Chronic Diarrhea: Diagnosis and Management

Association Between Dietary Live Microbe Intake and Chronic Diarrhea and Fecal Incontinence: A Cross-Sectional NHANES 2005-2010 Study

OBJECTIVE

We explored potential relationships between dietary live microbe intake and chronic diarrhea (CD) and fecal incontinence (FI).

METHODS

We conducted a cross-sectional retrospective study based on the National Health and Nutrition Examination Survey (NHANES) database. Participants were categorized into three groups according to the Sanders classification system (low, medium, and high dietary live microbe groups). CD and FI were defined using a bowel health questionnaire. Logistic regression and restricted cubic spline (RCS) analyses were performed on weighted data to explore potential relationships.

RESULTS

In univariate logistic regression analyses, participants in the high dietary live microbe group exhibited a lower CD prevalence when compared to those in the low group (odds ratio (OR) = 0.58, 95% confidence interval (CI): 0.43-0.79). After adjusting for covariates, model 2 (OR = 0.69 95% CI: 0.49-0.96) and model 3 (OR = 0.66 95% CI: 0.45-0.96) data were consistent with model 1 data. No significant association was identified between dietary live microbe intake and FI. Withal, subgroup analyses revealed significant associations between high dietary live microbes and CD in males or participants without abdominal obesity, hypertension, diabetes, and sleep disorder (p < 0.05).

CONCLUSIONS

In this cross-sectional study, consuming foods rich in live microbes may exert positive effects on CD risk. This finding may facilitate new management strategies for CD.

The etiological profile of chronic organic non-bloody diarrhea in India: Emergence of inflammatory bowel disease as a dominant cause

BACKGROUND

Chronic non-bloody diarrhea may be attributed either to functional or organic diseases. The latter category may present with malabsorption syndrome if there is extensive involvement of the small bowel, whereas diseases of the large bowel may only present with diarrhea sans malabsorption. Indian data has predominantly focussed on the etiological spectrum of malabsorption syndrome in adults. The primary aim of the current study was to evaluate etiological spectrum of chronic organic non-bloody diarrhea in India.

METHODS

This prospective observational study was done at a tertiary care hospital in North India. Patients ≥ 18 years presenting with chronic non-bloody diarrhea of > 4 weeks duration were enrolled in the study after exclusion of patients with IBS and anal incontinence.

RESULTS

During the study period of 12 months, 100 patients with chronic organic non-bloody diarrhea were evaluated. A definite etiological diagnosis was made in 97 patients (97%). The mean age of the patients was 48 ± 16.7 years (58% males). The median duration of diarrhea was 5.5 months (interquartile range [IQR] 3.5, 11). Inflammatory bowel disease (IBD) accounted for 45% of the cases making it the predominant cause for organic diarrhea. GI infections and adult-onset celiac disease accounted for 18% and 9% of the cases, respectively. Pancreatic disease, benign or neoplastic, accounted for 6% of the total cases. Notably, gastrointestinal (GI) malignancies manifesting as chronic non-bloody diarrhea were diagnosed in 5% of the patients.

CONCLUSION

Our data suggests a paradigm shift in the etiological spectrum of chronic organic non-bloody diarrhea in India with the emergence of IBD as the predominant cause displacing GI infections.

Bile acid diarrhea in patients with chronic diarrhea. Current appraisal and recommendations for clinical practice

Bile Acid Diarrhea (BAD) is a common cause of chronic diarrhea, often accompanied by urgency, occasional fecal incontinence, abdominal pain, and fatigue. A nationwide survey has shown limited awareness of BAD within the Italian medical community, prompting a panel of experts to develop a Position Paper that outlines the most practical and cost-saving diagnostic investigations and treatments for this frequently overlooked condition. The document provides an overview of the epidemiology, pathophysiology, clinical manifestations, and classification of the different types of Bile Acid Diarrhea (BAD). A key focus is the diagnostic approach to identifying and managing the many undiagnosed BAD patients in both primary care and specialized medical settings. Finally, the paper addresses the optimal therapeutic strategies for BAD, including traditional bile acid sequestrants and newer, promising treatments.

Association of body roundness index with chronic diarrhea and constipation, NHANES 2005-2010

BACKGROUND

Chronic diarrhea and constipation are known to be associated with obesity. Body roundness index (BRI), as a novel physical dimension assessment indicator, provides a more comprehensive evaluation of body and visceral fat than traditional methods. However, the relationship between BRI, chronic diarrhea, and constipation remains unclear. We aimed to investigate the relationship between BRI, chronic diarrhea, and constipation.

METHODS

A cross-sectional study based on the National Health and Nutrition Examination Survey 2005-2010 was conducted. Weighted multivariable logistic regression was used to analyze the association between BRI, chronic diarrhea, and constipation. Restricted cubic spline curves were plotted to verify the linear associations.

RESULTS

7182 participants were included in this study, among whom 491 had chronic diarrhea and 441 had constipation. Significant positive correlations were discovered between BRI and chronic diarrhea, while no correlation was detected with constipation in the fully adjusted multivariable logistic regression analysis. Restricted cubic spline curves confirmed the linear relationship described above. Further treating BRI as categorical variables, compared with the lowest tertile, the highest BRI tertile showed a 79% increase in chronic diarrhea incidence and a 35% decrease in chronic constipation incidence. Consistent findings were observed across different subgroups, and sensitivity analyses generally confirmed the robustness of our results.

CONCLUSIONS

BRI is significantly and linearly associated with chronic diarrhea. Higher body and visceral fat increase the risk of chronic diarrhea while reducing the risk of chronic constipation.

Assessing the impact of 25-hydroxyvitamin concentrations on mortality in chronic diarrhea: a cross-sectional analysis

Background

The aim of this study was to assess the relationship between serum 25-hydroxyvitamin levels and all-cause mortality in patients with chronic diarrhea.

Methods

We carried out a cross-sectional study using information drawn from the National Health and Nutrition Examination Survey (NHANES). To assess mortality outcomes, we compared our data with records from the National Death Index as of December 31, 2011. The NHANES data were used to determine mortality outcome. We used a Cox regression model-based approach to analyze the relationship between serum 25-hydroxyvitamin concentrations and mortality in chronic diarrhea patients.

Results

A total of 2,972 participants with chronic diarrhea were included in our study, 488 cases of all-cause mortality were recorded. The study showed an L-shaped relationship between 25-hydroxyvitamin concentrations and all-cause mortality with a threshold of 73.40 nmol/L. On the left side of the threshold, each 1-unit increase in 25-hydroxyvitamin concentrations was associated with a 2.2% reduction in the risk of all-cause mortality (HR 0.978; 95% CI: 0.969, 0.987); however, on the right side of the threshold, there was no significant correlation between 25(OH)D concentrations and all-cause mortality.

Conclusion

Serum 25-hydroxyvitamin D levels showed an L-shaped association with all-cause mortality in patients with chronic diarrhea, with 73.40 nmol/L as the potential threshold. However, because this was a cross-sectional study, only an association, not a causal relationship, can be inferred. Further prospective studies are needed to confirm these findings and explore the potential impact of vitamin D supplementation on mortality outcomes.

The Associations Between Life's Essential 8 and Diarrhea and Constipation: Results From the 2005-2010 National Health and Nutrition Examination Survey

INTRODUCTION

Few studies have investigated the association between Life's Essential 8 (LE8) and abnormal bowel health. We aimed to investigate the relationship between LE8 and diarrhea and constipation in the adult population of the United States.

METHODS

This cross-sectional study, based on population data, used information from the National Health and Nutrition Examination Survey conducted between 2005 and 2010. Diarrhea and constipation were classified based on Bristol Stool Form Scale and stool frequency. LE8 score is composed of 4 health behaviors (diet, physical activity, nicotine exposure, and sleep health) and 4 health factors (body mass index, blood lipids, blood glucose, and blood pressure) and is classified into low (0-49), moderate (50-79), and high (80-100) cardiovascular health groups. Weighted logistic regression and restricted cubic splines were used to analyze the relationship between the LE8 score and abnormal bowel health.

RESULTS

The study comprised 12,369 participants aged 20 years or older, among whom 1,279 (9.7%) had constipation and 1,097 (7.6%) had diarrhea. After adjusting for potential confounders, we observed negative associations between LE8 scores and diarrhea (odds ratio: 0.60, 95% confidence interval: 0.39-0.93), whereas the association between LE8 scores and constipation was not statistically significant (odds ratio: 0.82, 95% confidence interval: 0.59-1.13). In addition, health behavior scores and health factor scores were associated with constipation.

DISCUSSION

Higher LE8 levels are associated with a lower incidence of diarrhea, but not constipation.

Multilevel analysis of prevalence and determinants of diarrhea among under-five children in Somalia: insights from the Somalia demographic and health survey 2020

BACKGROUND

Diarrheal diseases remain a critical public health challenge, particularly for children under five in low- and middle-income countries such as Somalia. This study aimed to assess the prevalence and determinants of diarrhea in this vulnerable population, utilizing data from the 2020 Somalia Demographic and Health Survey.

METHODS

This investigation employed secondary data from the 2020 Somalia Demographic and Health Survey. The analysis involved the extraction and cleaning of variables using STATA version 17. The primary outcome variable was childhood diarrhea, analyzed alongside 19 explanatory variables encompassing sociodemographic and environmental factors. Descriptive statistics, chi-square tests, and multilevel logistic regression models were employed to elucidate associations.

RESULTS

The study identified a diarrhea prevalence of 5.24%. Notably, sociodemographic factors significantly influenced this prevalence. Families within the second wealth category exhibited reduced odds of diarrhea (AOR = 0.699; 95% CI: 0.522-0.936), with those in the middle wealth category experiencing even lower odds (AOR = 0.524; CI: 0.391-0.702). Vitamin A supplementation was found to be critical; children lacking recent supplementation had increased odds of diarrhea (AOR = 1.790; CI: 1.440-2.225). Furthermore, feeding practices indicated that children not using bottle nipples faced higher odds of diarrhea (AOR = 1.377; CI: 1.172-1.617). Maternal age also played a significant role, with mothers aged 45-49 presenting higher odds of their children experiencing diarrhea (AOR = 7.650; CI: 1.762-33.184). Institutional births were associated with lower odds of diarrhea (AOR = 0.693; CI: 0.568-0.847), while children of educated fathers exhibited increased odds (AOR = 1.414; CI: 1.090-1.833). Additionally, lack of deworming medication significantly heightened the odds of diarrhea (AOR = 4.450; CI: 3.619-5.482).

CONCLUSION

The prevalence of diarrhea among children under five relatively high in Somalia. Key determinants include vitamin A supplementation, feeding with bottle, household wealth, age of mothers, place of delivery, paternal education, and deworming medication. Public health interventions should focus on enhancing household economic status, and ensuring regular deworming. Increasing the coverage and frequency of vitamin A supplementation could enhance children's immune systems and reduce diarrhea incidence. Moreover, targeted economic support, health care programs for older mothers are essential to mitigate the adverse effects of socioeconomic factors on child health, ultimately leading to a substantial reduction in diarrheal diseases among young children.

L-shaped association of dietary inflammatory index (DII) and chronic diarrhea: results from NHANES 2005-2010

BACKGROUND

Since diet is a known modulator of inflammation, the Dietary Inflammatory Index (DII), which quantifies the inflammatory potential of an individual's diet, becomes a significant parameter to consider. Chronic diarrhea is commonly linked to inflammatory processes within the gut. Thus, this study aimed to explore the potential link between DII and chronic diarrhea.

METHODS

This research utilized data from the National Health and Nutrition Examination Survey (NHANES) 2005-2010. The DII was calculated according to the average intake of 28 nutrients using information gathered from two 24-hour recall interviews. The Bristol Stool Form Scale (BSFS) was adopted to describe chronic diarrhea, identifying stool Type 6 and Type 7. Multivariate logistic regression models examined the causal connection between DII and chronic diarrhea. Additionally, subgroup analyses and interaction tests were conducted.

RESULTS

The study encompassed 11,219 adults, among whom 7.45% reported chronic diarrhea. Initially, multivariate logistic regression analysis revealed a positive association between DII and chronic diarrhea. Nevertheless, this connection lost statistical significance (OR = 1.00; 95% CI, 0.96-1.05; P = 0.8501) after adjusting for all confounding variables. Stratified by sex, the analysis revealed a notable rise in the risk of chronic diarrhea with increasing DII among female participants (all P for trend < 0.05). This tendency remained constant even after full adjustment (P for trend = 0.0192), whereas no significant association was noted in males (all P for trend > 0.05). Furthermore, an L-shaped association emerged between DII and chronic diarrhea, with an inflection point of -1.34. In the population with DII scores below -1.34, each unit increase in DII correlated with a 27% reduction in the probability of chronic diarrhea (OR = 0.73; 95% CI, 0.57-0.93), whereas in the population with DII scores above -1.34, the risk increased by 4% (OR = 1.04; 95% CI, 0.98-1.10). Merely, the gender interaction was shown to be statistically significant based on subgroup analyses and interaction tests.

CONCLUSIONS

A favorable association between DII and chronic diarrhea exists in adults in the United States. Nevertheless, additional long-term prospective studies are required to confirm and solidify those findings.

Chronic Liver Disease Primarily Presenting with Motor Weakness by Intractable Hypokalemia with Combined Respiratory Alkalosis and Chronic Diarrhea: A Case Report

Introduction

Most patients with compensated cirrhosis remain asymptomatic. However, with the onset of decompensation, electrolyte and acid-base disturbances are frequent in patients with chronic liver disease, including hypokalemia. We encountered a case of chronic liver disease with portal hypertension, primarily presenting with motor weakness caused by intractable hypokalemia, hypoxia-associated respiratory alkalosis, and chronic diarrhea.

Case Presentation

A 54-year-old male presented to the emergency department with motor weakness. He reported experiencing exertional dyspnea and watery diarrhea for the past 3 months, approximately ten times daily. Arterial blood gas analysis indicated hypoxia and hypocapnia compatible with chronic respiratory alkalosis. The transtubular potassium gradient was 1.69, and the aldosterone/renin ratio was 17.6 (ng/dL)/(ng/mL/h). The patient had a 30-year history of consuming 360-720 mL of 20% alcohol almost daily. Abdominal computed tomography revealed multiple regenerative and dysplastic nodules in the liver, splenomegaly, ascites, esophageal varices, and diffuse edematous wall thickening in the bowel, suggesting portal hypertensive enteropathy. Computed tomography of the lungs showed no specific abnormalities in the lungs, pleura, or thoracic wall.

Conclusion

We present a case of liver cirrhosis complicated by intractable hypokalemia, respiratory alkalosis, portal hypertension, and chronic diarrhea. A 24-h urine analysis showed renal excretion levels of Na+, K+, and Cl- at 6.0, 2.5, and 11.0 mmol, respectively, suggesting renal retention of these electrolytes. Meanwhile, the serum levels of Na+, K+, and Cl- were 136, 1.8, and 98 mEq/L, respectively, indicating a preserved balance of sodium and chloride but not potassium. This case underscores the importance of clinicians considering both liver cirrhosis-associated hypoxia and chronic liver disease-induced chronic diarrhea as potential underlying causes, especially when more common causes of hypokalemia have been excluded.

Effects of opium tincture on gastrointestinal function and motility in healthy volunteers: A magnetic resonance imaging study

BACKGROUND

Opioids inhibit motility and secretion of the gut and have been used for antidiarrheal treatment for centuries. However, the underlying mechanisms of opium tincture are not evident.

AIM

To investigate the effects of opium tincture on gastrointestinal motility, intestinal volumes, and water content of different gut segments assessed by magnetic resonance imaging (MRI).

METHODS

Twenty healthy volunteers were included in a randomized, placebo-controlled, crossover study of 9 days of treatment with 30 drops of opium tincture per day. MRI was performed on day 1 (before treatment) and day 9 (during treatment). Measurements included assessments of gastric volume, gastric emptying, gastric motility, small bowel volume, small bowel water content, small bowel motility, colon volume, colon water content, and whole gut transit.

KEY RESULTS

Opium tincture delayed gastric emptying by a mean difference of 5.6 min [95% CI: 1.8-9.4], p = 0.004, and increased postprandial gastric meal volume (17-21%, p = 0.02). Small bowel endpoints did not change. Opium tincture delayed whole gut transit time (p = 0.027) and increased ascending colon volume by 59 mL [95% CI: 15-103], p = 0.004, and transverse colon volume by 48 mL [95% CI: 4-92], p = 0.027. T1-relaxation time of the descending colon chyme was decreased during opium treatment, indicating dryer feces (difference: -173 ms [95% CI: -336 -11], p = 0.03).

CONCLUSION AND INFERENCES

Opium tincture induced changes in the stomach and colon in healthy volunteers. An improved understanding of how opioids affect gut functions may lead to a better understanding and optimized management of diarrhea.

Association between ideal cardiovascular health and bowel conditions among US adults

Objective

The aim of this study is to explore the relationship between ideal cardiovascular health (CVH), as assessed using the Life's Essential 8 (LE8), and bowel conditions.

Methods

This cross-sectional study selected 11,108 participants aged ≥20 years from 2005 to 2010 National Health and Nutrition Examination Survey. LE8 scores (range 0-100) were measured according to American Heart Association definitions and were divided into health behavior and health factor scores. Bowel conditions including chronic diarrhea, constipation, and fecal incontinence were diagnosed by the Bowel Health Questionnaire. Weighted logistic regression and restricted cubic spline models were used for correlation analysis.

Results

Logistic regression results showed that LE8 scores were negatively associated with chronic diarrhea and fecal incontinence, but the difference with chronic constipation was not statistically significant. The health behaviors subscale was also negatively correlated with chronic diarrhea, chronic constipation, and fecal incontinence, but health factors were negatively related to chronic diarrhea and fecal incontinence and positively related to chronic constipation. The RCS was consistent with the trend of the logistic regression findings. Sensitivity analyses reconfirmed these outcomes.

Conclusion

LE8 is highly associated with chronic diarrhea and fecal incontinence, not with chronic constipation. Encouraging optimization of CVH levels may be beneficial for bowel disorders, and prevention of bowel disorders may enhance CVH.

Cholecystocolonic Fistula: A Case of Chronic Diarrhoea and Hidden Stones

A cholecystocolonic fistula (CCF) is a rare cause of chronic diarrhoea. It most often occurs in elderly women as a result of chronic inflammation due to gallstone disease or, rarely, malignancy. Curative treatment consists of cholecystectomy with excision of the fistula tract, but it is often overlooked preoperatively and thus entails a higher risk of postoperative complications. Here, we present a case of a 78-year-old woman with chronic diarrhoea who was diagnosed with a CCF during a colonoscopy. Cholecystectomy was complicated by acute cholangitis due to an obstructive stone in the common bile duct (CBD) that was masked preoperatively due to alternative biliary drainage via the CCF. Recognition of this rare entity can enhance clinicians' diagnostic appraisal and limit postoperative complications.

Chronic Diarrhea Owing to Microscopic Colitis: A Cohort Study with Insights into Diagnostic Challenges and Size of the Problem

BACKGROUND

Microscopic colitis (MC) is a recognized cause of chronic diarrhea and is often underestimated when a colonoscopy appears normal. This study aims to accurately diagnose chronic diarrhea through histopathological examination of colonoscopic mucosal biopsies and assess the prevalence of microscopic colitis and the diagnostic value of biomarkers.

METHODS

A hospital-based cohort study was conducted on 116 patients with chronic diarrhea. Colonoscopies and colonic mucosal biopsies were performed and analyzed, along with various tests including fecal calprotectin (FC) level, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), stool analysis, routine laboratory tests, and clinical data related to nocturnal diarrhea, abdominal pain, and unexplained weight loss.

RESULTS

In the study group, 32.8% had MC, with 25.9% having lymphocytic colitis (LC) and 6.9% having collagenous colitis (CC). Patients with MC had significantly higher FC, ESR, and CRP levels than those without colitis (p < 0.001). Factors associated with MC included nocturnal diarrhea (OR = 4.26; 95% CI [1.64-11.08]; p-value = 0.003) and abdominal pain (OR = 4.62; 95% CI [1.85-11.54]; p-value = 0.001). ESR at a cutoff >14 mm/h and FC at a cutoff >64 mcg/g showed excellent validity in diagnosing MC with area under the curve (AUC) values of 0.94 and 0.97, respectively.

CONCLUSIONS

Microscopic colitis, particularly LC-type, is not an uncommon cause of chronic diarrhea, especially when accompanied by symptoms such as abdominal pain and nocturnal diarrhea, warranting further investigation, including inflammatory markers and colonic biopsy. Inflammatory markers can be useful in diagnosing MC with proper values and approaches; however, further studies are needed.

Decreasing of Trimethylamine N-Oxide by Cecal Microbiota and Choline-Trimethylamine Lyase are Associated with Sishen Pill on Diarrhea with Kidney-Yang Deficiency Syndrome

BACKGROUND

Sishen Pill (SSP) is a traditional Chinese medicine prescription commonly used to treat diarrhea with kidney-yang deficiency syndrome. The aim was to investigate the underlying mechanisms of SSP's therapeutic effects, providing experimental evidence for its mechanism of action.

METHODS

A mouse model of diarrhea with kidney-yang deficiency syndrome was induced using adenine combined with Folium sennae. After successful model replication, SSP decoction was administered. CutC activity, TMAO, IL-6, TNF-α levels, and cecal content microbiota were measured.

RESULTS

SSP significantly improved the general behavioral characteristics of diarrhea mice, and reduced CutC activity, TMAO and IL-6 levels. Sequencing results indicated significant changes at the phylum and genus levels. Correlation analysis revealed a positive correlation between CutC activity and Faecalibaculum (p<0.05) and Chryseobacterium (p<0.05), and a significant negative correlation with Prevotellaceae UCG-001, Rikenella (p<0.05), Acinetobacter (p<0.05), Parasutterella (p<0.05), and Lacticaseibacillus (p<0.05). TNF-α levels showed a significant negative correlation with Lacticaseibacillus (p<0.05), Prevotellaceae UCG-001 (p<0.01), Parasutterella (p<0.05), and Candidatus Saccharimonas (p<0.05). IL-6 levels exhibited a significant negative correlation with Rikenella (p<0.05), Acinetobacter (p<0.05), Prevotellaceae UCG-001 (p<0.05), Lacticaseibacillus (p<0.01), and Parasutterella (p<0.05), and a significant positive correlation with Faecalibaculum (p<0.05), Chryseobacterium (p<0.01), and A2. Serum TMAO levels showed a significant positive correlation with Faecalibaculum (p<0.05) and Chryseobacterium (p<0.01), and hepatic TMAO levels exhibited a significant positive correlation with Chryseobacterium (p<0.05).

CONCLUSION

SSP significantly alleviated the symptoms of diarrhea with kidney-yang deficiency syndrome by modulating the cecal microbiota, downregulating CutC activity, and reducing TMAO and inflammatory factor levels. The cecal microbiota-CutC-TMAO-inflammatory cytokine axis may be a key mechanism underlying the therapeutic effects of SSP.

Antidiarrheal effect of Psidium guajava L. extract in acute diarrhea: a systematic review

Acute diarrheal diseases are a leading cause of childhood mortality and morbidity worldwide. Psidium guajava has been globally used for its antidiarrheal potential. We conducted a systematic review of scientific articles published up to the year 2021, which included in vivo pre-clinical tests and clinical trials involving patients with acute infectious diarrhea to verify the antidiarrheal, antibacterial and antispasmodic effects of galenic preparations or phytopharmaceuticals from P. guajava. PRISMA and Rayyan were used as tools for the selection of studies collected in four databases (Pubmed, Scopus, Web of Science and Science Direct). The keywords used to carry out the search were: 'Psidium guajava', 'guava', 'antidiarrhe*' and 'diarrhe*', joined by Boolean operators 'OR' or 'AND'. The characteristics of studies in animal models of acute diarrhea induction, as well as in vivo and in vitro motility and microbiological tests linked with its main pathophysiological mechanisms, were collected. Twenty-three articles were included. Twenty (87%) of these reported heterogenic preclinical studies, predominating pharmacological studies of efficacy against conventional antidiarrheal agents, which utilized relevant outcomes and models of infectious diarrhea from the top pathogens in the clinic along with classical castor oil-induced diarrhea associated with motility tests. Only three articles (13%) corresponded to clinical trials investigating the efficacy, dose and safety of these preparations. Most studies reported positive results and significant mechanistic evidence from antibacterial, anti-motility, anti-secretory and protective/anti-inflammatory perspectives. However, further studies are needed to define the clinical significance and safety treatment with P. guajava extracts. © 2024 Society of Chemical Industry.

Prevalence of Parasitic Disease Burden in the Adult Population Presenting With Persistent or Chronic Diarrhea

Introduction Parasitic infection is an overlooked cause of diarrhea in adults. It can cause persistent or chronic diarrhea that contributes to a significant burden on the overall morbidity of the population. Stool sampling would aid in the diagnosis of parasitic infection in adults presenting with diarrhea. Methods A cross-sectional study was conducted from January to June 2024 at Medical Teaching Institution (MTI)-Hayatabad Medical Complex, Peshawar, Pakistan. A total of 500 stool samples were collected using non-probability consecutive sampling. All the patients presenting with complaints of persistent or chronic diarrhea to the medical outpatient department or admitted to the medical units were included in the study. Patients with bloody diarrhea and those less than 13 years of age were excluded from the study. Verbal and written informed consent was obtained from all the patients included in the study. The stool samples of all the patients were collected, reported, and verified by the microbiology department. Results Out of 500 stool samples of the patients with persistent or chronic diarrhea, 174 (34.8%) were found to be infected with cysts or trophozoites of parasites. Gender distribution of parasitic infections showed that 89 out of 245 females (36.3%) and 85 out of 255 males (33.3%) were affected. The comparison between genders yielded a p-value of 0.482. All the patients showed mono parasitism. The most common isolate was Giardia lamblia in 90 (51.72%) cases, followed by H-Nana in 49 (28.17%) isolates, Entamoeba histolytica in 16 (9.20%), Ascaris lumbricoides in 14 (8.04%), Trichuris trichura in two (1.15%), Taenia saginata in two (1.15%), and Cryptosporidium in one (0.6%) infected patient.  Conclusion Parasitic intestinal infections, particularly Giardia and H-Nana, are prevalent yet overlooked causes of persistent and chronic diarrhea in adults. These findings underscore the importance of routine stool examination as a cost-effective diagnostic tool, potentially improving patient outcomes and reducing unnecessary medical interventions.​​​​​​​​​.

A Multi-Hospital Comparative Study on the Efficacy of Probiotics Versus Placebo in Preventing Antibiotic-Associated Diarrhea in Adult Patients

BACKGROUND

Antibiotic-associated diarrhea (AAD) is a prevalent complication of antibiotic therapy, attributed to disruptions in gut microbiota. Probiotics are increasingly studied for their potential in preventing AAD by restoring microbial balance.

OBJECTIVE

The aim of this investigation was to assess the efficacy of probiotics in reducing AAD in adult patients when compared to a placebo.

METHODOLOGY

This research was conducted from March 2023 to March 2024 using a randomized, placebo-controlled design at multiple institutions: Khyber Teaching Hospital, Peshawar; Prime Teaching Hospital, Peshawar; Mufti Mahmood Memorial Teaching Hospital, Dera Ismail Khan; Shalamar Hospital, Lahore; University Hospitals of Leicester; and DHQ Teaching Hospital Kohat, enrolling 340 adult patients prescribed systemic antibiotics. Eligible participants were aged 18 years and older, while those with chronic diarrhea, inflammatory bowel disease, immunodeficiency, recent probiotic or antibiotic use, or inability to provide informed consent were excluded. The sample size was calculated using WHO guidelines, resulting in a target of 340 to ensure adequate power. Participants were randomized to receive either probiotics (Lactobacillus rhamnosus GG and Bifidobacterium longum BB536) or placebo, administered within 24 hours of starting antibiotics. Daily monitoring of bowel habits and symptoms was performed using standardized diaries, and adherence was evaluated through pill counts. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 27 (Released 2020; IBM Corp., Armonk, New York, United States), comparing the incidence, severity, and duration of AAD between groups, with a significance threshold of p < 0.05.

RESULTS

In the probiotic group, 31 patients (18.23%) developed AAD compared to 53 patients (31.17%) in the placebo group (p=0.01). Among those with AAD, the probiotic group experienced a shorter duration (mean 3.5 ± 1.2 days) compared to placebo (mean 5.1 ± 1.8 days, p=0.002). Adherence rates were high in both groups (probiotic: 96.4%, placebo: 95.9%). Significant improvements in bowel habits were reported more frequently in the probiotic group (77.06%) than placebo (50.59%, p=0.02). The hospital stay duration was similar between groups (probiotic: mean 7.8 ± 2.1 days, placebo: mean 8.3 ± 2.4 days, p=0.15).

CONCLUSION

Probiotics significantly reduced the incidence and duration of AAD compared to placebo, with high adherence and favorable patient-reported outcomes.

Global Incidence of Diarrheal Diseases-An Update Using an Interpretable Predictive Model Based on XGBoost and SHAP: A Systematic Analysis

BACKGROUND

Diarrheal disease remains a significant public health issue, particularly affecting young children and older adults. Despite efforts to control and prevent these diseases, their incidence continues to be a global concern. Understanding the trends in diarrhea incidence and the factors influencing these trends is crucial for developing effective public health strategies.

OBJECTIVE

This study aimed to explore the temporal trends in diarrhea incidence and associated factors from 1990 to 2019 and to project the incidence for the period 2020-2040 at global, regional, and national levels. We aimed to identify key factors influencing these trends to inform future prevention and control strategies.

METHODS

The eXtreme Gradient Boosting (XGBoost) model was used to predict the incidence from 2020 to 2040 based on demographic, meteorological, water sanitation, and sanitation and hygiene indicators. SHapley Additive exPlanations (SHAP) value was performed to explain the impact of variables in the model on the incidence. Estimated annual percentage change (EAPC) was calculated to assess the temporal trends of age-standardized incidence rates (ASIRs) from 1990 to 2019 and from 2020 to 2040.

RESULTS

Globally, both incident cases and ASIRs of diarrhea increased between 2010 and 2019. The incident cases are expected to rise from 2020 to 2040, while the ASIRs and incidence rates are predicted to slightly decrease. During the observed (1990-2019) and predicted (2020-2040) periods, adults aged 60 years and above exhibited an upward trend in incidence rate as age increased, while children aged < 5 years consistently had the highest incident cases. The SHAP framework was applied to explain the model predictions. We identified several risk factors associated with an increased incidence of diarrhea, including age over 60 years, yearly precipitation exceeding 3000 mm, temperature above 20 °C for both maximum and minimum values, and vapor pressure deficit over 1500 Pa. A decreased incidence rate was associated with relative humidity over 60%, wind speed over 4 m/s, and populations with above 80% using safely managed drinking water services and over 40% using safely managed sanitation services.

CONCLUSIONS

Diarrheal diseases are still serious public health concerns, with predicted increases in the incident cases despite decreasing ASIRs globally. Children aged < 5 years remain highly susceptible to diarrheal diseases, yet the incidence rate in the older adults aged 60 plus years still warrants additional attention. Additionally, more targeted efforts to improve access to safe drinking water and sanitation services are crucial for reducing the incidence of diarrheal diseases globally.

Association between bowel movement disorders and depressive symptoms: a cross-sectional study

Objectives

This study aimed to explore the association between bowel movement disorders and depression in adults.

Method

A cross-sectional study was conducted using data from the National Health and Nutritional Examination Survey (NHANES), 2005-2010. Depression, constipation, diarrhea, and fecal incontinence were self-reported via questionnaires. Weighted logistic regression and subgroup analyses were performed to explore the association between bowel movement disorders and the risk of depression. Restricted cubic spline (RCS) was also conducted to investigate the association between bowel movements disorder and depression.

Results

A total of 13,820 participants were collected. Compared to the participants with normal bowel movements, the full-adjusted depression model ORs for constipation and diarrhea were 2.28 (95%CI,1.78-2.92), 1.75 (95%CI,1.31-2.31), respectively. Any kind of bowel leakage were associated with depression. The RCS showed the possible nonlinear association between bowel movement frequency/stool shape and depression.

Conclusions

Constipation, diarrhea, and bowel leakage are associated with an increased risk of depression.

Prevalence and associated factors of chronic diarrhea among adults with obesity in the United States: Evidence from the National Health and Nutrition Examination Survey 2005 to 2010

OBJECTIVE

Diarrhea in populations with obesity is underappreciated and factors associated with chronic diarrhea in individuals with obesity have not been studied. We aimed to analyze the prevalence of chronic diarrhea and associated factors among adults with obesity in a nationally representative population.

METHODS

Data of adults with obesity in the National Health and Nutrition Examination Survey (NHANES) during 2005-2010 were analyzed. Chronic diarrhea was defined according to the Bristol Stool Form Scale. Demographic, lifestyle, dietary, and metabolic factors were considered. Prevalence estimates were described by group, and odds ratios (ORs) for associated factors were calculated in multivariate logistic regression.

RESULTS

Overall, 5048 respondents with obesity (weighted sample, 63,493,500) completed the bowel health questionnaire and met eligibility criteria. The chronic diarrhea prevalence in adults with obesity was 8.18 % (95 % confidence interval [CI], 7.17 %, 9.19 %). Female sex, older age, obesity severity, high dietary sugar intake, depression, and history of diabetes or prediabetes were positively correlated with chronic diarrhea. Differences occurred in the distribution of associated factors between males and females.

CONCLUSION

The overall chronic diarrhea prevalence in adults with obesity was 8.18 % in the nationally representative US population. We identified sex differences in associated demographic, dietary, and metabolic factors with chronic diarrhea in adults with obesity.

Knowledge, attitudes, and practices of health personnel in the management of diarrhea: case of the Logone and Chari Department, Far North Cameroon

Introduction

management of diarrheal diseases is presented in the Integrated Management of Childhood Illnesses (IMCI) document, but is not standardized in adults. The objective of this study is to assess the knowledge, attitudes, and practices (KAP) of healthcare personnel with regard to the management of diarrhea.

Methods

a descriptive cross-sectional study was conducted among health care givers in health facilities in four (4) health districts (HDs) of Logone and Chari Department of Far North Cameroon in 2016. Consenting participants, selected exhaustively in the health facilities, responded individually to a semi-structured questionnaire administered face to face on a smartphone Open Data Kit (ODK) format. Statistical analyses of the data allowed us to highlight frequencies and proportions of variables such as the definition of diarrhea, the causes of diarrhea, diagnostic techniques and methods, and the management of these diseases.

Results

a total of 77 professionals participated in this study, of whom 56% were nurse assistants, 22% were nurses, and 5% were physicians; 78% of them knew the World Health Organization (WHO) definition of diarrhea. Twenty-two (29%) reported having IMCI and 82% of them practiced it. Seventy-seven (100%) reported they administered a rehydration solution according to the dehydration status of the first-line patient. Metronidazole (23%), amoxicillin (17%), and cotrimoxazole (14%) are the antimicrobials frequently prescribed in children less than 5 years of age.

Conclusion

health care providers in Logone and Chari Department have different opinions regarding diarrheal diseases as well as on the management of its diseases. To improve the management of diarrhea, it would therefore be important to set up a standard document for the management of its diseases while ensuring its implementation by health professionals.

Evidence-Based Clinical Guidelines for Chronic Diarrhea 2023

The Japan Gastroenterological Association (JGA) published the first version of clinical guidelines for chronic diarrhea 2023. These guidelines describe the definition, classification, diagnostic criteria, diagnostic testing methods, epidemiology, pathophysiology, and treatment of chronic diarrhea, and provide flowcharts for the diagnosis and treatment of chronic diarrhea based on the latest evidence. Treatment for chronic diarrhea begins by distinguishing secondary chronic constipation with a clear etiology, such as drug-induced diarrhea, food-induced diarrhea, systemic disease-associated diarrhea, infection-associated diarrhea, organic disease-associated diarrhea, and bile acid diarrhea. The first line of treatment for chronic diarrhea in the narrow sense, defined in these guidelines as functional diarrhea in routine medical care, is lifestyle modification and dietary therapy. The first medicines to be considered for oral treatment are probiotics for regulating the gut microbiome and anti-diarrheals. Other medications, such as 5HT3 receptor antagonists, anticholinergics, Kampo medicine, psychotherapy, antibiotics, bulking agents, adrenergic agonists, and somatostatin analogs, lack sufficient evidence for their use, highlighting a challenge for future research. This Clinical Guidelines for Chronic Diarrhea 2023, which provides the best clinical strategies for treating chronic diarrhea in Japan, will also be useful for medical treatment worldwide.

Lactiplantibacillus plantarum P9 for chronic diarrhea in young adults: a large double-blind, randomized, placebo-controlled trial

Current treatments for chronic diarrhea have limited efficacy and several side effects. Probiotics have the potential to alleviate symptoms of diarrhea. This randomized, double-blind, placebo-controlled trial evaluates the effects of administering the probiotic Lactiplantibacillus plantarum P9 (P9) strain in young adults with chronic diarrhea (Clinical Trial Registration Number: ChiCTR2000038410). The intervention period lasts for 28 days, followed by a 14-day post-intervention period. Participants are randomized into the P9 (n = 93) and placebo (n = 96) groups, with 170 individuals completing the double-blind intervention phase (n = 85 per group). The primary endpoint is the diarrhea symptom severity score. Both intention-to-treat (n = 189) and per-protocol (n = 170) analyses reveal a modest yet statistically significant reduction in diarrhea severity compared to the placebo group (20.0%, P = 0.050; 21.4%, P = 0.048, respectively). In conclusion, the results of this study support the use of probiotics in managing chronic diarrhea in young adults. However, the lack of blood parameter assessment and the short intervention period represent limitations of this study.

In vivo anti-Salmonella properties of aqueous extract of prickly pear (Opuntia ficus indica) cladode, hepatological and toxicological evaluation

The present study aimed to evaluate antidiarrheal potential of prickly pear cladode and its hepatoprotective role in different groups of diarrhea-induced mice. Mice received cefixime (4 mg/kg of bw) and different concentrations of aqueous cladode extract (250 mg/kg of bw, 500 mg/kg of bw and 1000 mg/kg of bw). Feces Salmonella typhi ATCC 19430 was used to assess antidiarrheal potential and hematological, biochemical parameters, and histopathological analyses were carried out for 17 days. The results showed that administration of Salmonella typhi ATCC 19430 in mice produced liver injuries with histological damage, whereas 1000 mg/kg of bw cladode extract reduced the Salmonella typhi ATCC 19430 load of feces earlier as compared to the other groups during 17 days. Hematological parameters, like red blood cells (RBCs) (6.19 ± 1.85 × 106/mm3) and hemoglobin (Hb) (10.06 ± 2.03 g/dL), of negative control group decreased, while white blood cells (WBCs) (13.46 × 106/mm3) increased from reference values. In lipid profile, low-density lipoprotein (LDL) (9.0 ± 2.41 mg/dL), high-density lipoprotein (HDL) (6.07 ± 2.45 mg/dL) and total cholesterol (TC) (35.22 ± 8.29 mg/dL) of negative control group decreased, while triglycerides (TG) (168.35 ± 71.75 mg/dL) increased from reference values. Alanine transferase (ALT) (60.30 ± 20.33 IU/L), alkaline phosphatase (ALP) (359.9 ± 100.05 IU/L) and aspartate transferase (AST) (168.77 ± 66.61 IU/L) of negative control group increased from reference values. Urea (27.36 ± 10.54 mmol/L) and creatinine (35.29 ± 12.15 mmol/L) of the negative control group increased. Cefixime also ameliorated injuries due to the administration of Salmonella typhi ATCC 19430. Conclusively, these findings indicated that pure aqueous extract of cladode showed more promising results regarding antidiarrheal potential. Hence, cladode might be used in food and supplement formulations as a functional ingredient.

Huangtu decoction alleviates chronic diarrhea of spleen-yang deficiency in mice by altering host metabolome and intestinal microbiota composition

BACKGROUND

Huangtu decoction (HTD), a traditional Chinese medicine recipe, warms the spleen, nourishes the blood, and stops bleeding. It has been used to treat dysentery, gastrointestinal bleeding, diarrhea, and other symptoms caused by spleen-yang deficiency for more than 2,000 years in China. However, the mechanism underlying the treatment of chronic diarrhea due to spleen-yang deficiency (CDSD) using HTD remains unclear.

AIMS

This study investigated whether HTD could mediate intestinal flora and serum metabolites to improve CDSD symptoms using a mouse model.

METHODS

A CDSD mouse model induced by senna and an abnormal diet was constructed. The regulatory effects of HTD at 12.5, 25.0, and 50.0 g/kg/d on CDSD mice were assessed by measuring their bodyweight, diarrhea rate, loose stool rate, and histopathology. Changes in the intestinal flora of CDSD mice were analyzed by 16S rRNA gene sequencing. Untargeted serum metabolomic analysis was performed using ultra-high performance liquid chromatography-mass spectrometry/mass spectrometry (UHPLC-MS/MS).

RESULTS

HTD had a modulating effect on CDSD by reducing the weight loss, diarrhea rate, loose stool rate, and pathologic damage. Intestinal flora analysis showed that HTD altered the community composition by decreasing the abundance of Allobaculum, Lactobacillus, and Ruminococcus. Serum metabolomics revealed that ascorbate and aldarate metabolism, aldosterone synthesis and secretion, platelet activation, hypoxia-inducible factor 1 signaling pathway, inositol phosphate metabolism, phosphatidylinositol signaling, galactose metabolism, and alpha-linolenic acid metabolism were modulated after HTD treatment.

CONCLUSION

HTD may alleviate CDSD symptoms by reducing weight loss, diarrhea rate, loose stool rate, and pathologic damage caused by modeling and regulating intestinal flora and serum metabolites in CDSD mice.

At an appointment with a patient with diarrhea: the doctor’s algorithm of actions

Diarrhoea is one of the most common gastroenterological complaints made by patients who seek medical attention. It can be a manifestation of the whole range of different diseases, although not exclusively of the digestive tract, which requires a thorough examination of the patient and often is a challenge for the clinician, especially in the limited time settings during an outpatient visit. The cause of diarrhoea should be identified early to begin treatment of the patient in a timely and rational manner. In managing a patient with diarrhoea, a diagnostic search must begin with the following actions: working out complaints in detail, identification of symptoms of anxiety and taking a medical history, including epidemiological, pharmaceutical, hereditary, allergic, as well as analysis of dietary preferences. A physical examination is an integral part of the patient management; it allows to assess the general health condition, identify signs of dehydration and clinical stigmas of the underlying condition, which may manifest itself as diarrhoea. After an initial examination and exclusion of anxiety symptoms, a number of laboratory and instrumental examination methods is prescribed to determine the cause of diarrhoea. Given the polyetiology of diarrhoea syndrome, the range of methods for examining the patient can be quite wide, therefore the choice of area for the diagnostic search and the scope of the necessary diagnostic procedures is carried out on an individual basis, taking into account the features of the clinical picture, history data and physical examination findings. Treatment of a patient with diarrhoea at the pre-examination stage must include rehydration, timely detection and correction of electrolyte disturbances and other possible complications. Once the cause of diarrhoea has been established, the patient is treated due to the identified etiological factor in accordance with the current clinical guidelines. The article presents a step-by-step algorithm for making a differential diagnosis in a patient with diarrhoea, and also presents our own clinical observations.

Effectiveness of Saccharomyces boulardii CNCM I-745 in Adult Indian Patients with Diarrhoea: A Real-world, Multicentre, Retrospective, Comparative Study

BACKGROUND

Multiple clinical studies have described the benefits of probiotic Saccharomyces boulardii (S. boulardii) CNCM I-745 against diarrhoea, but the real-world evidence supporting its use is lacking.

OBJECTIVE

To evaluate effectiveness of the S. boulardii CNCM I-745 group in a real-world setting.

METHODS

This was an electronic medical record (EMR)-based, retrospective, multicentre, comparative study in Indian adult patients presenting with diarrhoea managed between January 2020 and January 2022. Data of patients at the baseline visit, with a follow-up visit within 15 days, and who were administered S. boulardii CNCM I-745 (for the test group) or any other treatment modality excluding probiotics (for the control group) were considered. Effectiveness was evaluated on the basis of number of patients who did not complain of diarrhoea at follow-up.

RESULTS

Of 30,385 adult patients with diarrhoea, 270 patients prescribed S. boulardii CNCM I-745 were included, while the control group comprised 1457 patients. The baseline median age of the test group was 47 years (range 19-86 years), while it was 44 years (range 19-100 years) for the control group. The majority of patients in both study groups were females (56.7% in the test and 51.5% in the control group). Median duration between visits was 5 days (range 1-15 days) in both study groups. In all, 77.8% patients (95% CI 72.34-82.59) in the test group did not complain of diarrhoea at follow-up, while the proportion was 15.8% (95% CI 13.95-17.76) in the control group (p < 0.05). Odds ratio (OR) for absence of diarrhoea in the S. boulardii CNCM I-745 group versus the control group was 18.7 (95% CI 13.6-25.7, p < 0.05). For subgroups on concomitant antibiotics, a significant advantage was noted again for the test versus the control group (76.8% versus 18.4%; p < 0.05; OR: 14.7 with 95% CI 8.8-24.4; p < 0.05).

CONCLUSION

The effect of S. boulardii CNCM I-745 probiotic in controlling diarrhoea was better than anti-diarrhoeal and/or oral rehydration therapy in real-world clinical practice. The effect was similar even with concomitant antibiotic usage.

Medicinal grade opium tincture for severe diarrhea: effect revisited in observational study

PURPOSE OF REVIEW

Chronic diarrhea is a common disorder that interferes with normal daily activities and results in poor quality of life. Fecal urgency and incontinence often necessitate clinical consultation, but the pathophysiological mechanisms are difficult to differentiate in a clinical setting. Therefore, drugs targeting the opioid receptors, such as diphenoxylate and loperamide, are typically used, as they reduce both gut motility and secretion.

RECENT FINDINGS

For severe diarrhea, morphine-containing extemporaneous opium tincture drops have recently been reprofiled to a pharmaceutical. The drug is indicated for severe diarrhea in adults when other antidiarrheals do not give sufficient fecal emptying control. The pronounced effect is due to the liquid formulation with rapid onset as a drug dissolution step is avoided. A recent prospective, noninterventional study (CLARIFY) of patients treated with opioid drops demonstrates a rapid and sustained therapeutic effect. Tolerance does not develop for the antidiarrheal effect and no dependence was observed after discontinuation.

SUMMARY

This mini-review discusses the use of opium derivates for treatment of diarrhea, with an emphasis on opium drops as a new medicinal grade opium for the use as additional treatment of severe diarrhea, emphasizing its mechanism of action and evaluation of the risk-benefit ratio in the clinical setting.

Diarrhoea of unknown cause: medical treatment in a stepwise manner

The basic principle for the treatment of idiopathic diarrhoea (functional diarrhoea K59.1) is to delay transit through the gut in order to promote the absorption of electrolytes and water. Under mild conditions, bulking agents may suffice. With increasing severity, antidiarrhoeal pharmaceuticals may be added in a stepwise manner. In diarrhoea of unknown aetiology, peripherally-acting opioid receptor agonists, such as loperamide, are first-line treatment and forms the pharmaceutical basis of antidiarrheal treatment. As second-line treatment opium drops have an approved indication for severe diarrhoea when other treatment options fail. Beyond this, various treatment options are built on experience with more advanced treatments using clonidine, octreotide, as well as GLP-1 and GLP-2 analogs which require specialist knowledge the field.

Association between circadian syndrome and chronic diarrhea: a cross-sectional study of NHANES 2005-2010 data

Background

Circadian rhythms are reported to influence physiological processes in the gastrointestinal system, but associations between circadian syndrome (Circs) and chronic diarrhea (CD) remain unclear. Here, we explored such relationships to provide new insights into CD management.

Methods

We conducted a cross-sectional retrospective analysis using the National Health and Nutrition Examination Survey (NHANES) data between 2005 and 2010. Univariate and multivariable logistic regression analyses were performed on weighted data to explore associations between Circs and CD.

Results

Results were presented using forest plots, odds ratios (ORs), and 95% confidence intervals (CIs). Data with p-values < 0.05 were considered statistically significant. In total, 5,661 US participants, of which 412 had CD (weighted percentage = 6.20%), were enrolled. In univariate logistic regression analyses, participants with Circs had a significantly higher risk of CD (OR = 1.51, 95% CI: 1.15-1.99). After adjusting for covariates, model 2 (OR = 1.40, 95% CI: 1.03-1.90) and model 3 (OR = 1.42, 95% CI: 1.01-2.00) data were consistent with model 1 data. Additionally, the number of Circs components was positively associated with CD in all three models. Subgroup analyses revealed an association between CD and Circs in participants who had high blood pressure (OR = 2.46, 95% CI: 1.48-4.11, p < 0.001).

Conclusion

In this cross-sectional study, we found that Circs is positively associated with the risk of CD in US adults, especially in those with high blood pressure. This association may provide new management strategies for CD.

Evaluation of probiotics in the treatment of hypothyroidism in early pregnancy combined with small intestinal bacterial overgrowth

The aim of this study was to investigate the association between hypothyroidism in early pregnancy and small intestinal bacterial overgrowth (SIBO) and the effect of probiotics. Patients with hypothyroidism in early pregnancy and normal pregnant women during the same period were included in the methane-hydrogen breath test to compare the incidence of SIBO, smoothed curve fit, and differences in clinical symptoms. For those who combined with SIBO, the rate of clinical symptom conversion, thyroid hormones, and changes in associated inflammatory indexes were compared after 21 days of treatment with probiotics on top of conventional levothyroxine sodium tablets. The results are as follows: (1) The incidence of combined SIBO in patients with hypothyroidism in pregnancy was 56.0%, significantly higher than the 28.0% of normal pregnant women during the same period. (2) The highest value of hydrogen plus methane gas in 90 min in pregnancy hypothyroid patients showed a significant negative correlation with FT4 (p < .001, SD = 0.169). (3) Abdominal distension symptoms were significantly increased in both groups after combined SIBO (p = .036, p = .025), and the conversion rate after treatment was 69.2% and 75.0%, respectively. (4) In hypothyroidism, pregnancy combined with SIBO, TSH, and CRP was higher before treatment (p = .001, p = .012) and decreased significantly after treatment (p = .001, p = .008). Hypothyroidism in early pregnancy is associated with SIBO, and probiotic treatment is significantly effective.

Dysfunction of cecal microbiota and CutC activity in mice mediating diarrhea with kidney-yang deficiency syndrome

OBJECTIVE

Previous studies have indicated that diarrhea with kidney-yang deficiency syndrome leads to a disorder of small intestine contents and mucosal microbiota. However, the relationship of TMA-lyase (CutC) activity and TMAO with diarrhea with kidney-yang deficiency syndrome remains unexplored. Therefore, this study explores the relationship between cecal microbiota and choline TMA-lyase (CutC) activity, as well as the correlation between trimethylamine oxide (TMAO), inflammatory index, and CutC activity.

METHOD

Twenty SPF-grade male KM mice were randomly divided into the normal group (CN) and the diarrhea model group (CD). Diarrhea mouse models were established by adenine combined with Folium sennae administration. CutC activity, TMAO, interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) levels were detected, and the cecal content microbiota was sequenced.

RESULT

After 14 days, diarrhea occurred in the CD group. Compared with the CN group, there was no significant change in the activity of CutC in the small intestine of the CD group, while the activity of CutC in the cecum was significantly increased, and the levels of TMAO, IL-6, and TNF-α showed a significant increase. The Chao1 index, Observed_species index, Shannon index, and Simpson index all exhibited a decreasing trend. The main changes at the bacterial genus level were Alistipes, Enterorhabdus, Desulfovibrio, Bacteroides, Candidatus_Saccharimonas, and [Ruminococcus]_torques_group. The results of LEfSe analysis, random forest analysis and ROC curve analysis revealed Paludicola, Blautia, Negativibacillus, Paraprevotella, Harryflintia, Candidatus_Soleaferrea, Anaerotruncus, Oscillibacter, Colidextribacter, [Ruminococcus]_torques_group, and Bacteroides as characteristic bacteria in the CD group. Correlation analysis showed a significant negative correlation between cecal CutC activity and Ligilactobacillus, and a significant positive correlation with Negativibacillus and Paludicola. The level of TMAO was significantly positively correlated with CutC activity and IL-6.

CONCLUSION

Diarrhea with kidney-yang deficiency syndrome significantly affects the physiological status, digestive enzyme activity, CutC activity, TMAO levels, and inflammatory response in mice. Additionally, there are changes in the composition and function of cecal microbiota, indicating an important impact of diarrhea with kidney-yang deficiency syndrome on the host intestinal microbiota balance. The occurrence of diarrhea with kidney-yang deficiency syndrome may be associated with dysbiosis of intestinal microbiota, increased CutC activity, elevated TMAO levels, and heightened inflammatory factor levels.

Journal of Clinical Gastroenterology Lectureship Dubai 2022 : Management of Irritable Bowel Syndrome With Diarrhea

Irritable bowel syndrome (IBS) with diarrhea (IBS-D) affects ~1% of the general population and is characterized by abdominal pain associated with diarrhea. IBS-D symptoms significantly impact the quality of life of patients. Major uncertainties remain regarding the optimal management of these patients. Several therapies have been investigated over the years for the treatment of IBS-D. In the initial management, commonly prescribed approaches with an effect on global IBS symptoms include a low Fermentable Oligo-, Di-, Mono-Saccharides and Polyols diet and probiotics, while antispasmodics are used for targeting abdominal pain and loperamide for diarrhea only. Additional therapeutic options for the relief of global IBS symptoms include rifaximin, 5-HT 3 antagonists, gut-directed psychological therapies, and eluxadoline, while tricyclic antidepressants can target abdominal pain and bile acid sequestrants diarrhea. Promising evidence exists for the use of mesalazine and fecal microbiota transplantation in IBS-D, although further evidence is needed for definitive conclusions regarding their efficacy.

Clinicopathologic Characterization of Lymphocytic Colitis in the Pediatric Population

BACKGROUND

Lymphocytic colitis (LC) in the pediatric population has been associated with immune dysregulation.

METHODS

Single-center retrospective study of pediatric LC.

RESULTS

50 patients (35 female, 70%) with a median age of 12 years at diagnosis (interquartile range: 5.7-15.8) of LC were identified. At presentation, 11 patients (22%) had malnutrition, 16 (32%) had a known underlying immune dysregulation, 4 (8%) had celiac disease (CD), and none had a diagnosis of inflammatory bowel disease. The most common medications prior to diagnosis were non-steroidal anti-inflammatory drugs, proton pump inhibitor, and selective serotonin reuptake inhibitors (10% each). Colonic biopsies showed a median number of intraepithelial lymphocytes (IELs)/100 epithelial cells of 48 (range: 25-85), and only 10% of cases had neutrophilic cryptitis. Upper gastrointestinal tract findings included lymphocytic esophagitis (4%), and duodenal IELs without and with villous blunting (9% each) (n: 47). Ten patients (23%) had increased IELs in the terminal ileum (n: 43). Treatments including 5-ASA, budesonide, prednisone, and gluten-free diet improved symptoms in <50% of patients (n: 42), and all follow-up colonoscopies showed persistent LC (n: 13).

CONCLUSION

Our study supports the association of LC with immune-mediated conditions, most commonly celiac disease. Symptomatic improvement was seen in <50% of patients with none of the patients with repeat colonoscopy showing histologic improvement.

Prevalence and predictors of diarrhea among children under five in Ghana

BACKGROUND

Globally, childhood diarrhea is a major public health concern. Despite numerous interventions that have been put in place to reduce its incidence over the years, childhood diarrhea remains a problem and is the fourth leading cause of child mortality in Ghana. This study examined the predictors of diarrhea among children under the age of five in Ghana.

METHODS

Data from the 2014 Ghana Demographic and Health survey, a cross-sectional survey, was used for the purpose of this study. A total of 2,547 children under the age of five were included in this study. Logistic regression analysis was performed to establish the factors associated with childhood diarrhea and ascertain explanatory variables.

RESULTS

The prevalence of diarrhea was 11.7%. Male children (13.4%) and those living in rural areas (12%), particularly in the Brong Ahafo region (17%) recorded the highest prevalence of diarrhea. Children aged 6 to 35 months of age, maternal age and education, sex of children and region of residence were the predictors of diarrhea among children under the age of five years in this study.

CONCLUSION

To lessen the prevalence of diarrhea among children under five in Ghana, existing interventions must be evaluated in the context of the predictors identified. Based on observations deduced from this study, the Ministry of Health, Ghana Health Service and other health regulatory agencies should intensify monitoring and awareness in the various regions, particularly in the transition and savannah zones on the causes, risk factors, and methods of preventing diarrhea in children under five. Various stakeholders including government and non-governmental organizations should take into account the predictors of diarrhea identified in the design of interventions to effectively reduce morbidity and mortality associated with childhood diarrhea.

The dysfunction in intestinal microorganisms and enzyme activity as significant contributors to diarrhea with kidney-yang deficiency syndrome

OBJECT

To investigate the pathogenesis of diarrhea with kidney-yang deficiency syndrome by examining characteristic changes in intestinal microorganisms, enzyme activities, oxidative stress, and metabolism indices.

METHODS

Twenty mice were randomly and equally divided into control group (NC) and model group (NM). Mice in NM group received adenine suspension at a dosage of 50 mg/(kg⋅day) by gavage, 0.4 mL/time, once a day for 14 days, and Folium sennae decoction at a dosage of 10 g/(kg⋅day) by gavage, 0.4 mL/time, once a day for 7 days, starting on 8th day. Mice in NC group were administered an equivalent amount of sterile water by gavage once a day for 7 days, and twice a day from the 8th day. After modeling, assessments encompassed microbial culture, organ index calculation, microbial and enzyme activity detection, malondialdehyde (MDA) content determination, superoxide dismutase (SOD) activity, blood biochemical tests, and observation of kidney tissue pathological changes.

RESULTS

The results showed that in NM group, a reduction in the number of Lactobacillus and Bifidobacteria was noted, accompanied by an increase in the number of bacteria and E. coli. Xylanase activity in the intestinal contents and mucosa, protease activity in the intestinal mucosa, and intestinal mucosa microbial activity were diminished. Conversely, the activities of amylase, sucrase, and lactase increased in intestinal mucosa. Additionally, there was an elevation in the level of MDA. Renal tubular dilatation and inflammatory cell infiltration were observed in the renal interstitium.

CONCLUSION

These dysfunctions in intestinal microorganisms and enzyme activities suggest potential involvement in diarrhea with kidney-yang deficiency syndrome.

Evaluation of chronic diarrhea in patients newly diagnosed with HIV infection through the FilmArray® gastrointestinal panel

INTRODUCTION

The treatment and diagnosis of chronic diarrhea in the immunocompromised patient depends on the ability to rapidly detect the etiologic agents.

AIMS

Our aim was to evaluate the results of the FilmArray® gastrointestinal panel in patients newly diagnosed with HIV infection that presented with chronic diarrhea.

MATERIAL AND METHODS

Utilizing nonprobability consecutive convenience sampling, 24 patients were included that underwent molecular testing for the simultaneous detection of 22 pathogens.

RESULTS

In 24 HIV-infected patients with chronic diarrhea, enteropathogen bacteria were detected in 69% of the cases, parasites in 18%, and viruses in 13%. Enteropathogenic Escherichia coli and enteroaggregative Escherichia coli were the main bacteria identified, Giardia lamblia was found in 25%, and norovirus was the most frequent viral agent. The median number of infectious agents per patient was three (range of 0 to 7). The biologic agents not identified through the FilmArray® method were tuberculosis and fungi.

CONCLUSIONS

Several infectious agents were simultaneously detected through the FilmArray® gastrointestinal panel in patients with HIV infection and chronic diarrhea.

Association between frailty and chronic constipation and chronic diarrhea among American older adults: National Health and Nutrition Examination Survey

BACKGROUND

This study was to explore the relationship between chronic constipation, chronic diarrhea, and frailty in older Americans.

METHODS

This cross-sectional study selected a total of 4241 community-dwelling individuals aged 60 years and older from the 2005-2010 National Health and Nutrition Examination Survey. Frailty was measured using a 49-item frailty index, and a frailty index > 0.21 was defined as a frail status. Chronic constipation and chronic diarrhea were defined as the "usual or most common type of stool" by the Bristol Stool Form Scale (BSFS) Types 1 and 2 and BSFS Types 6 and 7, respectively. Weighted logistic regression analysis was used to examine the relationship between gut health and frailty status. Restricted cubic spline (RCS) curves were built to assess the association between frailty index and stool frequency.

RESULTS

Frailty status was associated with higher odds of constipation in an unadjusted model; however, after further adjusting for confounding variables, the relationship between frailty status and constipation was not statistically significant. We discovered a positive correlation between the frailty status and diarrhea after adjustment for all variables. The frailty index showed a U-shaped relationship with stool frequency, and the frailty index was the smallest at a frequency of 10 stools/week.

CONCLUSION

Negative associations were observed between frailty status and chronic constipation and diarrhea among older adults. Older adults who have a bowel movement frequency of about 10 times per week are the least frail. Future studies are warranted to confirm the causal relationship in this association.

Network medicine framework reveals generic herb-symptom effectiveness of traditional Chinese medicine

Understanding natural and traditional medicine can lead to world-changing drug discoveries. Despite the therapeutic effectiveness of individual herbs, traditional Chinese medicine (TCM) lacks a scientific foundation and is often considered a myth. In this study, we establish a network medicine framework and reveal the general TCM treatment principle as the topological relationship between disease symptoms and TCM herb targets on the human protein interactome. We find that proteins associated with a symptom form a network module, and the network proximity of an herb's targets to a symptom module is predictive of the herb's effectiveness in treating the symptom. These findings are validated using patient data from a hospital. We highlight the translational value of our framework by predicting herb-symptom treatments with therapeutic potential. Our network medicine framework reveals the scientific foundation of TCM and establishes a paradigm for understanding the molecular basis of natural medicine and predicting disease treatments.

Epithelial Transport in Disease: An Overview of Pathophysiology and Treatment

Epithelial transport is a multifaceted process crucial for maintaining normal physiological functions in the human body. This comprehensive review delves into the pathophysiological mechanisms underlying epithelial transport and its significance in disease pathogenesis. Beginning with an introduction to epithelial transport, it covers various forms, including ion, water, and nutrient transfer, followed by an exploration of the processes governing ion transport and hormonal regulation. The review then addresses genetic disorders, like cystic fibrosis and Bartter syndrome, that affect epithelial transport. Furthermore, it investigates the involvement of epithelial transport in the pathophysiology of conditions such as diarrhea, hypertension, and edema. Finally, the review analyzes the impact of renal disease on epithelial transport and highlights the potential for future research to uncover novel therapeutic interventions for conditions like cystic fibrosis, hypertension, and renal failure.

The effectiveness of walking exercise on the bowel preparation before colonoscopy: a single blind randomized clinical trial study

BACKGROUND AND AIM

Bowel preparation is a crucial factor affecting the diagnostic accuracy of colonoscopy, and few randomized control trials evaluated enhancement in bowel preparation. In this study, we aimed to evaluate the effectiveness of walking exercises on bowel preparation before a colonoscopy procedure.

METHODS

The present study is a single-blind randomized controlled trial involving 262 patients scheduled for colonoscopy procedures. These patients were randomly assigned to two groups: an intervention group (n = 131) and a control group (n = 131). In the intervention group, participants followed a predetermined plan that included the consumption of specific liquids and foods, bisacodyl pills, polyethylene glycol powder, and a regimen of walking exercises in preparation for their colonoscopy. Conversely, individuals in the control group followed the same regimen but were not instructed to engage in walking exercises. On the day of the colonoscopy, both groups were assessed for their level of physical activity using a foot counter. Additionally, an experienced gastroenterologist evaluated and compared the bowel preparation between the two groups using the Boston Bowel Preparation Scale (BBPS).

RESULTS

The number of footsteps recorded in the two groups exhibited a significant difference (P < 0.001). Although there was no statistically significant difference between the intervention and control groups in terms of mean BBPS scores (6.26 ± 1.9 vs. 6.29 ± 1.9, P = 0.416), individuals who took more than 6900 steps had significantly higher BBPS scores compared to those with fewer than 6900 footsteps (6.62 ± 1.8 vs. 5.92 ± 1.9, P = 0.003).In the univariate analysis, BBPS was found to be significantly associated with individuals under the age of 50 (OR: 2.45, 95% CI: 1.30-4.61, P = 0.006) and smoking status (OR: 0.41, 95% CI: 0.17-0.94, P = 0.043). In the multivariate analysis, the relationship between BBPS and age below 50 and smoking remained significant (OR: 2.50, 95% CI: 1.30-4.70, P = 0.005, and OR: 0.38, 95% CI: 0.16-0.93, P = 0.034, respectively).

CONCLUSION

A higher number of footsteps taken especially more than 6900 can significantly enhance bowel preparation; however, walking exercise as an intervention before colonoscopy is not significantly associated with BBPS. Also, older people and smokers seem to have fewer benefits from walking exercises for bowel preparation.

TRIAL REGISTRATION

ISRCTN32724024 (Registration date:22/08/2018).

Drinking alkaline mineral water confers diarrhea resistance in maternally separated piglets by maintaining intestinal epithelial regeneration via the brain-microbe-gut axis

INTRODUCTION

Diarrhea has the fourth-highest mortality rate of all diseases and causes a large number of infant deaths each year. The maternally separated (MS) piglet (newly weaned piglet) is an excellent model to investigate the treatment of diarrhea in infants. Drinking alkaline mineral water has the potential to be therapeutic in gastrointestinal disorders, particularly diarrhea, but the supporting evidence from system studies and the mechanisms involved have yet to be reported.

OBJECTIVES

This study aims to determine whether drinking alkaline mineral water confers diarrhea resistance in MS piglets under weaning stress and what the fundamental mechanisms involved are.

METHODS

MS piglets were used to create a stress-induced intestinal disorder-diarrhea susceptibility model. A total of 240 MS piglets were randomly divided into two groups (6 pens/group and 20 piglets/pen). IPEC-J2 cell line was used for in vitro evaluation. An alkaline mineral complex (AMC) water was employed, and its effect on the hypothalamus-pituitary-adrenocortical (HPA) axis, gut microbes, gut morphology, and intestinal epithelial cell (IEC) proliferation and differentiation were investigated using a variety of experimental methodology.

RESULTS

AMC water reduced diarrhea rate in MS piglets by inhibiting the HPA axis, ameliorating gut microbiota structure, and stimulating IEC proliferation and differentiation. Apparently, the brain-microbe-gut axis is linked with AMC water conferring diarrhea resistance in piglets. Mechanistically, AMC water decreased stress hormones (COR and Hpt) secretion by suppressing HPA axis, which then increased the abundance of beneficial gut microbes; accordingly, maintained the proliferation of IEC and promoted the differentiation of intestinal stem cells (ISC) into goblet cell and Paneth cell by activating the Wnt/β-catenin signaling pathway. In the absence of gut microbiota (in vitro), AMC activated the LPS-induced Wnt/β-catenin signaling inhibition in IPEC-J2 cells and significantly increased the number of Lgr5 + cells, whereas had no effect on IPEC-J2 differentiation.

CONCLUSION

Drinking alkaline mineral water confers diarrhea resistance in MS piglets by maintaining intestinal epithelial regeneration via the brain-microbe-gut axis; thus, this study provides a potential prevention strategy for young mammals at risk of diarrhea.

Relationship among Chinese herb polysaccharide (CHP), gut microbiota, and chronic diarrhea and impact of CHP on chronic diarrhea

Chronic diarrhea, including diarrhea-predominant irritable bowel syndrome (IBS-D), osmotic diarrhea, bile acid diarrhea, and antibiotic-associated diarrhea, is a common problem which is highly associated with disorders of the gut microbiota composition such as small intestinal bacterial overgrowth (SIBO) and so on. A growing number of studies have supported the view that Chinese herbal formula alleviates the symptoms of diarrhea by modulating the fecal microbiota. Chinese herbal polysaccharides (CHPs) are natural polymers composed of monosaccharides that are widely found in Chinese herbs and function as important active ingredients. Commensal gut microbiota has an extensive capacity to utilize CHPs and play a vital role in degrading polysaccharides into short-chain fatty acids (SCFAs). Many CHPs, as prebiotics, have an antidiarrheal role to promote the growth of beneficial bacteria and inhibit the colonization of pathogenic bacteria. This review systematically summarizes the relationship among gut microbiota, chronic diarrhea, and CHPs as well as recent progress on the impacts of CHPs on the gut microbiota and recent advances on the possible role of CHPs in chronic diarrhea.

Different Methods of Minimally Invasive Esophagojejunostomy After Total Gastrectomy for Gastric Cancer: Outcomes from Two Experienced Centers

BACKGROUND

Esophagojejunostomy after minimally invasive total gastrectomy (MITG) for gastric cancer (GC) is technically challenging. Failure of the esophagojejunal anastomosis can lead to significant morbidity, leading to short- and long-term quality of life (QoL) impairment or mortality. The optimal reconstruction method following MITG remains controversial. We evaluated outcomes of minimally invasive esophagojejunostomy after laparoscopic or robotic total gastrectomies.

METHODS

We retrospectively reviewed MITG patients between 2015 and 2020 at two high-volume centers in China and the United States. Eligible patients were divided into groups by different reconstruction methods. We compared clinicopathologic characteristics, postoperative outcomes, including complication rates, overall survival rate (OS), disease-free survival rate (DFS), and patient-reported QoL.

RESULTS

GC patients (n = 105) were divided into intracorporeal esophagojejunostomy (IEJ, n = 60) and extracorporeal esophagojejunostomy (EEJ, n = 45) groups. EEJ had higher incidence of wound infection (8.3% vs 13.3%, P = 0.044) and pneumonia (21.7% vs 40.0%, P = 0.042) than IEJ. The linear stapler (LS) group was inferior to the circular stapler (CS) group in reflux [50.0 (11.1-77.8) vs 44.4 (0.0-66.7), P = 0.041] and diarrhea [33.3 (0.0-66.7) vs 0.0 (0.0-66.7), P = 0.045] while LS was better than CS for dysphagia [22.2 (0.0-33.3) vs 11.1 (0.0-33.3), P = 0.049] and eating restrictions [33.3 (16.7-58.3) vs 41.7 (16.7-66.7), P = 0.029] at 1 year. OS and DFS did not differ significantly between LS and CS.

CONCLUSIONS

IEJ anastomosis generated better results than EEJ. LS was associated with a better patient eating experience, but more diarrhea and reflux compared with CS. Clinical and patient-reported outcomes show the superiority of IEJ with the LS reconstruction method in MITG for GC.

Clinical and microbiological characterization of Salmonella spp. isolates from patients treated in a university hospital in South America between 2012-2021: a cohort study

BACKGROUND

Salmonellosis is a major cause of morbidity and mortality and one of the most frequent etiologies of diarrhea in the world. Mortality due to Salmonellosis in Latin America still poorly understood, and there is a lack of studies that evaluate resistance and clinical manifestations. The aims of this study were to characterize patients infected with Salmonella spp. seen in a university hospital in Colombia between 2012 and 2021, to evaluate trends in antibiotic resistance and to determine the proportion of overall mortality and related factors.

METHODS

Retrospective observational study. All patients with microbiological diagnosis of Salmonella spp. were included. The sociodemographic, clinical and microbiological characteristics were described, and the proportion of antibiotic resistant isolates per year was estimated. The prevalence of mortality according to age groups was calculated. Log binomial regression models were used to establish factors associated with mortality.

RESULTS

Five hundred twenty-two patients were analyzed. Salmonellosis accounted for 0.01% of all medical consultations. The median age was 16 years old. The most common clinical presentation was gastroenteric syndrome (77.1%) and symptoms included diarrhea (79.1%), fever (66.7%), abdominal pain (39.6%) and vomiting (35.2%). Of the Salmonella spp. isolates, 78.2% were not classified, 19.1% corresponded to non-typhoidal Salmonella and 2.7% to Salmonella typhi. Mortality occurs in 4.02% of the patients and was higher in patients with hematologic malignancy (11.6%). When analyzing by age group, the proportion of deaths was 2.8% in patients aged 15 years or younger, while in those older than 15 years it was 5.4%. Factors associated to mortality where bacteremia (aPR = 3.41 CI95%: 1.08-10.76) and to require treatment in the ICU (aPR = 8.13 CI95%: 1.82-37.76). In the last 10 years there has been a steady increase in resistance rates to ciprofloxacin, ampicillin, ampicillin/sulbactam and ceftriaxone, reaching rates above 60% in recent years.

CONCLUSIONS

Despite improved availability of antibiotics for the treatment of salmonellosis in the past decades, mortality due to salmonellosis continues occurring in children and adults, mainly in patients with hematological malignancies and bacteremia. Antibiotic resistance rates have increased significantly over the last 10 years. Public health strategies for the control of this disease should be strengthened, especially in vulnerable populations.

First Clinical Nutrition Outpatient Consultation: A Review of Basic Principles in Nutritional Care of Adults with Hematologic Disease

METHODS

A bibliographic survey was carried out between 2020 and 2022 using two databases: PubMed/MEDLINE and Scientific Electronic Library Online (SciELO) and the information source Academic Google, irrespective of language or geography.

RESULTS

In the first nutrition consultation (FNC), there should be an investigative direction focused on nutritional interventions in the short, medium, and long term. The record in the patient's medical record is relevant for carrying out the consultation, according to the recommendations of the normative councils of medicine and nutrition. The main steps to be followed are the investigation of the presence of food allergies and intolerances; the drugs/nutritional supplements in use; changes in the digestive tract; the presence or absence of picamalacia; and socioeconomic and lifestyle data. In addition, it is necessary to carry out laboratory evaluations, semiological assessment, anthropometric assessment, and assessment of food consumption. In the end, the nutritional approach should be composed of calculation of energy and macronutrient and micronutrient needs, intervention in nutritional status deviations, nutritional guidelines, and nutritional therapeutic planning of return, focusing on adherence to treatment.

CONCLUSION

The first nutrition consultation may represent investigative steps that help the clinical nutritionist in the management, allowing a longitudinal and specific nutritional therapeutic planning for patients assisted in large reference centers for hematological disease.

Common gastrointestinal drug-drug interactions in geriatrics and the importance of careful planning

INTRODUCTION

Polypharmacy, which uses multiple medications to treat chronic illnesses, is common among elderly patients. However, it can lead to drug interactions, especially with gastrointestinal (GI) medicines that are extensively used. These drug interactions can have severe consequences and pose a significant challenge to healthcare providers. Therefore, it is crucial to identify the underlying mechanisms of these interactions and develop strategies to minimize medication errors.

AREAS COVERED

We analyzed databases on GI illnesses common in older adults, including GERD, peptic ulcer disease, IBS, IBD, constipation, and diarrhea. Our research identified noteworthy drug interactions and utilized major electronic databases such as USFDA, PubMed, Scopus, and Google Scholar until 15 May 202315 May 2023, along with a review of reference lists.

EXPERT OPINION

Aging can affect how the body processes drugs, leading to an increased risk of drug interactions. Therefore, healthcare professionals must carefully evaluate a patient's medical history and health condition to design personalized treatment plans.

Targeting Opioid Receptors in Addiction and Drug Withdrawal: Where Are We Going?

This review article offers an outlook on the use of opioids as therapeutics for treating several diseases, including cancer and non-cancer pain, and focuses the analysis on the opportunity to target opioid receptors for treating opioid use disorder (OUD), drug withdrawal, and addiction. Unfortunately, as has been well established, the use of opioids presents a plethora of side effects, such as tolerance and physical and physiological dependence. Accordingly, considering the great pharmacological potential in targeting opioid receptors, the identification of opioid receptor ligands devoid of most of the adverse effects exhibited by current therapeutic agents is highly necessary. To this end, herein, we analyze some interesting molecules that could potentially be useful for treating OUD, with an in-depth analysis regarding in vivo studies and clinical trials.

Diarrhea accompanies intestinal inflammation and intestinal mucosal microbiota dysbiosis during fatigue combined with a high-fat diet

OBJECTIVE

It was reported fatigue or a high-fat diet triggers diarrhea, and intestinal microbiota may play central roles in diarrhea. Therefore, we investigated the association between the intestinal mucosal microbiota and the intestinal mucosal barrier from fatigue combined with a high-fat diet.

METHOD

This study divided the Specific pathogen-free (SPF) male mice into the normal group (MCN) and the standing united lard group (MSLD). The MSLD group stood on water environment platform box for 4 h/day for 14 days, and 0.4 mL lard was gavaged from day 8, twice daily for 7 days.

RESULT

After 14 days, Mice in the MSLD group showed diarrhea symptoms. The pathological analysis showed structural damage to the small intestine in the MSLD group, with an increasing trend of interleukin-6 (IL-6) and IL-17, and inflammation accompanied by structural damage to the intestine. Fatigue combined with a high-fat diet considerably decreased Limosilactobacillus vaginalis and Limosilactobacillus reuteri, and among them, Limosilactobacillus reuteri positively associated with Muc2 and negatively with IL-6.

CONCLUSION

The interactions between Limosilactobacillus reuteri and intestinal inflammation might be involved in the process of intestinal mucosal barrier impairment in fatigue combined with high-fat diet-induced diarrhea.