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PubMed2006

Probiotics for the prevention of antibiotic-associated diarrhea and Clostridium difficile diarrhea.

Antibiotic-associated diarrhea is a common clinical problem occurring in up to 25% of patients, with diarrhea owing to Clostridium difficile accounting for up to a quarter of cases. The clinical and economic costs of antibiotic-associated diarrhea are significant and better treatments are needed. Probiotics may offer potential effective therapy for antibiotic-associated diarrhea by restoring intestinal microbial balance. A number of different probiotics have been evaluated in the prevention and treatment of antibiotic-associated diarrhea in adults and children, including the nonpathogenic yeast Saccharomyces boulardii and multiple lactic-acid fermenting bacteria such as Lactobacillus rhamnosus GG (LGG). A careful review of the literature supports the efficacy of S. boulardii in the prevention of antibiotic-associated diarrhea recurrent C. difficile infection in adults, whereas LGG is useful in the treatment of antibiotic-associated diarrhea in children. Not enough data exist to currently support the use of other probiotic preparations in these conditions. Although generally safe and well tolerated, both S. boulardii and LGG should be used cautiously in immunocompromised patients. Further study of probiotics, including large, well-designed, randomized controlled dose-ranging trials, comparative trials, and cost-benefit analyses are necessary.

Anti-Bacterial Agents↗

PubMed1990

Lack of a role of the duodenal microflora in pathogenesis of persistent diarrhea and diarrhea-related malabsorption in Peruvian children.

Although few episodes of diarrhea last longer than 14 days these episodes are particularly associated with growth faltering and malnutrition. We have examined the role of the duodenal microflora in prolonging diarrhea in Peruvian children ages 3 to 36 months by comparing the microflora in 89 children with persistent diarrhea, 38 children with acute diarrhea and 34 diarrhea-free controls from the same environment. Bacteria were retrieved from 93% of all aspirates, including 94% of those from controls. There were no significant differences among the 3 groups with respect to total bacterial count, to the proportion of children with duodenal Enterobacteriaceae and to the proportion with anaerobes, lending no support to the hypothesis that proliferation of bacteria in the small intestine during the acute illness prolongs diarrhea. When only children older than 18 months were compared, anaerobes were cultured more frequently from those with persistent diarrhea than from controls, but the presence of anaerobes was not associated with adverse clinical outcome. Although malabsorption, especially steatorrhea, was common, there was no association between elevated bacterial counts and fecal loss of nutrients in 69 children who received the same diet. In this population steatorrhea could not be attributed to bacterial overgrowth.

Acute Disease↗

PubMed1994

[Nosocomial epidemic outbreak of diarrhea from Clostridium difficile. Comparative study of diarrhea associated with the use of antibiotics].

BACKGROUND: Clostridium difficile is considered as one of the principal enteropathogens of nosocomial origin in developed countries in the last decade. No nosocomial outbreaks have been described in Spain. METHODS: A descriptive study of a nosocomial outbreak of diarrhea by C. difficile (DCD) which was produced during two months in a general hospital of 250 beds was carried out. The risk factors, clinical and analytical characteristics were compared with the cases of diarrhea associated to the use of antibiotics (DAA) produced during the same period. RESULTS: Of the 23 diarrheas studied, 17 (74%) corresponded to DAA and 6 (26%) to DCD, four of which were of nosocomial origin and were detected in the department of Nephrology. The incidence of DAA was 44/1000 patients who received antibiotic treatment per month and the incidence of DCD was 15.5/1000 patients/month. The patients with DAA received a mean of 1.82 antimicrobians per patient and in DCD 2.16 per patient (p: NS). The only differences found between DAA and DCD were: length of the symptoms (16.5 days in DCD, 8.5 days in DAA, p < 0.01) and the presence of blood in the feces (66.6% in DCD and 0 in DAA p < 0.01). No differences were observed in age, sex, base disease, mucous diarrhea, fever, mortality, high VSG and leucocytosis. Surveillance and control measures were effective in combating the epidemic outbreak. CONCLUSIONS: The diagnosis of diarrhea by C. difficile requires a high index of suspicion given the difficulty in differentiating the same from diarrhea associated to antibiotic use. The clinical profile and risk factors do not differ to those described in other geographic areas. The isolation and/or detection of toxins of C. difficile is recommended in patients submitted to antibiotic treatment and diarrhea of more than 72 hours of evolution.

Aged↗

PubMed1993

Child day care increases the risk of clinic visits for acute diarrhea and diarrhea due to rotavirus.

A case-control study of risk factors for acute diarrhea was conducted among children under 3 years of age attending a health maintenance organization clinic in Houston, Texas. During a 19-month period from September 1985 through March 1987, 339 children with diarrhea and 363 age- and season-stratified controls were enrolled. A total of 90% of cases were under age 2 years. Compared with children cared for at home, the risk of clinic visits for diarrhea was significantly greater for children receiving child day care and was similar for those attending day care centers (odds ratio (OR) = 2.4, 95% confidence interval (CI) 1.6-3.7), day care homes (OR = 2.0, 95% CI 1.3-3.1), mother's day out (OR = 1.8, 95% CI 0.8-4.2), or when cared for by a relative (OR = 2.0, 95% CI 1.2-3.2). Rotavirus-positive diarrhea was also significantly greater in child day care (OR = 2.4, 95% CI 1.1-5.1). The day care-associated risk was highest during the first month of enrollment (OR = 3.1, 95% CI 1.8-5.4). In this population, where 40% of children receive child care, 19% of the clinic visits for acute diarrhea were attributable to child care. These data indicate that child day care increases the risk of acute diarrhea, whether in a center or in a home, and the risk is highest in the first month of enrollment.

Acute Disease↗

PubMed1991

[Clinical and experimental study on the treatment of children diarrhea by granule of children-diarrhea fast-stopping].

Granule of children-diarrhea fast-stopping is a proved recipe composed of seven medical herbs such as Poria cocos, haw charcoal, Euphorbia humifusa, etc. After more 20 years' clinical application of 419 cases, the total effective rate proved to be 96.4% and the cure rate 90%, much better than the control groups [TCM: gelian san and shenglingbaizhu san; WM: gentamycin and PPA]. It had the effect of fast-stopping diarrhea and shortening the recovery period. It also had excellent curative effect for acute and chronic diarrhea, for noninfective and infective diarrhea with virus or germs, and for the diarrhea due to moist heat and spleen weakness in TCM. Clinical tests and experiments showed that this medicine had no toxic or side effects. The diarrhea-cure mechanisms were (1) Inhibiting germs so as to eliminate pathogeny. (2) Adjusting and improving organism immunity function. (3) Accelerating the recovery of intestinal digestion and absorption functions. (4) Inhibiting intestinal movement.

Animals↗

PubMed1995

Consensus statement: octreotide dose titration in secretory diarrhea. Diarrhea Management Consensus Development Panel.

Octreotide is an effective therapeutic option in controlling secretory diarrhea of varied etiology. However, marked patient-to-patient differences in the antidiarrheal effects necessitate titration of octreotide dose in individual patients to achieve optimal symptom control. A consensus development panel established guidelines for octreotide dose titration in patients with secretory diarrhea. Overall, the panel recommended an aggressive approach in selecting the initial octreotide dose and in making subsequent dose escalations in patients with secretory diarrhea due to gastrointestinal tumors (eg, carcinoids, VIPomas), AIDS, dumping syndrome, short bowel syndrome, radiotherapy, or chemotherapy. To avoid hypoglycemia in patients with diabetes mellitus-associated secretory diarrhea, the panel recommended a low initial octreotide dose and a conservative titration regimen with close monitoring a blood glucose levels. The end point of therapy should focus on a reduction in diarrhea (frequency of bowel movements or stool volume) rather than normalization of hormonal profile. Overall, octreotide is well tolerated; principal side effects are transient injection site pain and gastrointestinal discomfort. For many patients with secretory diarrhea, octreotide therapy is expected to improve the overall health and quality of life and in the long run will lessen health care costs.

Carcinoid Tumor↗

PubMedDate not supplied

A medium chain triglyceride-based diet in patients with HIV and chronic diarrhea reduces diarrhea and malabsorption: a prospective, controlled trial.

Our objective was to determine whether a medium-chained triglyceride (MCT)-based diet, compared to a long-chain triglyceride (LCT)-based diet, conveys a beneficial effect on diarrhea and fat malabsorption in human immunodeficiency virus (HIV)-infected individuals with chronic diarrhea and weight loss. A secondary objective was to evaluate the pathogens associated with the diarrhea and to evaluate whether the etiologic agent was a determinant of response to the nutritional intervention. Prospective, randomized double-blind comparative trial was conducted in 24 adult patients with HIV, diarrhea of greater than 4-wk duration, fat malabsorption, and loss of 10-20% of ideal body weight, these patients were recruited from our outpatient infectious disease clinic. Evaluations of diarrheal pathogens were made by complete stool examination, upper and lower endoscopy with quantitative culture, and biopsy. Body composition determinations, and measurements of fat, carbohydrate, and vitamin absorption pre- and postintervention. Patients were randomly assigned to one of two complete nutritional products with either medium- or long-chain triglyceride fat exclusively for 12 d followed by treatment of infectious pathogens. Ten patients were found to have Microsporidium and 9 patients had no identifiable pathogen. All patients responded to intervention with both nutritional products overall with 45% fewer stools, decreased stool fat and weight, and a significant increase in urine nitrogen. The group that received the MCT product demonstrated significantly decreased stool number (mean 4 to 2.5), stool fat (mean 14 to 5.4 g), and stool weight (mean 428 to 262 g) compared with baseline (P < 0.01 for all). Patients with both species of microsporidia and with pathogen negative diarrhea had good response. We found that HIV patients with diarrhea, regardless of etiology, and documented fat malabsorption may benefit symptomatically from a diet composed of an MCT-based liquid supplement.

Adult↗

PubMed1997

Prognostic Factors Related to Recovery from Diarrhea among U.S. Students with Diarrhea in Mexico.

Background: Medical charts of subjects treated with placebo from five double-blinded placebo-controlled clinical trials were reviewed to determine pre-enrollment prognostic factors related to later recovery from diarrhea. Method: Recovery or time from initiation of a placebo until passage of the last unformed stool after being declared well was calculated for each subject. Results: A longer duration of diarrhea was associated with presence of fever (rate ratio = 0.34; 95% CI = 0.2-0.9), presence of an invasive pathogen in the stool (rate ratio = 0.35; 95% CI = 0.2-0.7) or a noninvasive pathogen in stool (rate ratio = 0.7; 95% CI = 0.6-1.0), severe abdominal pain or cramps (rate ratio = 0.5; 95% CI = 0.3-0.9), passage of more than five watery stools per 24 hours (rate ratio = 0.58; 95% CI = 0.4-0.8). Severe vomiting predicted a shorter duration of post-enrollment diarrhea (rate ratio = 2.43; 95% CI = 1.1-5.6). Conclusion: A number of clinical and microbiologic factors found in travelers with diarrhea in the present study predicted duration of untreated diarrhea. The authors suggest the use of antimicrobial therapy in travelers with predictors of a long duration of diarrhea. Data developed in the present study may be used to create a historical control for clinical trials of antidiarrheal compounds using the same study criteria.

Journal Article↗

PubMed1996

Is prevalence of diarrhea a better predictor of subsequent mortality and weight gain than diarrhea incidence?

A number of different outcome measures have been proposed for use in prospective studies of morbidity associated with childhood diarrhea. These include the number of episodes experienced by each child over a defined period (a measure of incidence) and the number of days of diarrhea divided by the total number of days of observation for each child (a measure denoted "longitudinal prevalence"). The authors examined data from Ghana to determine which of these measures is more strongly associated with weight gain over a 4-month period and subsequent mortality. Both diarrhea incidence and longitudinal prevalence were associated with weight gain in children aged 6-23 months, but a statistically stronger association was observed with longitudinal prevalence (likelihood ratio statistic 28.95 on 1 degree of freedom against 19.70 for incidence). Neither measure was associated with weight gain in younger or older children. Longitudinal prevalence, but not incidence, was strongly associated with subsequent mortality (p = 0.002 for longitudinal prevalence; p = 0.557 for incidence). Although many epidemiologic studies of diarrhea focus on incidence, these data suggest that longitudinal prevalence is more strongly predictive of long-term health outcome. The authors conclude that longitudinal prevalence merits greater attention as a measure of outcome in diarrhea studies.

Child, Preschool↗

PubMed2004

Effect of glutamine supplementation on diarrhea, interleukin-8 and secretory immunoglobulin A in children with acute diarrhea.

OBJECTIVE: Glutamine is an important fuel for rapidly dividing cells such as enterocytes and lymphocytes. Exogenous glutamine supplementation in catabolic states preserves intestinal mucosal structure and function, decreases bacterial translocation, and supports normal immunologic responses. This study was planned to assess the effect of glutamine supplementation on duration and severity of diarrhea and to assess its immunomodulatory effect by measuring serum interleukin-8 (IL-8) and salivary immunoglobulin A (sIgA) in children with acute diarrhea. METHODS: In this placebo-controlled, double-blind and randomized trial, 6- to 24-month-old otherwise healthy children admitted to the Diarrheal Diseases Training and Treatment Center with acute diarrhea received either 0.3 g/kg/day of glutamine (n = 63) or placebo (n = 65) for 7 days. Serum IL-8 and sIgA levels were determined on admission and 7 days later. All cases were followed until the diarrheal episode ended. Anthropometric measurements and history of subsequent infectious diseases were monitored monthly for 3 months after treatment. RESULTS: Mean duration of diarrhea in the glutamine treated group was significantly shorter than that of the placebo group (3.40 +/- 1.96 days, 4.57 +/- 2.48 days, respectively; P = 0.004). No differences in serum IL-8 and sIgA were found between groups on admission or 1 week later. During 3 month follow-up, mean weight gain and incidence of infectious diseases were similar in both groups. CONCLUSION: Duration of diarrhea was shorter in children supplemented with glutamine. The beneficial impact of glutamine supplementation seems to be through effects on gastrointestinal mucosa rather than the host immune response.

Acute Disease↗

PubMed1995

[Microsporidiosis in patients with chronic diarrhea and AIDS, in HIV asymptomatic patients and in patients with acute diarrhea].

Microsporidia are intracellular protozoa that mainly affect AIDS patients and chronic diarrhea, caused by the strains Enterocytozoon bieneusi and Septata intestinalis, is the most common clinical manifestation. The diagnosis is made in intestinal biopsies, however the recently developed trichromic stain with chromotrope 2R, is able to detect microsporidia in stools and has a good correlation with the biopsy. Using this technique, we studied 43 asymptomatic HIV infected subjects, 89 AIDS patients with chronic diarrhea and 186 patients with acute diarrhea as controls. Thirty-three percent of patients with AIDS, 16.3% of HIV infected subjects and none of the individuals with acute diarrhea had microsporidia in their stools (p < 0.05). In 15 patients with AIDS we detected intermitted stool microsporidia shedding; this finding should encourage repetitive examinations in negative cases. The trichromic stain for microsporidia is proposed as a routine test in AIDS patients with diarrhea.

Acquired Immunodeficiency Syndrome↗

PubMed1997

Parasites and Diarrhea. I: Protozoans and Diarrhea.

Intestinal parasitism is extremely common, with approximately 70% of all people harboring one or more intestinal parasite. Parasitism and diarrhea are both hyperendemic in areas where sanitation is suboptimal. Many clinicians assume that the identification of intestinal parasites in patients with diarrhea implies that the parasites are the cause. This approach is frequently misguided. Some intestinal parasites such as Giardia lamblia and Entamoeba histolytica certainly do cause diarrhea. Others, for example Entamoeba coli and Ascaris lumbricoides, almost certainly do not. In addition, there are a number of other organisms that have been associated with diarrheal illness in some cases, which may or may not be important pathogens. In this article, we will review the role of protozoans as definite and possible causes of diarrhea. In Part II, we review the role of helminths in diarrhea.

Journal Article↗

PubMed1987

An educational intervention for altering water-sanitation behaviors to reduce childhood diarrhea in urban Bangladesh. II. A randomized trial to assess the impact of the intervention on hygienic behaviors and rates of diarrhea.

An educational intervention was designed to improve three water-sanitation behaviors empirically shown to be associated with high rates of childhood diarrhea in Dhaka, Bangladesh: lack of handwashing before preparing food, open defecation by children in the family compound, and inattention to proper disposal of garbage and feces, increasing the opportunity for young children to place waste products in their mouth. Fifty-one communities, each comprising 38 families, were randomized either to receive (n = 25) or not to receive (n = 26) the intervention. During the six months after the intervention, the rate of diarrhea (per 100 person-weeks) in children under six years of age was 4.3 in the intervention communities and 5.8 in the control communities (26% protective efficacy; p less than 0.0001). A corresponding improvement in handwashing practices before preparing food was noted, although no improvement was observed for defecation and waste disposal practices. These data suggest that educational interventions for water-sanitation practices can have an important beneficial effect upon childhood diarrhea in developing countries, particularly when the interventions are designed in a simple way to promote naturally occurring salutory behaviors that are empirically associated with lower rates of childhood diarrhea.

Bangladesh↗

PubMed1992

Congenital sodium diarrhea with a partial defect in jejunal brush border membrane sodium transport, normal rectal transport, and resolving diarrhea.

Defective jejunal sodium/proton exchange causes severe, congenital secretory diarrhea. We report a boy who presented typically in utero, but in whom diarrhea resolved during the first year of life. Pregnancy was complicated by polyhydramnios, and an ultrasound at 31 weeks showed a distended fetal small intestine. The abdomen was grossly distended at birth, and profuse secretory diarrhea began immediately. He subsequently thrived on breast milk and electrolyte supplements. Studies of jejunal brush border sodium/proton exchange at 6 months showed a partial defect. Nonequilibrium rectal dialysis showed rectal sodium and potassium transport to be intact. Diarrhea lessened after 9 months, and the patient subsequently required occasional laxatives. These observations suggest that there is a spectrum of congenital abnormality in this exchanger, and that in children with incomplete defects normal colonic sodium salvage can subsequently mask net small intestinal secretion.

Biological Transport↗

PubMedDate not supplied

[Diarrhea and biogenic amines: regional changes in brain histamine concentration and serotonin metabolism following castor oil-induced diarrhea in rats].

Regional changes in concentrations of histamine (HA), serotonin (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA) in the rat brain were investigated after diarrhea induced by castor oil. Significant decreases in body weight were observed from the 3rd day after daily oral administration of castor oil (2.5 ml/kg). HA concentrations in most brain regions decreased in diarrhea induced by a single administration of castor oil. A significant decrease was recognized particularly in the case of the hippocampus. The influence has begun to appear in the thalamus and hypothalamus in consecutive (3 d) administration. HA concentration in the striatal and hypothalamic regions of the rat treated with castor oil for 9 d significantly decreased in comparison with the control group. On the other hand, an inhibition of 5-HT turnover was observed in the thalamus at 3 h after a single administration of castor oil. However, this inhibition was not found in rats treated with castor oil for 3 d. Moreover, 5-HT concentration in the midbrain significantly decreased in rats that acquired the adaptability for the occurrence of diarrhea. These data present a new finding that the occurrence of diarrhea or acquisition of adaptability for diarrheal occurrence affects the central histaminergic or serotonergic neuron system.

Animals↗

PubMed2001

Use of nucleotides in weanling rats with diarrhea induced by a lactose overload: effect on the evolution of diarrhea and weight and on the histopathology of intestine, liver and spleen.

Until recently, dietary sources of nucleotides were thought not to be essential for good nutrition. Certain states with higher metabolic demands may require larger amounts that cannot be provided by endogenous production. The objective of the present study was to determine the action of nucleotides on the recovery from lactose-induced diarrhea in weaned rats. Thirty-six weanling Fisher rats were divided into two groups. Group 1 received a standard diet and group 2 received a diet containing lactose in place of starch. On the 10th day, six animals per group were sacrificed for histopathological evaluation. The remaining animals were divided into two other subgroups, each with 6 animals, receiving a control diet, a control diet with nucleotides (0.05% adenosine monophosphate, 0.05% guanosine monophosphate, 0.05% cytidine monophosphate, 0.05% uridine monophosphate and 0.05% inosine monophosphate), a diet with lactose, and a diet with lactose and nucleotides. On the 32nd day of the experiment all animals were sacrificed. Animals with diarrhea weighed less than animals without diarrhea. The introduction of nucleotides did not lead to weight gain. Mean diet consumption was lower in the group that continued to ingest lactose, with the group receiving lactose plus nucleotides showing a lower mean consumption. Animals receiving lactose had inflammatory reaction and deposits of periodic acid-Schiff-positive material in intestinal, hepatic and splenic tissues. The introduction of nucleotides led to an improvement of the intestinal inflammatory reaction. In lactose-induced diarrhea, when the stimulus is maintained--lactose overload--the nucleotides have a limited action on the weight gain and on recovery of intestinal morphology, although they have a protective effect on hepatic injury and improve the inflammatory response.

Analysis of Variance↗

PubMed1989

A case of the watery diarrhea-hypokalemia-achlorhydria syndrome: successful preoperative treatment of watery diarrhea with a somatostatin analogue.

A 35-year-old man presenting with severe watery diarrhea was diagnosed as having the watery diarrhea, hypokalemia and achlorhydria (WDHA) syndrome with the elevation of plasma vasoactive intestinal peptide (VIP) level. Imaging diagnostic techniques revealed a hypervascular tumor at the tail of the pancreas as well as a solitary liver metastasis. During the patient's stay in hospital, he developed acute renal failure probably due to persistent dehydration and severe hypokalemia. Although these complications improved with artificial dialyses, severe watery diarrhea continued, which made it difficult to achieve surgical resection of the tumor. A new long-acting and potent somatostatin analogue, SMS 201-995 (Sandoz Ltd, Basel, Switzerland), was tested and was shown to be effective; after a few hours of subcutaneous injection of this agent, the watery diarrhea disappeared, which in turn improved the patient's hypokalemia, hypercalcemia and metabolic acidosis. Three weeks later, distal pancreatectomy with splenectomy and hepatic lobectomy were successfully performed, and the patient resumed his normal life. The somatostatin analogue has been reported to be useful in the long-term treatment of patients with inoperable WDHA syndrome. The present case demonstrated that short-term administration of this agent is also useful for improving the condition of WDHA patients at the preoperative stage.

Adenoma, Islet Cell↗

PubMed1977

Symposium on diarrhea. 2. Clinical diagnosis of the causes of diarrhea.

Elucidation of the cause of diarrhea is facilitated by considering which of three principal determinants are of relevance in a particular case. These determinants relate to the onset (whether diarrhea is acute or chronic), to infection or an absence ofinfection and to the presence in the stool of blood or mucus, or both. Diagnosis is also facilitated by taking an accurate and full history, conducting a physical examination, performing sigmoidoscopy and, with proper care, attempting a therapeutic diagnosis. Findings from investigations should then enable one to arrive at a diagnosis. The diagnosis can be reached in an orderly fashion by classifying the types of diarrhea into eight categories: with respect to the acute or chronic onset a case of diarrhea may be noninfectious, without blood or mucus in the stool; noninfectious, with blood or mucus, or both; infectious, without blood or mucus; and infectious, with blood or mucus in the stool.

Acute Disease↗