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Your search term(s) "Diarrhea" returned 62 results.
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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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