Pharmacologic Agents for Chronic Diarrhea

Abstract

Chronic diarrhea is usually associated with a number of non-infectious causes. When definitive treatment is unavailable, symptomatic drug therapy is indicated. Pharmacologic agents for chronic diarrhea include loperamide, 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists, diosmectite, cholestyramine, probiotics, antispasmodics, rifaximin, and anti-inflammatory agents. Loperamide, a synthetic opiate agonist, decreases peristaltic activity and inhibits secretion, resulting in the reduction of fluid and electrolyte loss and an increase in stool consistency. Cholestyramine is a bile acid sequestrant that is generally considered as the first-line treatment for bile acid diarrhea. 5-HT3 receptor antagonists have significant benefits in patients with irritable bowel syndrome (IBS) with diarrhea. Ramosetron improves stool consistency as well as global IBS symptoms. Probiotics may have a role in the prevention of antibiotic-associated diarrhea. However, data on the role of probiotics in the treatment of chronic diarrhea are lacking. Diosmectite, an absorbent, can be used for the treatment of chronic functional diarrhea, radiation-induced diarrhea, and chemotherapy-induced diarrhea. Antispasmodics including alverine citrate, mebeverine, otilonium bromide, and pinaverium bromide are used for relieving diarrheal symptoms and abdominal pain. Rifaximin can be effective for chronic diarrhea associated with IBS and small intestinal bacterial overgrowth. Budesonide is effective in both lymphocytic colitis and collagenous colitis. The efficacy of mesalazine in microscopic colitis is weak or remains uncertain. Considering their mechanisms of action, these agents should be prescribed properly.

Tuna Bone Powder Alleviates Glucocorticoid‐Induced Osteoporosis via Coregulation of the NF‐κB and Wnt/β‐Catenin Signaling Pathways and Modulation of Gut Microbiota Composition and Metabolism

“…Recent studies have indicated that TNF-, IL-6, and IL-1 impair the intestinal epithelial barrier, causing bacterial translocation and pro-inflammatory cytokine migration and further aggravating systemic inflammation. [22] Tight junction proteins, such as ZO-1, Occludin, and Claudin-1, are involved in intestinal epithelial barrier function. ZO-1 is associated with epithelial integrity, Occludin plays a crucial role in tight junction structure and permeability, and Claudins are the key components and backbone of tight junctions.…”

Acid‐Hydrolyzed Gliadins Worsen Food Allergies through Early Sensitization

“…These results suggest an increase of the intestinal epithelial layer permeability in an earlier manner with the deamidated form of gliadins than with the native form. To investigate a possible explanation of gut permeability modification, we measured relative expression of tight junction (TJ) proteins ( Figure 3C): the junction adhesion molecule (JAM-A) involved in the regulation and maintenance of the TJ barrier, [21] the ZO proteins (ZO-1) which are required to link occludin to the actin cytoskeleton, [22] the occludin which has a crucial role in the TJ structure, [23] and the cingulin which is a protein localized in the cytoplasmic region of TJ. [24] Surprisingly, we did not find any significant modification of TJ protein expression except for ZO-1 which is significantly decreased in DG groups compared to controls (1.2 vs 0.71, p < 0.05) ( Figure 3C).…”

Clinical practice of Chinese medicine navel therapy for chronic diarrhea: A literature review

“…Opiates, adrenergic agonist, somatostatin analogue, bile acid‐binding resin, and fiber supplements are common therapies for chronic diarrhea. However, the current therapeutic effect is not satisfactory . Thus, people try to find ways to treat the symptoms from complementary and alternative medicine.…”

“…However, the current therapeutic effect is not satisfactory. 8 Thus, people try to find ways to treat the symptoms from complementary and alternative medicine.…”