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PubMed1975

Loperamide antagonism of castor oil-induced diarrhea in rats: a quantitative study.

The time-course of castor oil-induced diarrhea in fasted rats was quantified by weighing stools every 15 minutes for 8 hours after the challenge and then after 24 hours. Diarrhea began within 1 hour as a series of rapidly occurring evacuations over 20 to 40 minutes. The mean weight of these stools was 5.7 g; later irregular evacuations increased the weight to 9.4 g at 8 hours. The area of individual time-weight diagrams had a median value of 432 units. Pretreatment with 0.16 mg/kg of loperamide, a new antidiarrheal drug, significantly decreased the area of similarly obtained diagrams; 0.31 mg/kg caused a 50% reduction. This antagonism by loperamide of castor oil-induced diarrhea may involve reduction in the severity of inflammatory changes in the intestinal wall.

Animals↗
PubMed1997

[MANAGEMENT OF ACUTE DIARRHEA IN INFANTS AND CHILDREN]

Worldwide, diarrhea remains one of the most common causes of children morbidity and mortality in developing countries. Even now, in 1997, in the United States, each year results in near 400 deaths, 200,000 hospitalizations, 1.5 million outpatient visits, and a total of 20 million episodies among children. According to these data, it is easy to understand the real situation in poor countries. It is necessary to consider three specific management issues: (1) rehydration, (2) early refeeding, and (3) treatment of the infectious agent. Intravenous rehydration is the best form of treatment for children with severe dehydration, who are in shock or unable to take oral rehydration. Oral rehydration is simple, practical, inexpensive, effective and safe for children. Appropriate feeding should begin as soon as initial rehydration therapy has been completed, usually within 4 to 6 hours. Antidiarrheal agents are not recommended, because many of these drugs have potentially serious adverse effects in infants and young children. Because stool culture is often expensive and ineffective, a workup of patients with acute diarrhea should include: fecal leukocytes count, fecal hidden blood and fecal lactoferrin. Only a few percentage of patients need to receive antibiotics. The role of nucleotides and probiotics to prevent acute diarrhea is currently investigated.

Journal Article↗
PubMed1983

Management of second-trimester missed abortion with intramuscular 15-methyl-prostaglandin F2 alpha.

Midtrimester missed abortion was successfully managed by serial intramuscular injections of 15(S)-15-methyl-prostaglandin F2alpha (PGF2alpha) in 255 patients, the cumulative abortion rates after 24 and 36 hours being 97.6 and 99.6%, respectively. The mean 1st-dose-to-expulsion interval was significantly shorter in the paras, but the period after fetal death was not significant in this respect. In 60% of the cases, abortion was complete. No serious complications occurred. 2/3 of the patients developed gastrointestinal side effects. These side effects were not improved by standardized antiemetic and antidiarrheal treatment, but they were strongly reduced by priming the cervix with extraamniotic PGE2 gel before the PGF2alpha analog was administered.

Abortifacient Agents↗
PubMed2003

[Clinical study of 102 cases of abdominal-anus resection with telescopic anastomosis of colon rectal mucosa for lower segment of rectal cancer].

OBJECTIVE: To investigate the reliability and feasibility of abdominal-anus resection with preservation of anal sphincter by telescopic anastomisis of colon rectal mucosa for middle-lower segment of rectal cancer. METHODS: A retrospective analysis was made for abdominal-anus resection with telescopic anastomosis of colon rectal mucosa in 102 cases of middle-lower segment of rectal cancer. RESULTS: No anastomotic fistula and anastomotic stenosis occurred in the 102 cases. The increased defecation was found during early stage of postoperation, about 6-12 times per day. But this was easily controlled by antidiarrheal drugs. Twelve to 18 weeks later, defecation returned to normal. Follow-up was performed in 91 patients, and the follow-up rate was 89.2%. Mean follow-up period was 4.7 years. Local recurrence rate of the carcinoma was 5.4% (5/91), and hepatic metastasis rate was 13.1% (12/91). Three-year survival rate of postoperation was 86.9% (60/80), and five-year survival rate was 70.7% (29/41). CONCLUSIONS: With telescopic anastomosis of colon rectal mucosa, colon stoma can be avoided, and anastomotic fistula can be prevented. The operation is safety and effective in preservation of anal sphincter for rectal cancer therapy.

Adult↗
PubMed1992

Diagnosis and management of irritable bowel syndrome, constipation, and diarrhea in pregnancy.

Irritable bowel syndrome, constipation, and diarrhea may complicate a pregnancy. Complaints of IBS and constipation may be managed by nonpharmaceutical methods. A careful history should be conducted to determine whether these complaints are of an acute or a long-standing nature. Conservative treatment of IBS is recommended and may include stool-bulking agents, a high-fiber diet, elimination of offensive foods, and the behavioral treatment of passive muscle relaxation, biofeedback or supportive psychotherapy. Constipation is generally self-limiting. It also may be treated conservatively with stool-bulking agents, increases in dietary fiber, and the addition of pelvic muscle exercises, preferably using electromyographic biofeedback. Laxatives should be used judiciously (Table 1). Diarrhea is caused most often by infectious agents in pregnancy but may also be from food poisoning or a viral disease. Infectious diarrhea may be treated by mild antidiarrheal agents and safe antibiotics. Fluid replacement is the mainstay of treatment, and care should be taken, remembering that the treatment involves two patients. These complaints can generally be managed conservatively, but persistent cases should be investigated as in a nonpregnant patient.

Colonic Diseases, Functional↗
PubMed1992

Control study of oral rehydration solution (ORS)/ORS + dioctahedral smectite in hospitalized Thai infants with acute secretory diarrhea.

Dioctahedral smectite, a non systemic antidiarrheal agent, is mucoprotective and absorbs enterotoxins and rotavirus as demonstrated in animal models. Smectite has been successfully used in various countries in children and adults with acute diarrhea. This study was to assess the efficiency of smectite associated with rehydration in infants with acute secretory diarrhea. Sixty-two hospitalized Thai infants, aged 1-24 months, with acute secretory diarrhea were randomly divided into 2 groups receiving (1) oral rehydration solution (ORS) (30 cases), (2) ORS and Smectite (3.6 g/day) (32 cases). Both groups were comparable for age, weight, nutritional status and duration of symptoms before treatment. All 62 infants received lactose free formula and chicken rice soup as the standard diet. Stool frequency, weight change and duration of diarrhea were recorded. The mean duration of diarrhea was 84.7 +/- 48.5 hours in group 1, and 43.3 +/- 25.1 hours in group 2 (p = 0.005). The number of infants with diarrhea was significantly lower in group 2 on Day 1 (p < 0.01) and Day 3 (p = 0.001); furthermore 27% of infants in group 1 and 3% in group 2 had still diarrhea on Day 5. The stool frequency and weight changes were not statistically different in the two groups. No major side effects were observed except two cases of vomiting and hardened stools. It is concluded that (1) Smectite shortens the course of acute secretory diarrhea in Thai infants; (2) smectite may reduce the occurrence of prolonged diarrhea; furthermore (3) in our study dioctahedral smectite was found to be safe in children aged 1 to 24 months.

Chi-Square Distribution↗
PubMed2004

The brain-gut axis in irritable bowel syndrome--clinical aspects.

Irritable bowel syndrome (IBS) is the most common chronic gastrointestinal (GI) disorder, affecting about 20% of the world's population. Chronic abdominal pain or discomfort relieved by defecation and associated with altered bowel habits are the mainstay in diagnosis. The pathophysiology of IBS remains unknown. This biopsychosocial disorder involves dysregulation of the nervous system, altered intestinal motility, and increased visceral sensitivity. All of these result from dysregulation of the bidirectional communication between the gut with its enteric nervous system and the brain (the brain-gut axis), modulated by various psychosocial and environmental factors (e.g. infection, inflammation). Numerous neurotransmitters are found in the brain and gut that regulate GI activities, including 5-hydroxytryptamine (5-HT, serotonin) and its 5-HT3 and 5-HT4 receptors. The current approach to IBS patients is based on a positive diagnosis of the symptom complex, exclusion of underlying organic disease, and institution of a therapeutic trial. Traditional symptomatic treatment has included antidiarrheals, laxatives and bulking agents/fiber, low-dose tricyclic antidepressants, antispasmodics for pain, and "alternative" therapies (e.g. psychotherapy, hypnotherapy). The scientific evidence supporting this therapy is limited. Novel approaches include visceral analgesics and serotonin agonists and antagonists. In patients with severe diarrhea, 5-HT3 receptor antagonists (e.g. alosetron) and selective M3-type anticholinergics are indicated, in constipation 5-HT4 agonists (e.g. tegaserod), and in pain alfa2-adrenergics (e.g. clonidine), cholecystokinin antagonists, kappa-opioid agonists (e.g. fedotozine), and neurokinin antagonists; some of these agents are still being investigated. Understanding the brain-gut axis is crucial in the development of effective therapies for IBS.

Brain↗
PubMedDate not supplied

Refractory proctosigmoiditis probably caused by inferior mesenteric vein ligation at sigmoidectomy.

A case of refractory proctosigmoiditis is reported in a 65-year-old female post-sigmoidectomy patient. She had bloody diarrhea and abdominal pain 2 years after sigmoidectomy, in which the inferior mesenteric vein was ligated close to the inferior mesenteric artery root during the lymph node dissection, while the inferior mesenteric artery trunk and the last branch of the sigmoid arteries was preserved. The biopsied specimen obtained by a fiber optic colonoscopy was diagnosed as proctitis. Antidiarrheals, 5-aminosalicylic acid and steroid enemas showed only limited therapeutic effects. An angiography revealed a mild degree of rectal artery dilatation and tiny venous angiogenesis detected on the delayed phase images. Because the inferior mesenteric vein had been ligated, collateral veins developed to drain the blood on the distal side of the anastomosis to bilateral internal iliac veins. The venous blood of the descending colon (oral side of anastomosis) drained to left colic vein. The cause of rectosigmoiditis was considered to be venous congestion due to the inferior mesenteric vein ligation. A rectosigmoidectomy with reanastomosis using a double-stapling technique was performed, and the patient was discharged without symptoms.

Aged↗
PubMed2004

[The conservative treatment of nonspecific inflammatory bowel diseases].

The treatment of inflammatory bowel diseases includes the nutritional management, the pharmacotherapy and the surgical treatment. The main aim of treatment is to achieve the remission, to prevent a relapse and to take a decision of surgical treatment. The treatment is introduced in the relevance to the intensification of disease. To assess properly the level of the intensification of disease there is a need of deep knowledge of clinical manifestations of the disease. In the treatment the corticosteroids, 5-aminosalicylic acid (5-ASA) or immunosuppressive treatment are used. Immunosuppressive treatment is now a widely accepted standard in Crohn's disease treatment. Some cases of Crohn's disease could be treated with anti-TNFalpha antibodies that successfully treat the relapses of disease. This treatment is especially well suited to cases that are not successfully treated with the standard pharmacological treatment. The nonsurgical treatment is successful in most cases. There are no standards of treatment of microscopic colitis. We usually start the treatment with 5-ASA and an antidiarrheal agent. In case of failure of this treatment we introduce corticosteroids. In this paper authors present basic information about the current state of knowledge about inflammatory bowel diseases treatment.

Anti-Inflammatory Agents↗
PubMed2004

Diarrheal illnesses: a public health perspective.

Diarrheal illnesses remain among the leading causes of morbidity in the United States. Approximately five million diarrheal cases occur annually (Chin, 2000; Ostroff & Leduc, 2000), with an estimated incidence of one diarrheal episode per person per year (Aranda-Michel & Giannella, 1999). Though the causes of diarrheal illnesses vary, infectious agents account for a majority of cases (Aranda-Michel & Giannella, 1999; Chin, 2000; Ostroff & Leduc, 2000). Most diarrhea-causing infectious agents are transmitted through food, water, or person-to-person via the fecal-oral route and are the cause of numerous diarrheal outbreaks. The risk for exposure to such pathogens within the general population is universal; however, persons in pediatric, geriatric, and other immunocompromised populations are at increased risk for subsequent illness and complications (Centers for Disease Control and Prevention, 2001; Ostroff & Leduc, 2000). Moreover, many persons with diarrheal illness do not seek medical care and self-treat with over-the-counter antidiarrheal agents, which have potentially serious side effects among high-risk individuals. The public health impact of diarrheal illness is apparent and emphasizes the need for early diagnosis and appropriate treatment, timely notification of illness with public health implications, and coordination between healthcare professionals and public health officials to prevent and control the spread of infection.

Anti-Infective Agents↗
PubMed1991

Effect of clonidine on gallbladder contraction and small bowel transit time in insulin-treated diabetics.

Cholelithiasis is more prevalent in diabetics than in nondiabetics. Gallbladder dysmotility is supposed to be one of the causative factors. Reduced alpha-adrenergic tone has been demonstrated in the enterocytes of diabetic rats, and its correction by clonidine might explain the beneficial effect that the drug has on diabetic diarrhea. We therefore surmised that diabetic cholecystoparesis could also be due to alpha-adrenergic alterations. To test this hypothesis, we studied gallbladder contractions by real time ultrasonography, and small bowel transit time by lactulose hydrogen breath test, in 13 insulin-requiring diabetics before and after administration of the alpha-adrenergic stimulant clonidine (0.3 mg orally). That plasma levels were sufficient was evidenced indirectly by a fall in blood pressure. Clonidine significantly improved the rate of emptying (0.0193 +/- 0.00057/min vs. 0.0318 +/- 0.0027/min; p less than 0.005), but not the fasting and residual gallbladder volumes. Small bowel transit time was significantly prolonged after clonidine (169 +/- 17 min vs. 208 +/- 17; p less than 0.05). These results suggest that 1) reduced alpha-adrenergic tone corrected by clonidine may be present in the diabetic gallbladder, and 2) clonidine's antidiarrheal effect might be explained, at least in part, by a prolongation of the small bowel transit time.

Adult↗
PubMed1991

[Collagen colitis--a clinical entity of relevance].

Collagenous colitis is a clinical and pathological entity characterized by chronic watery diarrhea and deposition of collagen beneath the surface epithelium of the large intestine. By colonoscopy and barium enema the colon appears normal. The laboratory tests give usually normal results. 75% of the patients are middle-aged women with a mean age around 50 years. The etiology of the disease is still unknown. An association with various autoimmune diseases has been suggested, but was never proven. Up to now, it is not clear whether the collagenous colitis is a distinct entity or only an epi-phenomenon of another disease which leads to thickening of the collagen layer. Collagenous colitis is diagnosed if all other diseases with chronic watery diarrhea are excluded. A specific treatment is not known. Symptomatic treatment with bulk and antidiarrheal drugs improves the symptoms of most of the patients.

Colitis↗
PubMed1991

Computerized surveillance of adverse drug events in hospital patients.

OBJECTIVE: To develop a new method to improve the detection and characterization of adverse drug events (ADEs) in hospital patients. DESIGN: Prospective study of all patients admitted to our hospital over an 18-month period. SETTING: LDS Hospital, Salt Lake City, Utah, a 520-bed tertiary care center affiliated with the University of Utah School of Medicine, Salt Lake City. PATIENTS: We developed a computerized ADE monitor, and computer programs were written using an integrated hospital information system to allow for multiple source detection of potential ADEs occurring in hospital patients. Signals of potential ADEs, both voluntary and automated, included sudden medication stop orders, antidote ordering, and certain abnormal laboratory values. Each day, a list of all potential ADEs from these sources was generated, and a pharmacist reviewed the medical records of all patients with possible ADEs for accuracy and causality. Verified ADEs were characterized as mild, moderate, or severe and as type A (dose-dependent or predictable) or type B (idiosyncratic or allergic) reactions, and causality was further measured using a standardized scoring method. OUTCOME MEASURE: The number and characterization of ADEs detected. RESULTS: Over 18 months, we monitored 36,653 hospitalized patients. There were 731 verified ADEs identified in 648 patients, 701 ADEs were characterized as moderate or severe, and 664 were classified as type A reactions. During this same period, only nine ADEs were identified using traditional detection methods. Physicians, pharmacists, and nurses voluntarily reported 92 of the 731 ADEs detected using this automated system. The other 631 ADEs were detected from automated signals, the most common of which were diphenhydramine hydrochloride and naloxone hydrochloride use, high serum drug levels, leukopenia, and the use of phytonadione and antidiarrheals. The most common symptoms and signs were pruritus, nausea and/or vomiting, rash, and confusion-lethargy. The most common drug classes involved were analgesics, anti-infectives, and cardiovascular agents. CONCLUSION: We believe that screening for ADEs with a computerized hospital information system offers a potential method for improving the detection and characterization of these events in hospital patients.

Adolescent↗
PubMed1990

[Therapeutic strategy in the irritable bowel syndrome].

The irritable intestine is one of the most frequently encountered complaints in medical practice. Although treatment is generally difficult, a therapeutic strategy which can be used in most cases is proposed. Most patients with these symptoms do not seek medical attention. The motivation for medical consultation can however be of prime importance for adequate treatment. The attending physician must first establish the reality of disease by detailed history-taking, physical examination and sigmoidoscopy. Promoting factors such as dysentery, medications, alimentation, emotions or any other major event in the patient's life must be identified. The physician must reassure and console the patient accordingly. Bran-containing diets are reliable adjuvants for most patients. Follow-up is important to guarantee patient compliance and understanding. The essential risk in the irritable bowel syndrome is the doubtfulness which hovers over the disease entity and can be responsible for patient anxiety, or prompt expensive investigations, undesirable effects of medication or even unnecessary surgery. If the patient's complaints remain unchanged at the second medical visit, other diagnostics should be considered, thus avoiding unjustified investigations. Continued empathy with the patient is important. Medication, either for their placebo or specific symptomatic action (e. g. antidiarrheics) should be considered as well. The physician has to reassure and console the patient who does not improve. The patient can then be directed to a specialized unit, but only on the physician's specific orders.

Colonic Diseases, Functional↗
PubMed1990

Behavior of urban based child caretakers in the home treatment of diarrheal diseases.

Behaviors of low income urban mothers and child caretakers in the treatment of childhood less than 5 year diarrhea were analysed from a surveillance study conducted between August 1988 and July 1989. Help seeking behaviors of mothers and caretakers for 412 episodes of child diarrhea were as follows: investigators 37.1%, drug stores 18.2%, wait and see or self treatment 17.0%, private clinics 12.6%, near by hospital 10.2%, and local health center 4.9%. Major treatment practices included ORT alone (54%) and ORT plus antibiotics and/or antidiarrheal drug (22%). Overall ORT usage was 76%. Twelve percent of diarrheal episodes no treatment was given to the children. Antimicrobials were believed to be essential in addition to ORT especially when diarrhea was associated with fever, vomiting and bloody stools. Thirty-six percent of invasive diarrhea cases (Shigella, Salmonella, Campylobacter) were treated with antibiotics. Only 18.2% of noninvasive diarrhea received antibiotics, most of this antibiotic use being in rotavirus diarrhea where vomiting and some fever are prominent. Availability of oral rehydration salts (ORS) and good experience with ORT were the key to the extensive use or ORT in this study. A surprisingly small number of mothers and child caretakers (4.9%) sought help from the local health center when their children had diarrhea.

Anti-Bacterial Agents↗
PubMedDate not supplied

[Ileoanal anastomosis with and without reservoir in children and adolescents with ulcerative rectocolitis and familial polyposis].

We compared the postoperative evolution of patients in whom an ileoanal anastomosis was performed, with (group 1, n:9) an without (group 2, n:7) an ileal reservoir. 3 of the 9 patients in group 1 developed intractable diarrhea, it was necessary to reoperate these children and to construct an ileal reservoir. It was not necessary to reoperate any of the group 2 patients; 2 of whom still have an ileostomy due to the presence of preanastomotic abscess. These 2 last patients where excluded from the following analysis. 2 months after surgery, children in group 1 had 16 +/- 2 bowel movements a day, compared with 8 +/- 2 in group 2, p less than 0.05. Children in group 1 did less well than those in group 2 when the following parameters were compared: fecal incontinence (7/9 vs 0/5), perianal dermatitis (6/9 vs. 1/5), treatment with antidiarrheal agents (5/9 vs 0/5), missing school (4/9 vs 0/5) and diminished social activities (4/9 vs 0/5). We conclude that in children who require colectomy, better results are obtained when an ileoanal anastomosis with ileal reservoir is performed.

Adenomatous Polyposis Coli↗
PubMed1989

[Psychosomatic disorders of the colon].

The clinical and experimental psychological examination of 90 patients with the syndrome of the excitable colon has demonstrated that this pathology is a typical psychosomatic disorder. The dynamics of the disorder may involve three stages: psychosomatic reactions, psychosomatic cycles and psychopathization. The treatment of the syndrome should be conducted in accordance with the disease stage. At the stage of psychosomatic reactions, the treatment is to be oriented mainly to the psychotherapeutic action. The combination of amitriptyline (antidepressant and antidiarrheal effects) with teralen or phrenolon (antialgic effect) turned out most effective at the stage of the psychosomatic cycles. Psychotherapy administered in different varieties also appeared more effective when coupled with biological treatment. It is necessary that behavioral correctors (neuleptide) be included into drug treatment at the stage of psychopathization. In this case the role of psychotherapy slightly decreases. All the stages require the use of therapeutic means effecting motor function of the intestine and enzymatic system of the body.

Adolescent↗
PubMed1989

Prescription audit of under six children living in periurban areas.

One hundred and seventy two children were prescribed, in 212 episodes of illness, antimicrobial agents (28.4%), followed by antidiarrheals (10.9%), nutritional products (9.4%), analgesics (7.5%) and steroids (6.8%). Ampicillin (22.7%) and cotrimoxazole (12.7%) were the most commonly prescribed antimicrobials. Tetracyclines, which are not indicated in children below 8 years, were used in 7.1% of total exposures of chemotherapeutic agents. Penicillin, a comparatively safe and useful drug, was used only in 4.5% exposures. Analgin and hydroxyquinolines were used frequently. Corticosteroids were used for simple ailments like diarrhea, fever and jaundice. ORS was used in only 13.9% episodes of diarrhea. Adverse drug reactions were noted in 30 (17.4%) cases and death in 6 (3.5%) cases. The average cost per prescription for neonates was Rs 32.43 and for a child was Rs 30.65. Weight of the children was not taken prior to prescribing drugs. There is need for prescription audit as there is high consumption rate of drugs, with overuse of antimicrobial and nutritional products, and misuse of steroids.

Child↗