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Current Gastroenterology Reports May 2017Acute diarrhea often runs a self-limited course and little by way of treatment is needed except for oral rehydration therapy. Chronic diarrhea poses a longer-term... (Review)
Review
INTRODUCTION
Acute diarrhea often runs a self-limited course and little by way of treatment is needed except for oral rehydration therapy. Chronic diarrhea poses a longer-term problem. If not treatable with specific therapy aimed at the underlying pathophysiology, chronic diarrhea often needs long-term symptomatic therapy.
PURPOSE OF REVIEW
This paper aims to examine the options for symptomatic, nonspecific treatment of diarrhea.
RECENT FINDINGS
The most frequently used therapies are opiate antidiarrheal drugs. These drugs are effective for a wide variety of diarrheal conditions and generally can be used safely if monitored closely. They work by slowing motility and allowing more time for absorption. They vary in potency and in addictive liability. In recent years, a variety of other drugs have been developed, which provide more targeted therapy that can mitigate diarrhea in specific situations. These drugs work on other regulatory pathways in the gut or on mucosal absorptive mechanisms. There is evidence for efficacy for both traditional and newer agents used for the symptomatic management of diarrhea. Opiates are used most often for this indication. Other agents may benefit individuals, but further research is needed to establish indications and best practices.
Topics: Acute Disease; Analgesics, Opioid; Antidiarrheals; Chronic Disease; Diarrhea; Gastrointestinal Motility; Humans
PubMed: 28397130
DOI: 10.1007/s11894-017-0557-x -
Journal of Pain and Symptom Management Aug 2011
Review
Topics: Antidiarrheals; Diarrhea; Drug Interactions; Humans; Loperamide
PubMed: 21703817
DOI: 10.1016/j.jpainsymman.2011.06.001 -
Digestive Diseases and Sciences Feb 1987Successful treatment of severe diarrhea has traditionally relied upon opiates or opiate derivatives. Recent advances in our understanding of intestinal fluid and... (Review)
Review
Successful treatment of severe diarrhea has traditionally relied upon opiates or opiate derivatives. Recent advances in our understanding of intestinal fluid and electrolyte absorption have provided the opportunity to develop therapeutic agents specific for various points in the secretory and absorptive process. Present and proposed antidiarrheal agents, in addition to antimotility activity, will be capable of stimulating intestinal fluid absorption, inhibiting intestinal fluid secretion, or both. The mechanism(s) of action and clinical implications for proposed antidiarrheal agents are reviewed.
Topics: Antidiarrheals; Electrolytes; Gastrointestinal Motility; Humans; Intestinal Absorption
PubMed: 3542447
DOI: 10.1007/BF01297108 -
Biomedicine & Pharmacotherapy =... Feb 2019Diarrhea is one of the leading causes of infant death in the world accounting for high child mortality rate. It is also present in different pathophysiologies related to...
Diarrhea is one of the leading causes of infant death in the world accounting for high child mortality rate. It is also present in different pathophysiologies related to several etiological agents. The aim of this study is to investigate the antidiarrheal effect of α -Terpineol (α-TPN) in different diarrhea models in rodents. The antidiarrheal effect of α-TPN in the treatment of acute diarrhea and enteropooling induced by castor oil or PGE in Swiss mice pretreated orally with saline (NaCl 0.9%), Loperamide (5 mg/kg) and α-TPN (6.25, 12.5, 25 and 50 mg/kg) was analyzed. Additionally, parameters of severity, total weight of faeces and post-treatment for 4 h were evaluated. Modulation of the opioid and cholinergic pathways was performed and intestinal transit model using activated charcoal as marker was also used. The effect of α-TPN on secretory diarrhea was investigated using the model of fluid secretion in intestinal loops isolated from cholera toxin-treated mice. α-TPN showed antidiarrheal effect (*p < 0.05), reducing the total stool amount (*55%, *48%, *44%, *24%) and diarrheal (*47%, *66%; *56%, 10%) respectively for the doses tested. All doses investigated in the enteropooling test presented significant changes (*46%, *78%, *66%, *41% respectively) in relation to the control. α-TPN through the muscarinic pathway reduced the gastrointestinal transit (*31%), besides inhibiting PGE-induced diarrhea (*39%). α-TPN also reduced fluid formation and loss of Cl ions, by interacting directly with GM1 receptors and cholera toxin, thus increasing the uptake of intestinal fluids. The results suggest an anti-diarrheal activity of α-TPN due to its anticholinergic action, ability to block PGE and GM1 receptors and interaction with cholera toxin in secretory diarrhea, making it a promising candidate drug for the treatment of diarrheal diseases.
Topics: Animals; Antidiarrheals; Castor Oil; Cyclohexane Monoterpenes; Cyclohexenes; Diarrhea; Dose-Response Relationship, Drug; Female; Gastrointestinal Motility; Male; Mice; Monoterpenes
PubMed: 30540974
DOI: 10.1016/j.biopha.2018.11.131 -
Deutsche Medizinische Wochenschrift... Nov 2013Chronic diarrhea can be caused by multiple disease entities. Basic diagnostic tests are required in order to administer specific therapies whenever possible. If no... (Review)
Review
Chronic diarrhea can be caused by multiple disease entities. Basic diagnostic tests are required in order to administer specific therapies whenever possible. If no specific treatment can be used, a symptomatic management should be initiated in order to prevent massive electrolyte- and water losses. Substances that can be used are loperamide, cholestyramine, bulking agents, probiotics, anticholinergic agents and in severe cases opioids. If used properly these agents can be prescribed longterm with an acceptable side effect profile.
Topics: Antidiarrheals; Cholestyramine Resin; Cholinergic Antagonists; Chronic Disease; Diarrhea; Humans; Laxatives; Loperamide; Probiotics
PubMed: 24163167
DOI: 10.1055/s-0033-1349597 -
Annual Review of Pharmacology and... 1983
Review
Topics: Animals; Antidiarrheals; Biological Transport; Body Fluids; Castor Oil; Diarrhea; Diphenoxylate; Electrolytes; Gastrointestinal Motility; Humans; Ileum; Intestinal Mucosa; Kinetics; Loperamide; Morphine; Narcotics; Peristalsis; Receptors, Opioid
PubMed: 6307123
DOI: 10.1146/annurev.pa.23.040183.001431 -
Journal of Ethnopharmacology Nov 2023Psydrax schimperianus (A. Rich.) Bridson. roots are used for the treatment of diarrhea in West Arsi zone, Ethiopia.
ETHNOPHARMACOLOGICAL RELEVANCE
Psydrax schimperianus (A. Rich.) Bridson. roots are used for the treatment of diarrhea in West Arsi zone, Ethiopia.
AIM OF THE STUDY
This study aimed to investigate the in vivo antidiarrheal activity of crude extract and coumarins isolated from the roots of Psydrax schimperianus to provide a pharmacological basis for its traditional use as an antidiarrheal agent in Ethiopia.
MATERIALS AND METHODS
The crude root extract of P. schimperianus was tested in vivo for antidiarrheal efficacy in mice utilizing castor oil-induced diarrhea, gastrointestinal transit time, and enteropooling models at doses of 100, 200, and 400 mg/kg. Phytochemical investigation of the crude root extract led to the isolation of two coumarins, isoscopoletin, and scoparone. Isoscopoletin and scoparone were evaluated for antidiarrheal activity against castor oil-induced diarrhea model at 10 mg/kg and 20 mg/kg doses.
RESULTS
The crude root extract of P. schimperianus, at doses of 100, 200, and 400 mg/kg, inhibited defecation by 37.5%, 46.2%, and 61.2%, respectively. At a dose of 20 mg/kg, scoparone and isoscopoletin reduced defecation by 61.2% and 66.6%, respectively.
CONCLUSION
The study warrants further investigation of isoscopoletin and scoparone towards development as a novel treatment for diarrheal diseases.
Topics: Mice; Animals; Antidiarrheals; Castor Oil; Plant Extracts; Diarrhea; Coumarins
PubMed: 37301303
DOI: 10.1016/j.jep.2023.116705 -
American Journal of Health-system... Aug 1998The efficacy and use of antidiarrheal agents in patients who diarrhea associated with cancer treatments are reviewed. Diarrhea is common in cancer patients and may... (Review)
Review
The efficacy and use of antidiarrheal agents in patients who diarrhea associated with cancer treatments are reviewed. Diarrhea is common in cancer patients and may interfere with cancer treatment. Diarrhea may be induced by chemotherapy, radiation therapy, surgery, graft-versus-hot disease (GVHD) or infection after bone marrow transplantation, and other causes. The general goal of antidiarrheal therapy is to reduce fluid loss in the stool by inhibiting intestinal secretion, promoting absorption, and decreasing intestinal motility. Antidiarrheal agents may be classified as intestinal transit inhibitors, intraluminal agents, proabsorptive agents, and antisecretory drugs. Opiate agonists are the most commonly used intestinal transit inhibitors; they can be effective in treating cancer treatment-related diarrheas but must be used cautiously. Intraluminal agents include clays, activated charcoal, and cholestyramine; these adsorbents and other binding resins can interfere with the absorption of orally administered antidiarrheals and other drugs and are unlikely candidates for use in most cases of diarrhea in cancer patients. Clonidine, a proabsorptive agent, should be used only in patients with secretory diarrhea refractory to opiate agonist treatment. Octreotide is an antisecretory drug that has shown considerable efficacy in clinical trails as a treatment for diarrhea caused by chemotherapy of GVHD; its use for radiation therapy-induced diarrhea, although not studied clinically, is nevertheless an option. In general, opiate agonists and octreotide appears to offer the most efficacy and flexibility. Opiate agonists and octreotide are effective agents for cancer treatment-related diarrhea.
Topics: Antidiarrheals; Antineoplastic Agents; Bone Marrow Transplantation; Diarrhea; Humans; Neoplasms
PubMed: 9706182
DOI: 10.1093/ajhp/55.15.1573 -
Toxins Nov 2013Enterotoxigenic Escherichia coli (ETEC) produces two types of enterotoxins: heat-labile (LT) and heat-stable (STa and STb). These molecules are involved in the induction... (Review)
Review
Enterotoxigenic Escherichia coli (ETEC) produces two types of enterotoxins: heat-labile (LT) and heat-stable (STa and STb). These molecules are involved in the induction of secretory diarrhea in animals including humans. This condition is currently treated using a fluid replacement therapy and antibiotics. This treatment is often not available to people in developing countries, and several die from the condition provoke by ETEC. Over the years, plants and plant extracts have been use as traditional medicine to treat various gastrointestinal ailments including diarrhea. Many of these plant products have been claimed to be active against diarrhea, however few have been extensively studied. The main objective of this review was to gather the scattered information on the antidiarrheal activities reported for various plant products on ETEC. This includes two major effects: (1) The inhibitory effect on bacterial growth or viability and (2) The interference with ETEC enterotoxins activity upon the intestinal epithelium. We will focus on plant products and extracts for which we have major indications of their biological activity against ETEC and their enterotoxins. Because Vibrio cholerae toxin (CT) is structurally, antigenically and mechanistically related to LT, it will also be discussed in this review.
Topics: Animals; Anti-Bacterial Agents; Antidiarrheals; Diarrhea; Enterotoxigenic Escherichia coli; Enterotoxins; Humans; Plant Extracts
PubMed: 24212181
DOI: 10.3390/toxins5112009 -
Anais Da Academia Brasileira de Ciencias 2019This study investigated the effects of the ethanolic extract from the bark of Combretum leprosum (ECL) on intestinal transit and castor-oil induced diarrhea in mice. The...
This study investigated the effects of the ethanolic extract from the bark of Combretum leprosum (ECL) on intestinal transit and castor-oil induced diarrhea in mice. The oral administration of ECL (750 and 1000 mg/kg) slowed intestinal transit (ID50 of 455 mg/kg). The ECL (250-1000 mg/kg) reduced castor-oil induced diarrhea, in a time- and dose-dependent manner (p < 0.05). To determine if antidiarrheal effect of ECL involves α2-adrenergic or opioid receptor activation, the mice were pretreated with antagonists of these receptors, yohimbine or naloxone respectively. None of these drugs inhibited the antidiarrheal effect of ECL. To test if antidiarrheal effect of ECL is due to an antisecretory action, we realized the enteropooling assay on rats. The ECL increased bowel content and did not inhibit intestinal fluid secretion increase induced by misoprostol (100 µg/kg, s.c.). To determine if antimotility effect of ECL is due to a reduction on gastric motility, we realized the organ bath assay in the rat fundus stomach. Isotonic recordings show that the carbachol /KCl - induced contraction was not reversed by the addition of ECL. In conclusion, our results suggest that ECL contains antidiarrheal compounds and these compounds could induce a reduction of intestinal tract motility.
Topics: Animals; Antidiarrheals; Castor Oil; Combretum; Diarrhea; Female; Gastrointestinal Transit; Intestinal Secretions; Mice; Plant Extracts; Random Allocation; Rats, Wistar; Receptors, Adrenergic, alpha; Receptors, Opioid; Reproducibility of Results; Time Factors; Treatment Outcome
PubMed: 30569966
DOI: 10.1590/0001-3765201820170932