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PubMed1999

Functional outcome after colectomy and ileorectal anastomosis compared with proctocolectomy and ileal pouch-anal anastomosis in familial adenomatous polyposis.

OBJECTIVE: To compare the long-term functional results of ileorectal anastomosis (IRA) with those of ileal pouch-anal anastomosis (IPAA) in patients with familial adenomatous polyposis (FAP). SUMMARY BACKGROUND DATA: In patients with FAP, hundreds of colorectal adenomas develop, and the patient will die of colorectal cancer if left untreated. The surgeon must choose between colectomy with IRA and restorative proctocolectomy with IPAA. One factor crucial to decision making is the functional outcome after either procedure. To date, studies on this issue have reported conflicting results and have been based on small series of patients. METHODS: To assess various functional variables, a questionnaire was sent to 323 patients with FAP who underwent either IRA or IPAA and who were registered at the Netherlands Foundation for the Detection of Hereditary Tumors. The overall response rate was 86%; the responders comprised 161 patients who underwent IRA and 118 patients who underwent IPAA. RESULTS: Patients who underwent IRA scored significantly better for daytime and nighttime stool frequency, soiling, occasional passive incontinence, flatus and feces discrimination, stool consistency, and need for antidiarrheal medication. There was no difference with regard to perianal irritation, episodes of bowel discomfort, or dietary restrictions. The functional results according to the aggregate score of the Gastro-Intestinal Functional Outcome Scale, where the items specified above were integrated (0 indicating a poor and 100 a good overall function), were significantly better in patients with an IRA (74.5) than in patients with an IPAA (66.0) (p < 0.01). CONCLUSION: The functional outcome after IRA is significantly better than after IPAA. On the basis of these results, IRA might still be considered in patients with a mild phenotypic expression of the disease in the rectum.

Adenomatous Polyposis Coli↗
PubMed2004

Microscopic colitis.

Microscopic colitis is a condition that is clinically underrecognized as a cause of chronic or intermittent diarrhea and can be diagnosed only by mucosal biopsy. Microscopic colitis is more common in middle-age to elderly women, appears to be induced by some medications, particularly nonsteroidal antiinflammatory drugs, and has been associated with autoimmune conditions and sprue. Symptomatic treatment includes cholestyramine and antidiarrheal medications. Bismuth subsalicylate, and 5-amniosalicylates are therapeutic options; however, budesonide is more effective in achieving clinical and histologic improvement and/or remission and has been studied in more randomized trials. Use of immune modulators should be restricted to more severe cases that are steroid refractory or steroid dependent. Surgical intervention should be reserved for a very highly select group of refractory cases. Diverting ileostomy or colectomy appear to be equally effective surgical alternatives for microscopic colitis, which is not a risk factor for carcinoma.

Journal Article↗
PubMed1994

Octreotide therapy of large-volume refractory AIDS-associated diarrhea: a randomized controlled trial.

OBJECTIVE: To compare the effect of octreotide (a long-acting somatostatin analog) to that of antidiarrheal therapy plus placebo on large-volume refractory AIDS-associated diarrhea. DESIGN: A randomized controlled trial. SETTING: Referral-based clinic and hospital in a tertiary care center. PATIENTS: Twenty male patients with AIDS and refractory diarrhea, with stool volume > 1000 ml/day who failed to improve after initial supportive management. All patients finished the study. INTERVENTIONS: Patients were randomly given either octreotide in doses of 100, 200 and 300 micrograms subcutaneously every 8 h, or high doses of loperamide and diphenoxylate orally plus placebo subcutaneously for 10 days. MAIN OUTCOME MEASURES: Bowel movements and stool volume were registered before and every day after treatment by the patients themselves and the nursing personnel. RESULTS: Patients from both groups were similar for age, time of AIDS diagnosis, duration of diarrhea and etiology. Baseline mean bowel movements per day (9.4 +/- 2.8 in the octreotide group versus 10 +/- 3.1 in controls) and baseline mean stool volume (2753 +/- 840 versus 2630 +/- 630 ml/day, respectively) were similar in both groups before therapy (P < 0.05). Mean bowel movements per day after 10 days of therapy was 2.1 +/- 1.6 in the octreotide group versus 7 +/- 3 in controls (P < 0.05). Mean stool volume after 10 days of therapy was 485 +/- 480 in the octreotide group versus 1080 +/- 420 ml/day in controls (P < 0.05). Complete response (stool volume < 250 ml/day) was observed in two patients from the octreotide group and none from controls; partial response (decrease > 50% in stool volume) in four and two; and no response (decrease < 50% or no change) in four and eight (P < 0.05), respectively. Side-effects occurred in eight out of 10 octreotide patients and three out of 10 controls (P < 0.05), but none were significant to result in discontinuation of medication. CONCLUSION: Octreotide proved to be superior to conventional therapy in this short-term treatment of large-volume refractory AIDS-associated diarrhea.

Acquired Immunodeficiency Syndrome↗
PubMed1993

The treatment of autonomic dysfunction.

Autonomic dysfunction is responsible for much of the morbidity associated with frequently encountered neurological disorders, such as Parkinson's disease, multiple sclerosis, cerebrovascular disease, and peripheral neuropathies, as well as with the rarer primary autonomic nervous system degenerations. We review the treatment of those aspects of autonomic dysfunction that often present to the neurologist, including orthostatic hypotension, urinary incontinence and retention, and bowel dysmotility syndromes. Pathophysiology is discussed in each instance as it relates to a rational approach to therapy. For management of orthostatic hypotension, we review the use of mineralocorticoids, direct and indirect sympathomimetic agents, other pressors, dopamine-blocking agents, vasopressin receptor agonists, and others. Treatment of urinary incontinence and retention is addressed, with attention to drugs that modulate bladder contractility and bladder outlet resistance. Therapies for bowel dysmotility syndromes (such as gastroparesis, diarrhea, and fecal incontinence) are described, including bulk agents, laxatives, prokinetic agents, and antidiarrheal drugs.

Autonomic Nervous System Diseases↗
PubMed1998

A clinical approach to fecal incontinence.

Fecal incontinence is the impaired ability to control gas or stool. It is a disabling and distressing condition. Its exact incidence and prevalence are unknown. It is a disorder about which patients are frequently reluctant to discuss, even with their physician. However, it is a common condition especially in older individuals, where the prevalence has been reported to approach 60%. In women, incontinence reaches 54% as a result of childbirth. Of the patients surgically treated, the female-to-male ratio is 4 to 1. In an epidemiological study to identify its community-based prevalence, the University of Illinois determined fecal incontinence existed in 2.2% of the general population. There is available treatment for fecal incontinence. Many patients improve with conservative treatment (constipating agents, antidiarrheal medications, dietary changes) or with biofeedback. For patients where conservative treatment has failed, surgical treatment (direct-apposition sphincter repair, overlapping sphincteroplasty, postanal repair, neosphincter procedures) may be successful.

Adult↗
PubMed1984

Effects of loperamide on intestinal ion transport.

The synthetic opiate loperamide (LPMD) is an antidiarrheal compound which affects both intestinal motility and the transport of water and electrolytes. We have investigated its effects on ion transport in the stripped ileal mucosa of rabbits, mounted in Ussing chambers in vitro. Addition of LPMD to serosal bathing medium resulted in a dose-dependent decrement of short-circuit current (Isc). LPMD (50 microM) significantly increased net Cl absorption (JClnet) and JRnet (assumed to represent HCO3 secretion). LPMD also inhibited the Isc increments evoked either by agents that increase 3',5'-cyclic adenosine monophosphate (cAMP) content (theophylline and prostaglandin E2) or by the Ca2+ ionophore A23187; the opiate, however, did not prevent the Isc change induced by 3',5'-cyclic guanosine monophosphate (cGMP)-related agents such as 8-Br-cGMP and Escherichia coli heat-stable enterotoxin. LPMD did not alter basal or secretagogue-stimulated tissue cAMP. In contrast, LPMD caused a small increase in cGMP content of stripped ileal mucosa, but not in that of isolated enterocytes. The role of Ca2+ in LPMD action is suggested by the significantly different effect of the drug on JClnet in the presence and in the absence of Ca2+ in the serosal solution.

Animals↗
PubMedDate not supplied

Straight ileoanal anastomosis and ileal pouch-anal anastomosis in the surgical management of idiopathic ulcerative colitis and familial polyposis coli in children: follow-up and comparative analysis.

We compared the postoperative course in children and teenagers who underwent subtotal colectomy, mucosal proctectomy, and either straight ileoanal anastomosis (group 1, n = 8) or ileal pouch-anal anastomosis (group 2, n = 10) for the surgical treatment of idiopathic ulcerative colitis (n = 15) and familial polyposis coli (n = 3). Two of eight children in group 1 developed intractable diarrhea that persisted despite revision of the anastomosis to include an ileal pouch; therefore, ileostomies were necessary in both cases. One patient in group 2 had a diverting ileostomy as a result of abscess formation at the site of the ileoanal anastomosis. Despite a longer period of postoperative follow-up (48.9 +/- 11.8 months), the remaining six patients in group 1 had a significantly greater number of bowel movements each day (7.8 +/- 6.5) as compared with the nine patients in group 2 who had 4.8 +/- 2.6 stools each day (p less than 0.05) at a mean follow-up of 15.7 +/- 9.0 months. A proportion of children in both groups had a poor postoperative functional outcome as determined by fecal incontinence (2 of 6 in group 1, 6 of 9 in group 2), perianal dermatitis (2 of 6, 4 of 9), and therapy with the antidiarrheal agent loperamide (4 of 6, 2 of 9). Increased school attendance (5 of 6, 7 of 7) and improvement in level of participation in social activities (5 of 6, 7 of 7) as compared with the 6-month period prior to surgery occurred, however, for most of the children with ulcerative colitis in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenomatous Polyposis Coli↗
PubMed1993

Smectite in acute diarrhea in children: a double-blind placebo-controlled clinical trial.

Dioctahedral smectite (DS) a natural adsorbent clay capable of adsorbing viruses, bacteria, and other intestinal irritants in vitro, is claimed to possess beneficial "antidiarrheal" properties. This study tested the effect of DS on the duration of diarrhea and the frequency and amount of liquid stools. Ninety well-nourished boys, aged 3-24 months, with acute watery diarrhea and mild, moderate, or severe dehydration were included in a randomized double-blind, placebo-controlled trial. After initial rehydration, they received DS or placebo (1.5 g freshly dissolved in 50 ml of water, four times daily for 3 days) along with oral rehydration solution (ORS) and adequate feeding. The clinical characteristics of both groups were comparable on admission. Patients in the smectite group had a significantly shorter duration of diarrhea (mean +/- SD, 54 +/- 16 vs. 73 +/- 13 h) and significantly fewer stools (2.6 +/- 0.8 vs. 3 +/- 0.7 on second day; 1.9 +/- 0.7 vs. 2.4 +/- 0.7 on third day; and 11.3 +/- 3.2 vs. 13.8 +/- 3 overall). The amount of liquid stools was not significantly reduced. Weight gain at 24, 48, and 72 h and on recovery was significantly higher in the smectite group despite the comparable fluid and food intake in both groups. These results suggest a beneficial effect of DS in shortening the duration of diarrhea and reducing the frequency of liquid stools in children rehydrated with ORS.

Acute Disease↗
PubMed2001

Tolerability of enteric-coated didanosine capsules compared with didanosine tablets in adults with HIV infection.

BACKGROUND: A new enteric-coated (EC) didanosine (ddI) formulation (Videx EC; Bristol-Myers Squibb, Princeton, NJ, U.S.A.) may be better tolerated than the tablet form because it lacks the buffer component thought to be responsible for diarrhea and other gastrointestinal (GI) side effects. OBJECTIVE: To evaluate the frequency and magnitude of GI side effects (nausea, bloating, GI upset, diarrhea, abdominal cramps, gas [flatus]) before and after switching the formulation of ddI, in study subjects who were experiencing one or more GI symptom(s) of at least moderate severity. METHODS: A 6-week open label crossover study of current didanosine tablet users comparing daily symptom scores (7 point scale, 0 = absent to 6 = very severe) during weeks 1 to 2 (on tablets) to weeks 4 and 6 (on EC capsules). Formulation palatability and preference, lifestyle effects, and use of antidiarrheals or other medications for symptom relief were also assessed. RESULTS: GI symptom scores (7-day means) on tablets were diarrhea 2.11, gas 2.00, bloating 1.23, abdominal cramps 0.74, GI upset 0.69, nausea 0.66. After switching to EC (week 4 and week 6), mean scores decreased for diarrhea (mean scores 0.99 week 4, 0.79 week 6), gas (0.95, 0.79), bloating (0.49, 0.32), abdominal cramps (0.21, 0.05), GI upset (0.16, 0.14), and nausea (0.32, 0.22). Severity of all GI symptoms was significantly reduced after 4 weeks on EC capsules ( p <.01 by paired t- test). Negative impact of side effects on routine activities was significantly reduced (41% on tablet vs. 7% on EC; p <.01). All 42 study subjects preferred the EC form. CONCLUSIONS: According to patients' diary scores, switching to ddI in EC form significantly reduces nausea, bloating, GI upset, diarrhea, abdominal cramps, and gas for individuals who experienced GI side effects while taking the buffered tablet form. The striking tolerability advantages appear to support routine switching to EC for such patients and may suggest that widespread preferential selection of the EC form is appropriate to enhance didanosine tolerability and promote treatment adherence.

Adult↗
PubMed2005

Atazanavir plus ritonavir or saquinavir, and lopinavir/ritonavir in patients experiencing multiple virological failures.

OBJECTIVE: To evaluate atazanavir/ritonavir (ATV/RTV) (300/100 mg) once daily, atazanavir/saquinavir (ATV/SQV) (400/1200 mg) once daily, and lopinavir/ritonavir (LPV/RTV) (400/100 mg) twice daily, each with tenofovir (300 mg) once daily and a nucleoside reverse transcriptase inhibitor in treatment-experienced HIV-infected patients. METHODS: Randomized, open-label, 48-week multicenter trial of 358 randomized adult patients who had failed two or more prior HAART regimens with baseline HIV RNA > or = 1000 copies/ml and CD4 cell count > or = 50 x 10(6) cells/l. RESULTS: The primary efficacy endpoint [plasma HIV RNA reduction assessed by time-averaged difference (TAD)] was similar for ATV/RTV and LPV/RTV [TAD 0.13; 97.5% confidence interval, -0.12 to 0.39] at 48 weeks. Mean reductions from baseline for ATV/RTV and LPV/RTV were comparable at 1.93 and 1.87 log10 copies/ml, respectively. Mean CD4 cell count increases were 110 and 121 x 10(6) cells/l for ATV/RTV, and LPV/RTV, respectively. The efficacy of ATV/SQV was lower than LPV/RTV by both these parameters. Declines in total cholesterol and fasting triglycerides were greater with ATV/RTV and ATV/SQV than with LPV/RTV (P < or = 0.005). Lipids in the LPV/RTV arm at week 48 generally increased from baseline. Lipid-lowering agents were used more frequently in the LPV/RTV arm than in the ATV arms (P < 0.05 versus ATV/RTV), as were antidiarrheal agents (P < or = 0.04 versus both ATV treatments). No new or unique safety findings emerged. CONCLUSIONS: ATV boosted with RTV is as effective and well tolerated as LPV/RTV in treatment-experienced patients, with a more favorable impact on serum lipids. Pharmacokinetically enhanced ATV provides a suitable choice for therapy of treatment-experienced HIV-infected patients.

Adenine↗
PubMed2006

Diarrhoea in the critically ill.

PURPOSE OF REVIEW: The purpose of this review is to update the knowledge on diarrhoea, a common problem in critically ill patients. Epidemiological data will be discussed, with special emphasis on diarrhoea in tube-fed patients and during antibiotic therapy. The possible preventive and therapeutic measures will be presented. RECENT FINDINGS: The need for concise definitions of diarrhoea was recently re-emphasized. The use of pump-driven continuous instead of intermittent enteral feeding is less often associated with diarrhoea. The discontinuation of enteral feeding during diarrhoea is not justified. Clostridium difficile-associated diarrhoea is frequent during antibiotic therapy with quinolones and cephalosporins. Formulas enriched with water-soluble fibres are probably effective to prevent diarrhoea, and promising data on the modulation of gut microflora with probiotics and prebiotics were recently released. SUMMARY: Diarrhoea is common in critically ill patients, especially when sepsis and hypoalbuminaemia are present, and during enteral feeding and antibiotic therapy. The management of diarrhoea includes generous hydration, compensation for the loss of electrolytes, antidiarrheal oral medications, the continuation of enteral feeding, and metronidazole or glycopeptides in the case of moderate to severe C. difficile colitis. The place of enteral formulas enriched with water-soluble fibres, probiotics and prebiotics is not yet fully defined.

Anti-Bacterial Agents↗
PubMedDate not supplied

Polymyxin B-immobilized fiber hemoperfusion in a patient with active ulcerative colitis.

A case involving a 31-year-old woman with active ulcerative colitis is described. She suffered symptoms of infraumbilical abdominal pain, severe diarrhea, and low-grade fever that did not improve with conventional treatment, including antidiarrheal drugs and antibiotics. Ulcerative colitis was diagnosed according to endoscopic and histologic findings. She was treated with prednisolone and sulfasalazine, and her symptoms disappeared after 1 month. Sulfasalazine therapy was continued for 3 months, and the patient's condition remained stable for 4 years. Recently, she was admitted with abdominal pain, severe diarrhea, and melena. She was again treated with prednisolone and intravenous hyperalimentation, but her symptoms did not improve. Colonoscopy showed multiple ulcers with bleeding and polyposis and severe edema in the colon. In addition, she had a high blood endotoxin concentration (38.0 pg/ml; normal < 9.8 pg/ml). She underwent polymyxin B-immobilized fiber (PMX-F) hemoperfusion therapy twice. After 2 weeks, her symptoms resolved completely, colonoscopy showed disappearance of the edema, revascularization of the mucosa, and improvement of the ulcers, and blood endotoxin concentration decreased to 5.0 pg/ml. These results suggest that PMX-F treatment may be beneficial for the management of ulcerative colitis with endotoxemia.

Acute Disease↗
PubMedDate not supplied

Dietary and medical management of short bowel syndrome in adult patients.

Resection of the small bowel can lead to malabsorption of fluid, electrolytes, minerals, and other essential nutrients, resulting in malnutrition and dehydration. Individualized and tailored nutritional management for patients with short bowel syndrome (SBS) helps to optimize intestinal absorption, leading to nutritional independence such that a patient can resume as normal a lifestyle as possible. Parenteral nutrition (PN), used to supply the required nutrients following resection, is associated with a number of complications affecting patient morbidity and mortality. Attempts should be made to wean patients from PN to an oral diet as soon as possible. Dietary management is complex and needs to be individualized for each patient on the basis of his or her specific gastrointestinal anatomy, underlying disease, and lifestyle. In addition to nutrient intake, management of SBS also requires appropriate oral rehydration, vitamin and mineral supplementation, and pharmacotherapy. Several medications provide a useful adjunctive function to dietary intervention, including antidiarrheal agents, H2 antagonists and proton pump inhibitors, pancreatic enzymes, somatostatin analogs, antimicrobials, and trophic factors.

Adult↗
PubMed2006

A comparison of hand-sewn versus stapled ileal pouch anal anastomosis (IPAA) following proctocolectomy: a meta-analysis of 4183 patients.

OBJECTIVE: Using meta-analytical techniques, the study compared postoperative adverse events and functional outcomes of stapled versus hand-sewn ileal pouch-anal anastomosis (IPAA) following restorative proctocolectomy. BACKGROUND: The choice of mucosectomy and hand-sewn versus stapled pouch-anal anastomosis has been a subject of debate with no clear consensus as to which method provides better functional results and long-term outcomes. METHODS: Comparative studies published between 1988 and 2003, of hand-sewn versus stapled IPAA were included. Endpoints were classified into postoperative complications and functional and physiologic outcomes measured at least 3 months following closure of ileostomy or surgery if no proximal diversion was used, quality of life following surgery, and neoplastic transformation within the anal transition zone. RESULTS: Twenty-one studies, consisting of 4183 patients (2699 hand-sewn and 1484 stapled IPAA) were included. There was no significant difference in the incidence of postoperative complications between the 2 groups. The incidence of nocturnal seepage and pad usage favored the stapled IPAA (odds ratio [OR] = 2.78, P < 0.001 and OR = 4.12, P = 0.007, respectively). The frequency of defecation was not significantly different between the 2 groups (P = 0.562), nor was the use of antidiarrheal medication (OR = 1.27, P = 0.422). Anorectal physiologic measurements demonstrated a significant reduction in the resting and squeeze pressure in the hand-sewn IPAA group by 13.4 and 14.4 mm Hg, respectively (P < 0.018). The stapled IPAA group showed a higher incidence of dysplasia in the anal transition zone that did not reach statistical significance (OR = 0.42, P = 0.080). CONCLUSIONS: Both techniques had similar early postoperative outcomes; however, stapled IPAA offered improved nocturnal continence, which was reflected in higher anorectal physiologic measurements. A risk of increased incidence of dysplasia in the ATZ may exist in the stapled group that cannot be quantified by this study. We describe a decision algorithm for the choice of IPAA, based on the relative risk of long-term neoplastic transformation.

Anastomosis, Surgical↗
PubMed1994

A case of intractable diarrhea firmly suspected to have autoimmune enteropathy.

Protracted diarrhea with insulin dependent diabetes mellitus (DM) and hypothyroidism in a 9 month old Japanese girl who was firmly suspected to have autoimmune enteropathy (AIE) is reported. Her severe secretory diarrhea failed to respond to intensive antidiarrheic treatment and was gradually improved with steroid therapy. The circulating autoantibodies to enterocytes in her serum were detected by indirect immunofluorescence technique and the impaired suppressor T (Ts) cell function was proved by plaque forming assay using bead-separated CD4 or CD8 T cells together with CD19 B cells. The anti-enterocyte antibodies were exclusively of immunoglobulin M (IgM) class and were detected with the progress of the protracted diarrhea. Maximum antibody titer was obtained at the onset of DM and the disappearance of autoantibodies was associated with the resolution of the clinical symptoms and signs. The helper functions of adult CD4 T cells to induce Ig-secreting cells from adult and the patient were strikingly suppressed by adult CD8 T cells. However, the CD8 T cells from the patient lost the ability to inhibit the induction of these Ig-secreting cells when stimulated with adult CD4 T cells. Moreover, the patient's CD8 T cells stimulated rather than suppressed the induction of Ig-secreting cells from the patient when stimulated with the patient's CD4 T cells. These results suggest that the impaired Ts cell function in this patient might play some immunological role in the pathogenesis of AIE.

Autoantibodies↗
PubMed2002

Irritable pouch syndrome: a new category of diagnosis for symptomatic patients with ileal pouch-anal anastomosis.

OBJECTIVE: Pouchitis often is diagnosed based on symptoms alone. However, increased stool frequency, urgency, and abdominal pain could be due to a condition resembling irritable bowel syndrome. This study was designed to assess the etiology of bowel symptoms using the Pouchitis Disease Activity Index (PDAI). METHODS: Symptoms, endoscopy, and histology were assessed in 61 consecutive symptomatic patients with ulcerative colitis after ileal pouch-anal anastomosis. Pouchitis was defined as a PDAI score of > or = 7, cuffitis was defined as endoscopic and histological inflammation of the rectal cuff and no inflammation of the pouch, and irritable pouch syndrome (IPS) was defined as symptoms with a PDAI of <7 and the absence of cuffitis. RESULTS: Thirty-one patients (50.8%) had pouchitis, four (6.5%) had cuffitis, and 26 (42.6%) had IPS. Demographics were similar in the three groups. Increased stool frequency, urgency, and abdominal cramps were the most common symptoms in the three groups. Rectal bleeding was seen only in cuffitis (p < 0.001). No patient in the three groups had fever. Twenty-seven patients (87.1%) with pouchitis responded to a 2-wk course of ciprofloxacin or metronidazole with a reduction in PDAI scores of > or = 3. All four patients with cuffitis responded to topical hydrocortisone or mesalamine with a reduction in the PDAI symptom component score of > or = 1. Twelve patients with IPS (46.2%) responded to antidiarrheal, anticholinergic, and/or antidepressant therapies with a reduction in the PDAI symptom component score of > or = 1, whereas the remaining patients had persistent symptoms despite therapy. CONCLUSIONS: A substantial number of symptomatic patients after ileal pouch-anal anastomosis do not meet the diagnostic criteria for either pouchitis or cuffitis and have been classified as having IPS. There is an overlap of symptoms among patients with pouchitis, cuffitis, and IPS, and endoscopic evaluation can differentiate among these groups. Distinction between these three groups has therapeutic implications.

Adult↗
PubMed1994

Evaluation of a New Latex Agglutination Test for Fecal Lactoferrin in Travelers' Diarrhea.

The detection and diagnosis of travelers' diarrhea by fecal culture method, often insensitive, expensive, and time consuming, could well be replaced with the latex agglutination test to detect fecal lactoferrin. As an initial screening, this test could be useful to differentiate between those patients who are more likely to have an invasive enteropathogen and those patients requiring antidiarrheal chemotherapy only. Fecal samples from 92 patients with travelers' diarrhea were tested for occult blood, fecal leukocytes, and fecal lactoferrin at stool dilutions of 1:50 and 1:200. The results were compared with findings from fecal cultures for enteropathogens. Statistical analyses were performed measuring the performance of the latex agglutination test for fecal lactoferrin to calculate its sensitivity, specificity, and positive and negative predictive values. Invasive pathogens were identified in 36 (39%), and a noninvasive pathogen was found in 18, or 20%, of the cases. At the stool dilution of 1:50, fecal lactoferrin showed more sensitivity than did leukocytes or occult blood in detecting the presence of invasive enteropathogens and, with a negative predictive value of 94%, was superior in predicting their absence. At the 1:200 dilution, a lower sensitivity of 55%, but a higher specificity of 82%, compared to 55% with the 1:50 dilution, was demonstrated. The determination of fecal lactoferrin might prove to be more useful and less expensive and time consuming as an initial screening for patients presenting with travelers' diarrhea. Further evaluation and antibacterial treatment could, therefore, be reserved for those with a positive lactoferrin test.

Journal Article↗
PubMed1995

Observational Study of Travelers' Diarrhea.

Background: European air travelers returning from Algeria, Egypt, Mexico, Morocco, and Tunisia were interviewed about their experience of travelers' diseases upon arrival in Brussels. Diarrhea was mentioned by 37% of the adults and 27% of the children. These subjects were questioned about the types of measures taken, type and duration of drug treatment (if any), and about duration of diarrhea and side effects experienced. Methods: Final analysis was performed based on 2160 interviews. The largest proportion of diarrhea was reported in the age group 15-24 years (46%). Results: The majority of the 2160 subjects had opted for drug treatment (81%): 927 subjects for loperamide alone, 235 for loperamide in combination with nifuroxazide, and 178 for nifuroxazide alone. Other drugs had been used less frequently. The median time to recovery was 2.4 days with loperamide compared to 3.2 days with nifuroxazide and to 3.4 days for the no-treatment group. Conclusions: A stratification of the results by severity of the diarrhea suggests a rank of antidiarrheal potency as follows: loperamide > nifuroxazide > no-drug treatment. The side effect with the highest incidence was constipation (2.4% with loperamide). (J Travel Med 2:11-15, 1995) Travelers' diarrhea is usually defined as the passage of at least three unformed stools per day or any number of such stools when accompanied by fever, abdominal cramping, or vomiting. The definition may be broadened to include more trivial bowel disturbance.1,2 The duration of this self-limited disease generally is 3 to 5 days. Medical intervention aims at shortening the duration of disease, thus allowing the sufferer to resume his or her usual activities at an early stage. A shortened period of recovery to physical well-being has obvious favorable economic implications if the traveler is on business and may help the maintenance of a desired level of quality of life while a traveler is on holiday. An observational study of various medical complaints made by European travelers about their stay in areas outside Europe (Algeria, Egypt, Mexico, Morocco, and Tunisia) was conducted. Air travelers returning from these areas between July 15 and August 16, 1992, were interviewed upon arrival at Brussels airport by means of a standardized questionnaire written up in lay language. As shown in Table 1, the total number of complaints in the adult group (>= 15 years of age, n = 5373) was 4919 and 446 in the pediatric group (n = 818). With fever as an exception, there were fewer complaints in children. Only approximately 50% of the travelers did not suffer

Journal Article↗