with IBS; weight of less than 1,000 grams rules out pancreatic cholera syndrome. When the weight exceeds 2,000 grams per day, patients usually require intravenous fluids. Treatment options include bismuth subsalicylate, opiates, bulking agents, kaolin attapulgite, anticholinergics, and cholestyramine. 1 figure. 3 tables. 15 references.
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Clinical Practice Guideline: The Management of Acute Gastroenteritis in Young Children. In: American Academy of Pediatric. Pediatric Clinical Practice Guidelines and Policies: A Compendium of Evidence-based Research for Pediatric Practice. Elk Grove Village, IL: American Academy of Pediatrics. 2001. p. 182-194.
This practice parameter formulates recommendations for health care providers about the management of acute diarrhea in children ages 1 month to 5 years. It was developed through a comprehensive search and analysis of the medical literature. Three specific management issues were considered: methods of rehydration, refeeding after rehydration, and the use of antidiarrheal agents. Main outcomes considered were success or failure of rehydration, resolution of diarrhea, and adverse effects from various treatment options. Oral rehydration was found to be as effective as intravenous therapy in rehydrating children with mild to moderate dehydration and is the therapy of first choice in these patients. Refeeding was supported by enough comparable studies to permit valid analysis. Early refeeding with milk or food after rehydration does not prolong diarrhea; there is evidence that it may reduce the duration of diarrhea by approximately half a day and is recommended to restore nutritional balance as soon as possible. Data on antidiarrheal agents were not sufficient to demonstrate efficacy; therefore, the routine use of antidiarrheal agents is not recommended, because many of these agents have potentially serious adverse effects in infants and young children. 1 figure. 3 tables. 93 references.
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Clostridium Difficile Infection. Participate. 10(3): 6-7. Fall 2001.
Clostridium difficile (a gram positive anaerobic bacterium) is now recognized as the major causative agent of colitis (inflammation of the colon) and diarrhea that may occur following antibiotic intake. This brief article on Clostridium difficile infection is from a newsletter from the International Foundation for Functional Gastrointestinal Disorders. The author notes that this bacterium is primarily acquired in hospitals and chronic care facilities following antibiotic therapy covering a wide variety of bacteria (broad spectrum) and is the most frequent cause of outbreaks of diarrhea in hospitalized patients. The author describes the development of the C. difficile infection, transmission factors, clinical features (symptoms), C. difficile infection in patients with other intestinal diseases, laboratory diagnosis, and therapy, including therapy for relapsing C. difficile infection.
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Dealing with Irregularity: Constipation, Diarrhea, Excessive Gas and Foul-Smelling Gas. Digestive Health and Nutrition. 3(1): 16-20. January-February 2001.
This article offers strategies for dealing with problems of bowel irregularity, including constipation, diarrhea, excessive gas, and foul-smelling gas. The author notes that bowel habits vary greatly among individuals, so each person's perception of whether there even is a problem and how to deal with it best is different. The author stresses that too little fiber and liquid in the diet are by far the most common reasons for constipation among people living in western cultures. The fiber found in foods such as fruits, grains, and vegetables adds bulk to the stool, making it easier to move through the colon (large intestine). Liquids add both bulk and fluid to the stool. Exercise helps prevent constipation by maintaining energy levels and promoting intestinal activity. A number of pain medications; antidepressants; antacids that contain aluminum; diuretics; and antiinflammatory and antiseizure medications are some of the many medications that can contribute to constipation. Changes in routines can also cause irregularity. The author explores the role of aging as a cause of constipation. Laxatives are an effective remedy for constipation, but they should be used with caution. As with constipation, diarrhea means different things to different people. Bacterial and viral infections are the most common causes of acute diarrhea; food intolerance is another frequent cause of both diarrhea and gas. Regardless of the cause, diarrhea usually lasts only a few days and ends on its own without the need for medical attention. The author reviews the concerns regarding dehydration, which can be a consequence of diarrhea, particularly in children and in the elderly. Gas comes from two sources: swallowed air and the breakdown of certain undigested foods in the large intestine. Simple ways of reducing the gas from swallowed air include eating and drinking more slowly, not chewing gum, and having dentures properly fitted. For episodes of excessive or smelly intestinal gas, the use of a food diary may help identify the offending items. The author concludes by reiterating the importance of adequate fiber and fluid intake. The websites of four information resource organizations are listed.
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Diarrhea and Malabsorption in the Elderly. Gastroenterology Clinics of North America. 30(2): 427-444. June 2001.
Diarrhea from infectious organisms is common in the elderly and leads to frequent hospitalizations and a relatively high mortality (death) rate in this population. Diarrhea can be a disabling manifestation of several systemic disorders, including diabetes mellitus, and drug induced diarrhea is particularly common in advanced age. This article, from a special issue on gastrointestinal (GI) disorders in the elderly, addresses diarrhea and malabsorption in the elderly. Although the physiologic functions of intestinal digestion and absorption of macronutrients and most micronutrients are not decreased simply as a function of aging, malabsorptive diseases including chronic pancreatitis and celiac disease (gluten intolerance) are more common in the elderly than has been realized in the past. A particular potential cause of covert malabsorption of macro and micronutrients in older patients is bacterial overgrowth, which may occur in the absence of 'blind loops.' The impact of silent malabsorption on the nutritional health of older patients may be more severe than in the young. Physicians who care for elderly patients are cautioned to be alert to the possible presence of diarrhea and malabsorption. Older patients may not admit to having chronic diarrhea, particularly if they are also incontinent. When an intestinal infection and potential medication-induced gastrointestinal disturbances have been excluded, the differential diagnosis of diarrhea in the elderly is the same as in the young. In the elderly, micronutrient deficiency is a common presenting clinical picture; because the symptoms of malabsorption are covert, the diagnosis often is delayed and nutritional deficiencies are more common and more severe than in the young. 1 table. 102 references.
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Diarrhea Following Small Bowel Resection. In: Bayless, T.M. and Hanauer, S.B. Advanced Therapy of Inflammatory Bowel Disease. Hamilton, Ontario: B.C. Decker Inc. 2001. p. 471-474.
This chapter on diarrhea following small bowel resection (removal) for Crohn's disease is from the second edition of a book devoted to the details of medical, surgical, and supportive management of patients with Crohn's disease (CD) and ulcerative colitis (UC), together known as inflammatory bowel disease (IBD). In intestinal diseases, such as CD and colitis, the normal orderly process of absorption is disrupted, and malabsorption of fluid and electrolytes may cause diarrhea. These intestinal diseases also may result in nutrient malabsorption and the consequences of malnutrition. Intestinal resection permanently removes one or more segments of the intestine. The extent of the absorptive defect depends upon which segment has been removed, how extensive the resection has been, and the ability of other segments to compensate for the missing functions of that segment. Diarrhea can develop shortly after recovery from surgery and refeeding, or some time after recovery from surgery. The time of onset after surgery is an important clue to the possible cause of the diarrhea, thus, careful patient history is crucial for appropriate diagnosis. If a specific problem, such as bacterial overgrowth, is identified, specific treatment can be applied and may substantially improve the situation. Often a specific treatable entity cannot be diagnosed and nonspecific treatment must be applied. Nonspecific treatment can provide significant improvement in symptoms and allow for use of the absorptive surface of the intestine in a more efficient fashion. Nonspecific treatments include diet therapy (reduction in fat intake, frequent feedings, dietary supplements, reduced caffeine intake); antidiarrheal medications; stool modifying agents; adjunctive medications; and replacement therapy (oral rehydration solution, vitamins). 4 tables. 8 references.
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Gastrointestinal Complications in Stem Cell Transplantation. In: Bayless, T.M. and Hanauer, S.B. Advanced Therapy of Inflammatory Bowel Disease. Hamilton, Ontario: B.C. Decker Inc. 2001. p. 649-654.
Stem cell transplantation (SCT) is the standard of care for the treatment of many hematologic (blood) malignancies, pediatric solid tumors, inherited disorders, and aplastic anemia (a deficiency of all the formed elements of blood). SCT also is being used to treat many autoimmune disorders in experimental situations. This chapter on gastrointestinal complications in SCT is from the second edition of a book devoted to the details of medical, surgical, and supportive management of patients with Crohn's disease (CD) and UC, together known as inflammatory bowel disease (IBD). Several patients with CD and leukemia have remitted or remained in remission after bone marrow transplantation. Complications related to SCT are becoming more widely recognized. Gastrointestinal complications of SCT result from preparative regimen toxicity, infection, and acute and chronic graft-versus-host (GVH) disease, which may be difficult to diagnostically separate and are therefore addressed in this chapter. Diarrhea related to toxicity induced by the preoperative regimen may last until day 15 after SCT. Infectious causes of diarrhea must be considered and can include bacterial and viral pathogens. Once infectious causes are ruled out, antidiarrheal agents (such as loperamide) may be initiated. Nausea, vomiting, and anorexia occur commonly during the preparative regimen; if they are severe, total parenteral (outside the GI tract) nutrition (TPN) must be used. At its simplest level, GVH disease arises from the recipient's immune recognition of minor antigenic differences between donor and recipient. Patients with gut GVH disease present with abdominal pain, nausea, and vomiting or diarrhea. The physical examination and history may include a rash on the hands, feet, and ears. In addition, significant GI bleeding may occur post transplant and contribute to higher mortality associated with SCT. 4 figures. 10 references.
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Gastrointestinal Conditions in the Endurance Athlete. Practical Gastroenterology. 25(12): 13, 17-18, 20, 22, 24. January 2002.
Endurance athletic events have become plentiful in recent decades and can include distance running, cycling, rowing, and swimming, alone or in combination. Gastrointestinal (GI) conditions can occur in both the recreational and competitive endurance athlete. This article reviews the most common exercise related GI disorders, including diarrhea, GI bleeding, abdominal pain, and gastroesophageal reflux (return of the stomach's gastric acid to the esophagus). The author encourages primary care providers and gastroenterologists to familiarize themselves with the symptoms and care of the various gastrointestinal manifestations of endurance athletics. The author focuses on two specific groups who experience exercise-induced diarrhea who may require additional attention: older athletes (older than 40 years) and athletes who experience symptoms such as gross bleeding, abdominal pain, weight loss, fevers, or a persistent change in bowel habits. 1 table. 32 references.
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Guidelines for Adults on Self-Medication for the Treatment of Acute Diarrhoea. Alimentary Pharmacology and Therapeutics. 15(6): 773-782. June 2001.
Acute uncomplicated diarrhea is commonly treated by self medication. Guidelines for treatment exist, but are inconsistent, sometimes contradictory, and often owe more to dogma than to evidence. This article reports on a review of the literature to determine best practice and guidelines for adults on self medication for the treatment of acute diarrhea. In general, it is recognized that treatment of acute episodes relieves discomfort and social dysfunction. There is no evidence that it prolongs the illness. Self medication in otherwise healthy adults is safe. Oral loperamide is the treatment of choice. Older antidiarrheal drugs are also effective in the relief of symptoms, but carry the risk of unwanted adverse effects. Oral rehydration solutions do not relieve diarrhea and confer no added benefit for adults who can maintain their fluid intake. Probiotic agents are, at present, limited in efficacy and availability. Antimicrobial drugs, available without prescription in some countries, are not generally appropriate for self medication, except for travelers on the basis of medical advice prior to departure. Medical intervention is recommended for the management of acute diarrhea in the frail, the elderly (older than 75 years), persons with concurrent chronic disease, and children. Medical intervention is also required when there is no abatement of the symptoms after 48 hours, or when there is evidence of deterioration, such as dehydration, abdominal distention, or the onset of dysentery (fever and or bloody stools). 1 table. 79 references.
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Impact of Vitamin A Supplementation to Rural Children on Morbidity Due to Diarrhoea. Indian Journal of Medical Research. 113: 53-59. February 2001.
A number of studies have shown the association between vitamin A deficiency and the increased risk of diarrheal and other childhood morbidities (illnesses) and mortality (death). However, some studies have raised controversies regarding the reduction of the incidence of diarrhea after vitamin A supplementation to children. This article reports on a study undertaken to evaluate the effectiveness of vitamin A supplementation to young rural children in reducing the incidence of diarrhea. The double blind randomized intervention trial was carried out amongst 404 rural children between 6 and 59 months of age to assess the impact of vitamin A supplementation on morbidity due to diarrhea. Children were allocated to receive either 200,000 or 50,000 International Units (IU) of vitamin A; the same dose was repeated after six months. Morbidity due to diarrhea was observed by twice a week household surveillance, during the subsequent one year of follow up. The incidence of diarrhea in the two supplemented groups was also compared with the incidence observed during the year preceding supplementation. The incidence of diarrhea was similar in the two supplemented groups. However, the overall incidence of diarrhea among all the children in the two supplemented groups (0.56 episodes per child per year) was significantly lower than the incidence before supplementation (1.15 episodes per child per year). The results of this study indicate that vitamin A supplementation in a dose of 200,000 IU has no additional advantage over 50,000 IU, at least when the aim is to reduce the incidence of diarrhea. For control of morbidity due to diarrhea, vitamin A supplementation in a dose of 50,000 IU every six months appears to be adequate, cost effective, and suitable for younger children. 3 tables. 21 references.
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Purines, Alcohol and Boron in the Diets of People with Chronic Digestive Problems. Journal of Nutritional and Environmental Medicine 11(3): 23-32. September 2001.
This article reports on a study undertaken to determine whether there is a significant relationship between the consumption of alcohol, purines, and boron, and the incidence of irritable bowel syndrome (IBS) or frequent diarrhea. The study includes 120 individuals, seeking help with chronic health problems, who were assessed for their intake of purines, alcohol, and boron, which are dietary items that use body stores of vitamin B2 and molybdenum. The patients stated whether they had IBS or frequent diarrhea. The proportions with different types of diet who had symptoms were compared. The group was extended to 578 individuals, and the calculations repeated, both for the whole group and for males and females separately. In all three groups, those with higher intakes of alcohol, purines, and boron had a higher prevalence of IBS or frequent diarrhea. The relationship was found to be significant. High purine foods commonly eaten are meats, herring, mackerel, sardines, and yeast; other sources include mussels, roe, scallops, and some spices. Boron, a toxic mineral, can be found in tomatoes, peppers, apples, pears, peaches, plums, grapes, soya, parsnips, rosehips, hazelnuts, peanuts, and almonds. The author concludes that reducing alcohol, purines, and boron in the diet of patients with IBS or chronic diarrhea may be a cost effective treatment. One appendix reprints the nutrition and allergy clinic questionnaire that was used to gather patient information about dietary habits. 6 tables. 17 references.
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Technical Report Summary: Acute Gastroenteritis. In: American Academy of Pediatric. Pediatric Clinical Practice Guidelines and Policies: A Compendium of Evidence-based Research for Pediatric Practice. Elk Grove Village, IL: American Academy of Pediatrics. 2001. p. 195-201.
The practice parameter on acute gastroenteritis (published concomitantly in this journal) is intended to present current knowledge about the optimal treatment of children with diarrhea. This technical report details the process followed in the development of the practice parameter, and presents the evidence used to formulate the final recommendations. The authors describe the development of the evidence model, the literature review, article selection, statistical methods, recommendations and level of evidence. Three areas were considered: oral rehydration therapy versus intravenous therapy; early refeeding; and drug therapy for diarrhea. Conclusions were that oral rehydration therapy (ORT) is recommended as the preferred treatment of fluid and electrolyte losses due to diarrhea in children with mild to moderate dehydration. Appropriate diets are recommended during an episode of diarrhea as soon as rehydration has been achieved. Drug agents are not recommended to treat acute childhood diarrhea.
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Case Study: Antibiotic-Induced Acute Diarrhea. Physician Assistant. 24(11): 56-58. November 2000.
This article reports the case of a 57 year old woman who presented to the emergency department with a 4 day history of abdominal cramps, nausea, and 2 to 3 episodes of watery diarrhea per day. She denied fever, vomiting, or bright red rectal bleeding. Her medical history was significant for seasonal allergic rhinitis, sinusitis, and depression. The differential diagnosis in this case included acute gastroenteritis, nonspecific abdominal pain, infectious diarrhea, giardiasis, Crohn's disease, ulcerative colitis, and antibiotic associated colitis (AAC). Because the clinical suspicion was high for AAC, the patient was given the diagnosis of presumptive Clostridium difficile enterocolitis and the cefpodoxime (a drug she was taking for the sinus infection) was stopped. She was started on metronidazole (Flagyl) 500 milligrams 3 times daily for 10 days and placed on a banana, applesauce, rice, and toast (BRAT) diet. At a family practice follow up appointment 2 days later, the patient was feeling much better. Laboratory studies showed presence of C. difficule toxins. The article describes this patient's need for a second course of drug therapy before complete resolution of the problem. The discussion section notes that antibiotic precipitated diarrhea is fairly common and may occur during the course of treatment or for several weeks after termination of the therapy. The first step for treating this disorder is discontinuing the probably offending antibiotics and starting treatment empirically with Flagyl or oral vancomycin. Antispasmodics are not recommended as they may worse the infectious process by prolonging contact between the organism and the intestinal mucosa. If the symptoms persist despite appropriate therapy, consultation with an infectious disease specialist is indicated. 3 references.
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House Call. Digestive Health and Nutrition. p. 26-27. May-June 2000.
This column is a regular feature in Digestive Health and Nutrition; in each issue, the medical editor and associate editors answer reader questions about gastroenterological concerns. This entry addresses six topic areas: the outward symptoms of hepatitis C, diarrhea and gas with weight loss (possibly triggered by the use of herbal remedies), chronic hepatitis C, tests to monitor liver cancer, posttherapy complications of antibiotics, and uncontrollable weight loss. Chronic hepatitis C infection can result in cirrhosis (scarring) of the liver with ascites (fluid in the abdominal cavity) and low clotting factors, leading to easy bruising. Low response to the hepatitis C drugs is disappointing, but they should still be tried, since some responses are dramatic. In some patients, chronic hepatitis C may lead to cirrhosis followed by liver failure or the development of primary liver cancer (hepatocellular carcinoma), usually after 20 to 40 years of infection. It is generally recommended that patients with hepatitis C and cirrhosis undergo semiannual testing with ultrasound and alphafetoprotein. There are many herbs that can cause diarrhea, but in almost all cases the diarrhea stops when the patient stops taking the herbal remedy. Antibiotics can themselves cause diarrhea (notably the antibiotic induced infection Clostridium difficile). Ciprofeoxacin and metronidazole may help chronic diarrhea if the condition is due to bacterial overgrowth secondary to a blind loop syndrome, small intestinal diverticulosis, or a stagnant small intestine. The author concludes that weight loss is not a symptom of irritable bowel syndrome and usually indicates another condition.
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Investigation of Diarrhea in AIDS. Canadian Journal of Gastroenterology. 14(11): 933-940. December 2000.
Chronic diarrhea is a common problem in patients with AIDS, resulting in significant morbidity (illness) and potential mortality (death). In the early stages of immunodeficiency, HIV infected patients are susceptible to infection with the same enteric pathogens that cause diarrhea in immunocompetent hosts, but with progressive immunodeficiency, these patients become susceptible to numerous opportunistic disorders. This article reviews the investigation of diarrhea in patients with AIDS. The main factor to consider when tailoring the work up of diarrhea in the HIV infected patient is the immune status, which is reflected by the total CD4 lymphocyte cell count. A CD4 count of less than 100 cells per microliter is significantly correlated with opportunistic disorders. For the HIV infected patient with diarrhea, repeated stool studies to investigate for bacteria, ova (eggs of parasites), and parasites should be the first step. When either upper or lower gastrointestinal tract symptoms are present and stool studies are negative, endoscopy directed to the probable organ of involvement is appropriate. If localizing symptoms are absent, the most appropriate next test is sigmoidoscopy with biopsies. Not infrequently, despite extensive evaluation, the cause of diarrhea in patients with AIDS remains unexplained. Recently, the widespread use of highly active antiretroviral therapy, including protease inhibitors, has led to a change in the epidemiology of diarrhea in AIDS patients. As their immune status improves, HIV infected patients treated with combination therapy become less prone to opportunistic disorders. However, diarrhea appears to be frequent because several antiretroviral agents can themselves cause diarrhea. 3 tables. 58 references.
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Mind-Gut Connection. Digestive Health and Nutrition. p. 20-24. May-June 2000.
Emotions may play an important role in the digestive system. Gastroenterologists have found that for many patients, treatment for some digestive disorders must be geared toward the emotional as well as the physical aspects of their condition. This article explores this connection between mind and gut, focusing on the role of stress. The effects of stress on the digestive system can include slowing down the rate at which food leaves the stomach, causing changes in bowel habits, and stimulating the grown of certain unwanted bacteria (germs) in the stomach. Mental health may have a particular role in the functional gastrointestinal (GI) disorders, including irritable bowel syndrome (IBS), functional diarrhea, functional chest pain, and functional dyspepsia (frequent episodes of discomfort or pain in the upper abdomen that are not related to meals or defecation). Mental health may also play a part in some inflammatory conditions such as Crohn's disease or ulcerative colitis, although there is little evidence to support this theory. For patients with mild symptoms of a functional GI disorder, treatment might consist solely of lifestyle modifications and diet changes. For short bouts of diarrhea, like those experienced by a student before a test or by a nervous speaker before a presentation, over the counter medications may provide effective relief. If these medications are not effective, the physician may prescribe drugs that delay the passage of waste through the digestive tract by slowing bowel contractions. For more chronic conditions, antidepressants may be prescribed to raise the pain threshold and to reduce psychological distress, thereby easing bowel symptoms. One sidebar summarizes some of the common GI conditions and symptoms that may be affected by mental health, including noncardiac chest pain, ulcers, irritable bowel syndrome, and chronic functional abdominal pain. Another sidebar reviews psychological approaches to treatment, including hypnosis, cognitive behavioral treatment and stress management, biofeedback, and relaxation techniques. The article concludes with a brief list of sources for additional information (primarily websites).
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Multiyear Prospective Study of the Risk Factors for and Incidence of Diarrheal Illness in a Cohort of Peace Corps Volunteers in Guatemala. Annals of Internal Medicine. 132(12): 982-988. June 20, 2000.
Diarrheal illness is the most common medical disorder among travelers from developed to developing countries and is common among expatriate residents in developing countries. This article reports on a prospective longitudinal study undertaken in rural Guatemala to assess the risk factors for and incidence of diarrheal illness among Americans living in a developing country. The study cohort was 36 Peace Corps volunteers and the study included collection of daily dietary and symptom data for more than 2 years. The 36 volunteers in this study had 307 diarrheal episodes (mean, 7 per person), which lasted a median of 4 days (range, 1 to 112) and a total of 10.1 percent of the 23,689 person-days in the study. The incidence density (episodes per person year) was 4.7 for the study as a whole, 6.1 for the first 6 month period, 5.2 for the second 6 month period, and 3.6 thereafter. Statistically significant risk factors for diarrheal illness included drinking water whose source and quality were unknown (for example, the tap); eating food prepared by a Guatemalan friend or family; eating food at a small, working class restaurant; eating fruit peeled by someone other than a Peace Corps volunteer; drinking an iced beverage; and eating ice cream, ice milk, or flavored ices. Exposures generally were riskier if they occurred during travel elsewhere in Guatemala rather than in the person's usual work area. The authors conclude that diarrheal illness of mild to moderate severity continued to occur throughout Peace Corps service but decreased in incidence as length of stay increased. Various dietary behaviors increased the risk for diarrheal illness, which suggests that avoidance of potentially risky foods and beverages is beneficial. 1 figure. 3 tables. 25 references.
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Prescription Medications That Can Be Harmful to the Digestive System. Digestive Health and Nutrition. p. 26-29. September-October 2000.
This article reviews the possible negative impact of prescription medications on the digestive system. Drugs that are swallowed enter the body through the gastrointestinal (GI) tract, making it an easy target for side effects. However, injected or infused drugs can also upset the GI tract. Sometimes taking the drug with food will decrease GI side effects; however, food can interfere with the actions of some medications. Nonsteroidal antiinflammatory drugs (NSAIDs) are very effective in helping to reduce the inflammation and pain caused by arthritis and other conditions, however, they increase the risk of ulcers when taking long term. Damage also can occur in the small and large intestine due to the prolonged use of NSAIDs. The drugs can bring about a relapse of inflammatory bowel disease (IBD) and they may cause a rare condition called collagenous colitis or cause diverticula pouches in the colon wall to bleed or perforate. Diarrhea is another common and potentially serious side effect of some prescription drugs; antibiotics, in particular, often cause diarrhea. Other drugs that cause diarrhea, include chemotherapy cancer drugs, magnesium-containing antacids, the antiobesity drug Xenical, and some diabetes drugs. In addition, some drugs can slow the motility of the GI tract or can limit activities, resulting in constipation. Other GI problems can include esophageal irritation (from oral pills getting stuck in the esophagus), liver toxicity, and pancreatitis (inflammation of the pancreas). The author concludes by reminding readers that most drugs have the potential for causing GI upset and that patients should work closely with their physicians to monitor side effects. 1 table.
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Safe at the Table. Digestive Health and Nutrition. p. 28-31. May-June 2000.
Foodborne illness, more commonly referred to as 'food poisoning,' is a frequent but underrecognized cause of gastrointestinal distress that can lead to complications and even death. This article reviews foodborne illness and offers strategies for preventing food contamination. Quick diagnosis is essential to help prevent the sometimes lethal effects of a foodborne illness; however, diagnosis can be difficult since food poisoning is often confused with stomach flu. Headache, vomiting, diarrhea, abdominal cramps, and fever can accompany either illness. And with the onset of food poisoning, symptoms occur sometimes as late as 36 hours after ingestion, so it is natural to first blame an intestinal bug rather than food ingested the day before yesterday. Children and infants are particularly threatened by foodborne bacterial infections, especially Escherichia coli, which can lead to the development of a secondary disorder called hemolytic uremic syndrome (HUS). Contamination of food by infected food handlers is probably the most common cause of foodborne illness; other common causes include eating shellfish harvested from sewage polluted waters, or improperly prepared chicken and other types of poultry. The article reviews the more common foodborne contaminants: Salmonella and Campylobacter, Perfringens, E. coli, Staphylococcus, and Listeria monocytogenes. The article concludes with a brief list of additional resources, including government agencies and websites. 2 tables.
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