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BMJ (Clinical Research Ed.) Apr 2016
Review
Topics: Antibiotic Prophylaxis; Antidiarrheals; Bacterial Infections; Bacterial Vaccines; Chronic Disease; Diarrhea; Disease Susceptibility; Fluid Therapy; Humans; Hygiene; Referral and Consultation; Risk Factors; Self Care; Travel
PubMed: 27094342
DOI: 10.1136/bmj.i1937 -
NPJ Biofilms and Microbiomes Jun 2023The diarrheal disease causes high mortality, especially in children and young animals. The gut microbiome is strongly associated with diarrheal disease, and some...
The diarrheal disease causes high mortality, especially in children and young animals. The gut microbiome is strongly associated with diarrheal disease, and some specific strains of bacteria have demonstrated antidiarrheal effects. However, the antidiarrheal mechanisms of probiotic strains have not been elucidated. Here, we used neonatal piglets as a translational model and found that gut microbiota dysbiosis observed in diarrheal piglets was mainly characterized by a deficiency of Lactobacillus, an abundance of Escherichia coli, and enriched lipopolysaccharide biosynthesis. Limosilactobacillus mucosae and Limosilactobacillus reuteri were a signature bacterium that differentiated healthy and diarrheal piglets. Germ-free (GF) mice transplanted with fecal microbiota from diarrheal piglets reproduced diarrheal disease symptoms. Administration of Limosilactobacillus mucosae but not Limosilactobacillus reuteri alleviated diarrheal disease symptoms induced by fecal microbiota of diarrheal piglets and by ETEC K88 challenge. Notably, Limosilactobacillus mucosae-derived extracellular vesicles alleviated diarrheal disease symptoms caused by ETEC K88 by regulating macrophage phenotypes. Macrophage elimination experiments demonstrated that the extracellular vesicles alleviated diarrheal disease symptoms in a macrophage-dependent manner. Our findings provide insights into the pathogenesis of diarrheal disease from the perspective of intestinal microbiota and the development of probiotic-based antidiarrheal therapeutic strategies.
Topics: Animals; Swine; Mice; Antidiarrheals; Diarrhea; Microbiota; Lactobacillus; Bacteria; Escherichia coli; Homeostasis
PubMed: 37280255
DOI: 10.1038/s41522-023-00403-6 -
Annals of Noninvasive Electrocardiology... Mar 2018Loperamide is a popular antidiarrheal medication that has been used for many years. It is currently gaining more attention among healthcare professionals due to its... (Review)
Review
Loperamide is a popular antidiarrheal medication that has been used for many years. It is currently gaining more attention among healthcare professionals due to its increasing potential for side effects. At present, it is considered safe enough to be sold over the counter. In contrast with other opioid agonists, loperamide is a peripherally acting μ-receptor agonist exerting its effects mainly on the myenteric plexus of the gastrointestinal longitudinal muscle layer. It decreases peristalsis and fluid secretion resulting in longer gastrointestinal transit time. The bioavailability of the drug is extremely low. Moreover, it is actively excluded from the central nervous system; hence, it lacks the central effects of euphoria and analgesia at the recommended dosages. Loperamide abuse has been steadily increasing in the United States. Abusers typically ingest high doses in desire to achieve a satisfactory central nervous system drug penetration. This has made it a potential over the counter substitute for self-treating opioid withdrawal symptoms and achieving euphoric effects.
Topics: Antidiarrheals; Cardiotoxicity; Diarrhea; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Humans; Loperamide; Male; Patient Safety; Risk Assessment
PubMed: 29125226
DOI: 10.1111/anec.12505 -
The Cochrane Database of Systematic... Apr 2018As mortality secondary to acute infectious diarrhoea has decreased worldwide, the focus shifts to adjuvant therapies to lessen the burden of disease. Smectite, a... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
As mortality secondary to acute infectious diarrhoea has decreased worldwide, the focus shifts to adjuvant therapies to lessen the burden of disease. Smectite, a medicinal clay, could offer a complementary intervention to reduce the duration of diarrhoea.
OBJECTIVES
To assess the effects of smectite for treating acute infectious diarrhoea in children.
SEARCH METHODS
We searched the Cochrane Infectious Diseases Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Pubmed), Embase (Ovid), LILACS, reference lists from studies and previous reviews, and conference abstracts, up to 27 June 2017.
SELECTION CRITERIA
Randomized and quasi-randomized trials comparing smectite to a control group in children aged one month to 18 years old with acute infectious diarrhoea.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened abstracts and the full texts for inclusion, extracted data, and assessed risk of bias. Our primary outcomes were duration of diarrhoea and clinical resolution at day 3. We summarized continuous outcomes using mean differences (MD) and dichotomous outcomes using risk ratios (RR), with 95% confidence intervals (CI). Where appropriate, we pooled data in meta-analyses and assessed heterogeneity. We explored publication bias using a funnel plot.
MAIN RESULTS
Eighteen trials with 2616 children met our inclusion criteria. Studies were conducted in both ambulatory and in-hospital settings, and in both high-income and low- or middle-income countries. Most studies included children with rotavirus infections, and half included breastfed children.Smectite may reduce the duration of diarrhoea by approximately a day (MD -24.38 hours, 95% CI -30.91 to -17.85; 14 studies; 2209 children; low-certainty evidence); may increase clinical resolution at day 3 (risk ratio (RR) 2.10, 95% CI 1.30 to 3.39; 5 trials; 312 children; low-certainty evidence); and may reduce stool output (MD -11.37, 95% CI -21.94 to -0.79; 3 studies; 634 children; low-certainty evidence).We are uncertain whether smectite reduces stool frequency, measured as depositions per day (MD -1.33, 95% CI -2.28 to -0.38; 3 studies; 954 children; very low-certainty evidence). There was no evidence of an effect on need for hospitalization (RR 0.93, 95% CI 0.75 to 1.15; 2 studies; 885 children; low-certainty evidence) and need for intravenous rehydration (RR 0.77, 95% CI 0.54 to 1.11; 1 study; 81 children; moderate-certainty evidence). The most frequently reported side effect was constipation, which did not differ between groups (RR 4.71, 95% CI 0.56 to 39.19; 2 studies; 128 children; low-certainty evidence). No deaths or serious adverse effects were reported.
AUTHORS' CONCLUSIONS
Based on low-certainty evidence, smectite used as an adjuvant to rehydration therapy may reduce the duration of diarrhoea in children with acute infectious diarrhoea by a day; may increase cure rate by day 3; and may reduce stool output, but has no effect on hospitalization rates or need for intravenous therapy.
Topics: Acute Disease; Adolescent; Antidiarrheals; Child; Child, Preschool; Diarrhea; Humans; Infant; Randomized Controlled Trials as Topic; Rotavirus Infections; Silicates
PubMed: 29693719
DOI: 10.1002/14651858.CD011526.pub2 -
Journal of the American College of... Jun 2023Epidemic increases in opioid deaths prompted policies limiting access to prescription opioids in North America. Consequently, the over-the-counter opioids loperamide...
BACKGROUND
Epidemic increases in opioid deaths prompted policies limiting access to prescription opioids in North America. Consequently, the over-the-counter opioids loperamide (Imodium A-D) and mitragynine, the herbal ingredient in kratom, are increasingly used to avert withdrawal or induce euphoria. Arrhythmia events related to these nonscheduled drugs have not been systematically studied.
OBJECTIVES
In this study, we sought to explore opioid-associated arrhythmia reporting in North America.
METHODS
The U.S. Food and Drug Administration Adverse Event Reporting System (FAERS), Center for Food Safety and Applied Nutrition Adverse Event Reporting System (CAERS), and Canada Vigilance Adverse Reaction (CVAR) databases were searched (2015-2021). Reports involving nonprescription drugs (loperamide, mitragynine) and diphenoxylate/atropine (Lomotil) were identified. Methadone, a prescription opioid (full agonist), served as a positive control owing to its established arrhythmia risk. Buprenorphine (partial agonist) and naltrexone (pure antagonist), served as negative controls. Reports were classified according to Medical Dictionary for Regulatory Activities terminology. Significant disproportionate reporting required a proportional reporting ratio (PRR) of ≥2, ≥3 cases, and chi-square ≥4. Primary analysis used FAERS data, whereas CAERS and CVAR data were confirmatory.
RESULTS
Methadone was disproportionately associated with ventricular arrhythmia reports (PRR: 6.6; 95% CI: 6.2-7.0; n = 1,163; chi-square = 5,456), including 852 (73%) fatalities. Loperamide was also significantly associated with arrhythmia (PRR: 3.2; 95% CI: 3.0-3.4; n = 1,008; chi-square = 1,537), including 371 (37%) deaths. Mitragynine demonstrated the highest signal (PRR: 8.9; 95% CI: 6.7-11.7; n = 46; chi-square = 315), with 42 (91%) deaths. Buprenorphine, diphenoxylate, and naltrexone were not associated with arrhythmia. Signals were similar in CVAR and CAERS.
CONCLUSIONS
The nonprescription drugs loperamide and mitragynine are associated with disproportionate reports of life-threatening ventricular arrhythmia in North America.
Topics: Humans; Analgesics, Opioid; Diphenoxylate; Loperamide; Naltrexone; Arrhythmias, Cardiac; Buprenorphine; Methadone; Nonprescription Drugs
PubMed: 37286256
DOI: 10.1016/j.jacc.2023.04.009 -
Revista Da Associacao Medica Brasileira... May 2018
Topics: Analgesics, Opioid; History, 19th Century; History, 20th Century; History, Ancient; History, Medieval; Humans; Opioid-Related Disorders; Opium
PubMed: 30304135
DOI: 10.1590/1806-9282.64.05.393 -
Current Opinion in Gastroenterology May 2017Our objective was to review advances in bile acids in health and disease published in the last 2 years. Bile acid diarrhea (BAD) is recognized as a common cause of... (Review)
Review
PURPOSE OF REVIEW
Our objective was to review advances in bile acids in health and disease published in the last 2 years. Bile acid diarrhea (BAD) is recognized as a common cause of chronic diarrhea, and its recognition has been facilitated by development of new screening tests.
RECENT FINDINGS
Primary BAD can account for 30% of cases of chronic diarrhea. The mechanisms leading to BAD include inadequate feedback regulation by fibroblast growth factor 19 (FGF-19) from ileal enterocytes, abnormalities in synthesis or degradation of proteins involved in FGF-19 regulation in hepatocytes and variations as a function of the bile acid receptor, TGR5 (GPBAR1). SeHCAT is the most widely used test for diagnosis of BAD. There has been significant validation of fasting serum FGF-19 and 7 α-hydroxy-cholesten-3-one (C4), a surrogate measure of bile acid synthesis. Bile acid sequestrants are the primary treatments for BAD; the farnesoid X-receptor-FGF-19 pathway provides alternative therapeutic targets for BAD. Bile acid-stimulated intestinal mechanisms contribute to the beneficial effects of bariatric surgery on obesity, glycemic control and the treatment of recurrent Clostridium difficile infection.
SUMMARY
Renewed interest in the role of bile acids is leading to novel management of diverse diseases besides BAD.
Topics: Antidiarrheals; Bile Acids and Salts; Chronic Disease; Diarrhea; Enterohepatic Circulation; Fibroblast Growth Factors; Gastric Bypass; Humans; Obesity, Morbid
PubMed: 28169840
DOI: 10.1097/MOG.0000000000000344 -
Evidence-based Complementary and... 2022is believed to have antidiarrheal potential but with limited scientific evidence. This study aimed investigating antidiarrheal and antibacterial activity of aqueous and...
BACKGROUND
is believed to have antidiarrheal potential but with limited scientific evidence. This study aimed investigating antidiarrheal and antibacterial activity of aqueous and 80% methanol seed extracts of the plant in mice and selected diarrhea-causing bacterial strains, respectively.
METHODS
Castor oil-induced diarrhea, prostaglandin-induced enteropooling, and castor oil-induced charcoal meal test models in mice of either sex using three dose levels (60, 120, and 240 mg/kg) were applied to evaluate antidiarrheal activity. Parameters, including onset, number, wet stool weight, weight and volume of secretion, and intestinal motility, were taken into consideration. The antibacterial activity was assessed on , and using disk diffusion and microdilution techniques.
RESULTS
Compared to controls, pretreatment of mice at the graded dose (60, 120, and 240 mg/kg) resulted in a significant ( < 0.05) drop in frequency of wet stools and watery content of diarrhea as well as in delaying onset of diarrhea. Both extracts exhibited inhibition of diarrhea in a dose-dependent manner in all models used. The extracts also showed significant ( < 0.05) reduction in intestinal motility in castor oil-induced models. Both extracts showed a marginal activity against the selected bacterial strains; a better effect was seen with 80% methanol seed extract.
CONCLUSION
Both extracts of the plant have beneficial effect in controlling diarrhea. This finding supports the use of the plant as a traditional antidiarrheal remedy.
PubMed: 36091586
DOI: 10.1155/2022/9582687 -
Molecules (Basel, Switzerland) Jan 2022Monterey cypress () is a decorative plant; however, it possesses various pharmacological activities. Therefore, we explored the phytochemical profile of root methanol...
Monterey cypress () is a decorative plant; however, it possesses various pharmacological activities. Therefore, we explored the phytochemical profile of root methanol extract (CRME) for the first time. Moreover, we investigated its antidiarrheal (in vivo), antibacterial, and antibiofilm (in vitro) activities against clinical isolates. The LC-ESI-MS/MS analysis of CRME detected the presence of 39 compounds, besides isolation of 2,3,2″,3″-tetrahydro-4'--methyl amentoflavone, amentoflavone, and dihydrokaempferol-3--α-l-rhamnoside for the first time. Dihydrokaempferol-3--α-l-rhamnoside presented the highest antimicrobial activity and the range of values of MICs against isolates was from 64 to 256 µg/mL. The antidiarrheal activity of CRME was investigated by induction of diarrhea using castor oil, and exhibited a significant reduction in diarrhea and defecation frequency at all doses, enteropooling (at 400 mg/kg), and gastrointestinal motility (at 200, 400 mg/kg) in mice. The antidiarrheal index of CRME increased in a dose-dependent manner. The effect of CRME on various membrane characters of was studied after typing the isolates by ERIC-PCR. Its impact on efflux and its antibiofilm activity were inspected. The biofilm morphology was observed using light and scanning electron microscopes. The effect on efflux activity and biofilm formation was further elucidated using qRT-PCR. A significant increase in inner and outer membrane permeability and a significant decrease in integrity and depolarization (using flow cytometry) were detected with variable percentages. Furthermore, a significant reduction in efflux and biofilm formation was observed. Therefore, CRME could be a promising source for treatment of gastrointestinal tract diseases.
Topics: Animals; Anti-Bacterial Agents; Antidiarrheals; Castor Oil; Cathartics; Cupressus; Diarrhea; Gastrointestinal Motility; In Vitro Techniques; Male; Mice; Phytochemicals; Plant Extracts; Salmonella enterica
PubMed: 35056664
DOI: 10.3390/molecules27020346 -
Journal of Ayurveda and Integrative... 2015The Ayurvedic literature during the medieval period suggests the use of Musta (Cyperus rotundus), a common weed, as a pratinidhi dravya (substitute) for Ativisha... (Review)
Review
The Ayurvedic literature during the medieval period suggests the use of Musta (Cyperus rotundus), a common weed, as a pratinidhi dravya (substitute) for Ativisha (Aconitum heterophyllum), an endangered species. Contemporary Ayurvedic practice also uses Cryptocoryne spiralis, (known as Naattu Atividayam in South India) and Nagaramusta (Cyperus scariosus) as substitutes for Ativisha and Musta, respectively. This article reviews published literature on the pharmacology of the above four species. Both A. heterophyllum and C. rotundus are reported to possess antiinflammatory, antipyretic, antibacterial and antidiarrhoeal properties, while antiinflammatory and antibacterial activities are attributed to C. scariosus. No reports exist on the bioactivity of Cryptocoryne spiralis. It is interesting to note that other than the veerya which is different, the biological properties of Ativisha and Musta are similar according to Ayurvedic classification of dravyaguna. This is also supported by modern pharmacological studies, which show that, both A. heterophyllum and C. rotundus have antidiarrheal, antipyretic, antiinflammatory, antihyperlipidemic and hypoglycemic activities. However, the similarities between the discussed species cannot be attributed to their phytochemical composition or taxonomical classification as these are quite distinct. The dravyaguna method of classifying materials, which we are calling as "pharmaco-taxonomy", offers a unique way of classifying those plant materials which lack similarity at the botanical or chemical level, but are similar at the level of biological functions.
PubMed: 26167002
DOI: 10.4103/0975-9476.146551