How to manage chronic diarrhoea in the elderly?

Crooks, Benjamin; Limdi, Jimmy K.; McLaughlin, John

doi:10.1136/flgastro-2018-101097

Cited by 7 publications

(6 citation statements)

References 44 publications

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“…This leaves the question of what else can be done for those who do not respond. Pathways for treatment of chronic functional diarrhea in adults, especially older adults, need to be developed further to include dietary strategies [ 14 , 43 ], and this study suggests that the LFD should be an important component to include in such pathways. Future research is needed to determine if older adults with chronic diarrhea are more likely to have poor nutrient intake (especially calcium, iodine, and folate) compared to those older adults without chronic diarrhea.…”

Section: Discussionmentioning

confidence: 99%

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A Low FODMAP Diet Is Nutritionally Adequate and Therapeutically Efficacious in Community Dwelling Older Adults with Chronic Diarrhoea

et al. 2020

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The low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP)diet has been extensively researched, but not in the management of older adults with functional gastrointestinal symptoms. This study determines the positive and negative impacts of this dietary treatment in older adults with chronic diarrhea. A non-blinded intervention study was conducted with adults over 65 years with chronic diarrhea referred for colonoscopy where no cause was found. Participants followed a dietitian-led low FODMAP diet for six weeks and completed a structured assessment of gastrointestinal symptoms, the Hospital Anxiety and Depression scale, and a four-day food diary before and after the intervention. Twenty participants, mean age 76 years, were recruited. Adherence to the low FODMAP diet was acceptable; mean daily FODMAP intake reduced from 20.82 g to 3.75 g (p < 0.001) during the intervention and no clinically significant changes in macro- or micronutrient intakes were observed. There were clinically significant improvements in total gastrointestinal symptoms (pre diet 21.15/88 (standard deviation SD = 10.99), post diet 9.8/88 (SD = 9.58), p < 0.001) including diarrhea (pre diet 9.85 (SD = 3.84), post diet 4.05 (SD = 3.86), p < 0.001) and significant reductions in anxiety (pre diet 6.11/21 (SD = 4.31), post diet 4.26/21 (SD = 3.38), p < 0.05). In older adults the low FODMAP diet is clinically effective and does not jeopardise nutritional intake when supervised by an experienced dietitian.

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Section: Discussionmentioning

confidence: 99%

“…They showed that 4.1% of older adults over the age of 65 have functional diarrhea [ 13 ]. The pathology of chronic diarrhea in older adults can be challenging, typically requiring consideration of colorectal cancer, polypharmacy [ 14 ], or age-related changes in gut physiology and microbiome.…”

Section: Introductionmentioning

confidence: 99%

A Low FODMAP Diet Is Nutritionally Adequate and Therapeutically Efficacious in Community Dwelling Older Adults with Chronic Diarrhoea

et al. 2020

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“…BAD is thought to be under-diagnosed and may affect up to 41% of patients presenting with IBS-D [ 107 , 108 ]. Bile acid diarrhoea is suggested to be a possible cause of chronic diarrhoea in those who do not respond to dietary and lifestyle changes [ 1 ].…”

Section: Dietary Management Of Chronic Diarrhoeamentioning

confidence: 99%

What Are the Pearls and Pitfalls of the Dietary Management for Chronic Diarrhoea?

et al. 2021

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Chronic diarrhoea affects up to 14% of adults, it impacts on quality of life and its cause can be variable. Patients with chronic diarrhoea are presented with a plethora of dietary recommendations, often sought from the internet or provided by those who are untrained or inexperienced. In this review, we summarise the possible causes of chronic diarrhoea that can be managed by diet, the symptom improvement and quality of life benefits but also the potential risks of such dietary treatments. Clinicians need to consider both the benefits and risks of dietary treatments before making dietary recommendations to manage chronic diarrhoea. The pivotal role that dietitians have in ensuring optimal symptom improvement without jeopardising nutritional and overall health is discussed.

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“…Stool cultures and Clostridium difficile toxin assay are recommended to exclude infective aetiologies[ 48 , 49 ]. Loose stools for over 6 wk help to distinguish infective causes from IBD[ 50 , 51 ]. In a recent UK study, 10% of IBD relapses were associated with enteric infections, 50% of which were Clostridium difficile related[ 101 ].…”

Section: Investigations For Ibdmentioning

confidence: 99%

“…It is usually accompanied by ileal and/or colonic disease[ 132 , 133 ]. Upper GI endoscopy should be performed in patients with dyspepsia, vomiting, or other upper GI symptoms but is not routinely indicated in adults with proven or suspected CD[ 51 , 72 ]. Focal gastritis may be a feature of CD[ 134 ].…”

Section: Investigations For Ibdmentioning

confidence: 99%

First United Arab Emirates consensus on diagnosis and management of inflammatory bowel diseases: A 2020 Delphi consensus

Alkhatry

Al‐Rifai

Annese

et al. 2020

WJG

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Ulcerative colitis and Crohn’s disease are the main entities of inflammatory bowel disease characterized by chronic remittent inflammation of the gastrointestinal tract. The incidence and prevalence are on the rise worldwide, and the heterogeneity between patients and within individuals over time is striking. The progressive advance in our understanding of the etiopathogenesis coupled with an unprecedented increase in therapeutic options have changed the management towards evidence-based interventions by clinicians with patients. This guideline was stimulated and supported by the Emirates Gastroenterology and Hepatology Society following a systematic review and a Delphi consensus process that provided evidence- and expert opinion-based recommendations. Comprehensive up-to-date guidance is provided regarding diagnosis, evaluation of disease severity, appropriate and timely use of different investigations, choice of appropriate therapy for induction and remission phase according to disease severity, and management of main complications.

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How to manage chronic diarrhoea in the elderly?

Cited by 7 publications

References 44 publications

A Low FODMAP Diet Is Nutritionally Adequate and Therapeutically Efficacious in Community Dwelling Older Adults with Chronic Diarrhoea

A Low FODMAP Diet Is Nutritionally Adequate and Therapeutically Efficacious in Community Dwelling Older Adults with Chronic Diarrhoea

What Are the Pearls and Pitfalls of the Dietary Management for Chronic Diarrhoea?

First United Arab Emirates consensus on diagnosis and management of inflammatory bowel diseases: A 2020 Delphi consensus

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