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.

[Refractory Watery Diarrhea Due to an End-Stage Vasoactive Intestinal Peptide Production Tumor Treated with Opium Tincture-A Case Report].

A female patient aged 77 years had refractory watery diarrhea caused by a vasoactive intestinal peptide production tumor. She had impaired consciousness. After presenting to our hospital, we administered opium tincture, after which the diarrhea ceased. Intravenous feeding was able to be stopped along with the potassium load and the infusion of octreotide, and loperamide. The antidiarrheal effects continued after opium tincture was stopped, and the patient was discharged home. These results reveal that opium tincture can be efficacious in treating end-stage refractory diarrhea.

An Assessment of a Public Health Initiative of Homeopathy for Primary Teething.

BACKGROUND: During primary teething, children suffer from running nose, mild fever, diarrhoea and other mild irritations and inflammations. A public health programme, 'Homoeopathy for the Healthy Child', was undertaken on a pilot basis focusing on promotion of healthy teething by provision of home-based care through six pre-identified homeopathic medicines for complaints commonly observed during primary teething. This article assesses the feasibility of this programme and reports the impact of this initiative on teething profile in children and episodes of diarrhoea and upper respiratory tract infection (URTI). MATERIALS AND METHODS: Accredited Social Health Activists (ASHAs) were trained in child care and usage of a kit comprising six medicines, namely Calcarea phosphoricum 6X (CP), Ferrum phosphoricum 3X, Magnesium phosphoricum 6X, Belladonna 30C, Chamomilla 30C and Podophyllum 30C. Calcarea phosphoricum was given regularly to each participating child from 6 months to 1 year of age. Home-based care for diarrhoea, URTI and mild fever was provided by ASHAs using the other five medicines in the kit. Dentition pattern and diarrhoea/URTI episodes were recorded over a period of the next 12 months. RESULTS: Eleven thousand four-hundred and twenty-six children were followed up regularly. Amongst those who enrolled at 6-7 months, a larger proportion of children were approaching expected teething in successive months as compared with children enrolled at 12 months, thus indicating that teething delays, if any, were overcome during this period. Incidence of diarrhoea and URTI showed decrease in the months after enrolment. Children responded favourably to the medicines given by ASHAs at the time of diarrhoea/URTI episodes, and ASHAs expressed satisfaction with the programme. CONCLUSION: An approach with regular use of CP and home-based care with homeopathy through health workers for common problems in teething children is acceptable to the community and enhances outreach of services to the public at large. Observations in terms of the healthy teething period may be further validated through studies of homeopathy with suitable comparator group.

Village health care providers in Matlab, Bangladesh: a study of their knowledge in the management of childhood diarrhoea.

This study was conducted among village health care providers in Matlab, Bangladesh in 1987. The objectives were to assess their knowledge of childhood diarrhoea and methods of management. All types of health care providers considered diarrhoea as a major childhood disease and opined that treatment should be initiated in case of four or more loose motions a day. Slightly more than half of the allopaths were aware of the scientific causes of diarrhoea; homeopaths and traditional healers in large proportions related diarrhoeal diseases with certain types of food, and 'evil eyes'. Eighty per cent of the allopaths reported use of oral rehydration solution in treating watery diarrhoea against 20% of the others. Prescription of antibiotics in treating dysentery was higher among allopaths than others. Allopaths were also less restrictive regarding continuation of breastfeeding and intake of food during diarrhoea among children.

[Colitis ulcerosa and opioid addiction]. / Opioidsucht bei Colitis ulcerosa.

The occurrence of an opioid addiction within an opioid treatment of pain or diarrhoea in inflammatory bowel disease is rarely reported. We report on a 36-year-old male with a 14 years lasting left sided chronic ulcerative colitis who developed after the initiation of a therapy with tincture of opium because of abdominal pain and diarrhoea an opioid addiction with the consumption of opium and later buprenorphin. Additionally to the diagnostics and therapy of the ulcerative colitis a detoxication was carried out. The diarrhoea slightly increased during the buprenorphin withdrawal. Diarrhoea refractory to other treatment should be treated by loperamid because of its lacking effects on the central nervous system. In chronic abdominal or musculoskeletal pain in inflammatory bowel disease opioids can be used if no surgical or other medical pain relief is possible. A consequent control of the therapeutic and side effects of the opioid therapy is necessary, especially of an abuse of opioid medication. The published case reports of a therapeutic induction of opioid addiction demonstrate that psychiatric comorbidity is an essential or even necessary risk factor. A checklist with seven criteria of opioid addiction during opioid therapy is presented.

Drug therapy reviews: pharmacotherapy of diarrhea.

Gastrointestinal physiology, and the pathophysiology, diagnosis, symptoms and treatment of acute and chronic diarrhea are reviewed. Drugs used in the treatment of diarrhea include opiates (morphine, codeine), synthetic anti-diarrheals (diphenoxylate, loperamide), anticholinergics (atropine, propantheline), adsorbents (kaolin, pectin, cholestyramine resin) and Lactobacillus acidophilus. Chronic diarrhea and acute diarrhea caused by microorgansims, drugs and viruses are described. The management of diarrhea can be divided into three categories: (1) supportive therapy (fluid and electrolyte replacement); (2) symptomatic therapy which improves the consistency of the stool and reduces the frequency of bowel movements; and (3) specific therapy aimed at treating the cause (e.g., antibiotics for bacteria-induced diarrhea) or blocking the cellular mechanisms of fluid and electrolyte loss. Most acute diarrheal conditions can be managed successfully by avoiding oral solids and ingesting carbohydrate-electrolyte solutions. Synthetic antidiarrheals may increase the toxicity associated with bacterial diahhrea.

Diarrea / Diarrhea

La Diarrea es un problema de salud en nuestro país que requiere una permanente evaluación y control. Sus mecanismos fisiopatológicos son conocidos y, uno de ellos, el relacionado a la diarrea secretoria, ha ganado prioridad en el momento actual por la epidemia del cólera en el Perú. La Diarrea Aguda ( DA ) puede asociarse a factores infecciosos, como virus y bacterias, y no infecciosos por otras toxinas de diversos orígenes. Su manejo terapeútico está basado en el enfoque etiológico y clínico, y de acuerdo a cada caso requiere el uso de loa rehidratación y/o antibioticoterapia. El empleo de antiperistálticos y absorbentes, no ha demostrado una real eficacia. Los factores socio-económicos, culturales y de saneamientos ambientales, influyen definidamente en esta enfermedad. Estudios nacionales de DA en adultos, han confirmado en el 50 por ciento de casos la detección de gérmenes enteropatógenos; mientras que en países desarrollados los han encontrado en el 28 por ciento. Por todo ello, el control e higiene de centros de venta de alimentos, medidas de saneamiento y educación comunitaria, son básicos para la prevención de la DA. La Diarrea Crónica ( DC ), es un síndrome con una variedad de causas, que cambian de acuerdo también a cada tipo de población o país. En el Perú, las parasitosis e infecciones son causas más frecuentes, siendo la sobrepoblación bacteriana intestinal, también una causa importante, estudios realizados. Muchos casos de DC son de etiología multifactorial y se asocian o son parte de enfermedades sistémicas, metabólicas, por inmunodeficiencia y neoplásicas. Cada caso requiere un enfoque diagnóstico integral, con técnicas simples, a veces concluyentes; y/o más complejas, pero orientadas por las patologías más frecuentes en cada entorno poblacional

Diarréia crônica e infecçöes repetidas em adulto / Chronic diarrhea and repeated infections in an adult

Um caso de infecçäo por Shigella flexneri em uma mulher de 34 anos de idade com hipogamaglobulinemia e diarréia é apresentado; o problema diagnóstico representado por diarréia no paciente com hipogamaglobulinemia é discutido. A revisäo de 7 outros pacientes com hipogamaglobulinemia tratados no HCRP é apresentado e é enfatizado que vários agentes patogênicos podem causar diarréia nesses pacientes