RESUMEN
In clinical trials, rhubarb extract (Rb) was demonstrated to efficiently alleviate constipation. We would like to find out the underlying mechanism of rhubarb relieving constipation. However, there are few studies on the effects of rhubarb on colonic mucus secretion and constipation. The aim of this study was to investigate the effects of rhubarb on colonic mucus secretion and its underlying mechanism. The mice were randomly divided into four groups. Group I was the control group and Group II was the rhubarb control group, with Rb (24 g/kg body weight [b.w.]) administered through intragastric administration for three days. Group III mice were given diphenoxylate (20 mg/kg b.w.) for five days via gavage to induce constipation. Group IV received diphenoxylate lasting five days before undergoing Rb administration for three days. The condition of the colon was evaluated using an endoscope. Particularly, the diameter of blood vessels in the colonic mucosa expanded considerably in constipation mice along with diminishing mucus output, which was in line with the observation via scanning electron microscope (SEM) and transmission electron microscope (TEM). We also performed metagenomic analysis to reveal the microbiome related to mucin gene expression level referring to mucin secretion. In conclusion, Rb relieves constipation by rebuilding mucus homeostasis and regulating the microbiome.
Asunto(s)
Rheum , Ratones , Animales , Difenoxilato/metabolismo , Difenoxilato/farmacología , Difenoxilato/uso terapéutico , Mucinas/metabolismo , Mucinas/farmacología , Mucinas/uso terapéutico , Estreñimiento/tratamiento farmacológico , Estreñimiento/metabolismo , Colon/metabolismo , Moco/metabolismo , HomeostasisAsunto(s)
Enfermedades del Sistema Nervioso Autónomo/fisiopatología , Diabetes Mellitus Tipo 1/fisiopatología , Diabetes Mellitus Tipo 2/fisiopatología , Neuropatías Diabéticas/fisiopatología , Diarrea/fisiopatología , Sistema Nervioso Entérico/fisiopatología , Antidiarreicos/uso terapéutico , Enfermedades del Sistema Nervioso Autónomo/etiología , Síndrome del Asa Ciega/diagnóstico , Enfermedad Celíaca/diagnóstico , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Neuropatías Diabéticas/etiología , Diagnóstico Diferencial , Diarrea/diagnóstico , Diarrea/tratamiento farmacológico , Diarrea/etiología , Difenoxilato/uso terapéutico , Insuficiencia Pancreática Exocrina/diagnóstico , Fármacos Gastrointestinales/uso terapéutico , Motilidad Gastrointestinal/fisiología , Hipoglucemiantes/efectos adversos , Imidazoles/uso terapéutico , Inflamación , Enfermedades Inflamatorias del Intestino/diagnóstico , Células Intersticiales de Cajal , Absorción Intestinal/fisiología , Mucosa Intestinal , Síndrome del Colon Irritable/diagnóstico , Loperamida/uso terapéutico , Neuroglía , Edulcorantes no Nutritivos/efectos adversos , Estrés Oxidativo/fisiología , Fenilalanina/análogos & derivados , Fenilalanina/uso terapéutico , Antagonistas del Receptor de Serotonina 5-HT3/uso terapéuticoRESUMEN
Diarrhea is a distressing symptom which limits the quality of life in patients receiving palliative care and is associated with high morbidity and mortality. In patients with AIDS, it is a more common problem than for other entities (e.g., cancer). Loperamide is considered the first choice medication for the symptomatic treatment of diarrhea. This literature review examines the efficacy of loperamide in the symptomatic treatment of diarrhea in palliative care. Two databases (Medline and Embase) were searched through June 2012. A total of 286 studies were identified, but only 7 met the inclusion criteria (1 cohort and 6 experimental studies) in which loperamide (alone or in combination) was tested. There is a lack of significant studies which investigate the efficacy of loperamide in the symptomatic treatment of diarrhea. Two trials indicated superiority of loperamide over placebo. In comparison with octreotide, the results were contradictory. The combination of acetorphan with loperamide was more effective than acetorphan alone, but the combination of loperamide with diphenoxylate was inferior to octreotide. The identified studies revealed methodical problems. A definite recommendation for administration of loperamide can, therefore, not be derived from this work.The English full-text version of this article is available at SpringerLink (under "Supplemental").
Asunto(s)
Antidiarreicos/uso terapéutico , Diarrea/tratamiento farmacológico , Loperamida/uso terapéutico , Cuidados Paliativos , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Antidiarreicos/efectos adversos , Ensayos Clínicos Controlados como Asunto , Diarrea/etiología , Difenoxilato/efectos adversos , Difenoxilato/uso terapéutico , Quimioterapia Combinada , Humanos , Loperamida/efectos adversos , Octreótido/efectos adversos , Octreótido/uso terapéutico , Tiorfan/efectos adversos , Tiorfan/análogos & derivados , Tiorfan/uso terapéuticoRESUMEN
Antimicrobial and antimotility agents are not recommended for the treatment of Shiga toxin-producing Escherichia coli O157 infection. In our study, many persons with Shiga toxin-producing E. coli O157 infection took antimicrobial (62%) and antimotility agents (32%); 43 (29%) of 146 reported commencing antimicrobial treatment after laboratory confirmation. Efforts are needed to promote practice guidelines.
Asunto(s)
Antibacterianos/efectos adversos , Infecciones por Escherichia coli/tratamiento farmacológico , Escherichia coli O157/efectos de los fármacos , Síndrome Hemolítico-Urémico/etiología , Parasimpatolíticos/efectos adversos , Toxinas Shiga/biosíntesis , Adolescente , Adulto , Antibacterianos/uso terapéutico , Estudios de Casos y Controles , Niño , Preescolar , Difenoxilato/efectos adversos , Difenoxilato/uso terapéutico , Infecciones por Escherichia coli/complicaciones , Infecciones por Escherichia coli/epidemiología , Infecciones por Escherichia coli/microbiología , Síndrome Hemolítico-Urémico/epidemiología , Síndrome Hemolítico-Urémico/microbiología , Humanos , Loperamida/efectos adversos , Loperamida/uso terapéutico , Parasimpatolíticos/uso terapéutico , Vigilancia de la Población/métodos , Pautas de la Práctica en Medicina , Adulto JovenAsunto(s)
Antidiarreicos/administración & dosificación , Diarrea/tratamiento farmacológico , Disentería/terapia , Viaje , Adulto , Antibacterianos/efectos adversos , Antibacterianos/uso terapéutico , Atropina/efectos adversos , Atropina/uso terapéutico , Bismuto/efectos adversos , Bismuto/uso terapéutico , Niño , Estudios Transversales , Difenoxilato/efectos adversos , Difenoxilato/uso terapéutico , Combinación de Medicamentos , Disentería/epidemiología , Disentería/etiología , Fluidoterapia , Fluoroquinolonas/efectos adversos , Fluoroquinolonas/uso terapéutico , Humanos , Loperamida/efectos adversos , Loperamida/uso terapéutico , Compuestos Organometálicos/efectos adversos , Compuestos Organometálicos/uso terapéutico , Probióticos/uso terapéutico , Factores de Riesgo , Salicilatos/efectos adversos , Salicilatos/uso terapéuticoRESUMEN
Along with the dizzying rise in the world's population and economic globalization, travel activity has also increased. Travelers' diarrhea, caused by changed sanitary conditions, has a very different pathogenic spectrum and clinical course from those of our native forms of infectious enterocolitis. Awareness of the warning signs of complications in the clinical course and of the differential diagnoses is therefore a prerequisite for rational therapy. This covers oral rehydration, motility inhibitors, adsorbents, antisecretory agents, probiotics, and last but not least the use of antibiotics, which make an essential contribution if correctly used. There are interesting developments in the form of nonabsorbable antibiotics and new antisecretory agents, which inhibit protein synthesis and enzymes and are increasingly used as antidiarrheal agents with few side effects. In the combination of various therapeutic options in travelers' diarrhea there is still much scope for research. The priority is the correct implementation of the options available today, in order to avoid, as far as possible, therapeutic setbacks and the development of resistance.
Asunto(s)
Disentería/terapia , Viaje , Adulto , Antibacterianos/efectos adversos , Antibacterianos/uso terapéutico , Atropina/efectos adversos , Atropina/uso terapéutico , Bismuto/efectos adversos , Bismuto/uso terapéutico , Niño , Estudios Transversales , Difenoxilato/efectos adversos , Difenoxilato/uso terapéutico , Combinación de Medicamentos , Disentería/epidemiología , Disentería/etiología , Fluidoterapia , Fluoroquinolonas/efectos adversos , Fluoroquinolonas/uso terapéutico , Humanos , Loperamida/efectos adversos , Loperamida/uso terapéutico , Compuestos Organometálicos/efectos adversos , Compuestos Organometálicos/uso terapéutico , Probióticos/uso terapéutico , Factores de Riesgo , Salicilatos/efectos adversos , Salicilatos/uso terapéuticoAsunto(s)
Humanos , Masculino , Femenino , Lactante , Niño , Antibacterianos/uso terapéutico , Diarrea/etiología , Diarrea/terapia , Difenoxilato/uso terapéutico , Loperamida/administración & dosificación , Loperamida/uso terapéutico , Preparaciones Farmacéuticas/administración & dosificación , Antidiarreicos/farmacología , Farmacogenética/métodos , Infecciones por Rotavirus/parasitologíaRESUMEN
We report two cases of unintentional poisoning with anticholinergic agents. The first patient, a 7-year-old girl, was prescribed four different medications by a general practitioner for treatment of abdominal colic and diarrhoea. All drugs had anticholinergic properties. The second patient, a 16-month-old boy, ingested his mother's cyproheptadine tablets. Both children presented with central and peripheral symptoms and signs compatible with acute anticholinergic syndrome. They recovered spontaneously following intravenous fluid replacement and close observation. Gastric lavage was also performed on the boy. Poisoning with cholinergic antagonists in children is a potentially serious hazard in Hong Kong. It may be avoided by careful prescribing on the part of general practitioners and safe storage of all medicinal products in the home environment.
Asunto(s)
Antidiarreicos/efectos adversos , Atropina/efectos adversos , Antagonistas Colinérgicos/efectos adversos , Ciproheptadina/efectos adversos , Difenoxilato/efectos adversos , Antidiarreicos/envenenamiento , Antidiarreicos/uso terapéutico , Atropina/envenenamiento , Atropina/uso terapéutico , Niño , Antagonistas Colinérgicos/envenenamiento , Antagonistas Colinérgicos/uso terapéutico , Cólico/diagnóstico por imagen , Cólico/tratamiento farmacológico , Ciproheptadina/envenenamiento , Ciproheptadina/uso terapéutico , Difenoxilato/envenenamiento , Difenoxilato/uso terapéutico , Combinación de Medicamentos , Sobredosis de Droga/prevención & control , Quimioterapia Combinada , Femenino , Lavado Gástrico , Hong Kong , Humanos , Lactante , Masculino , Errores de Medicación , RadiografíaRESUMEN
The Crohn's disease activity index (CDAI) is the most widely used measure of clinical disease activity in patients entered into clinical trials. The prospective nature of the CDAI calculation precludes its use as a clinical assessment tool. We compared the retrospective evaluation of the CDAI with the prospective evaluation in a heterogeneous patient population of 100 patients with Crohn's disease. The correlation between the two assessment methods was good with an r-value of 0.84 (p < 0,0001). There was a tendency of patients with a high retrospective CDAI to have a lower prospective CDAI which is explained by intention to treat. This study shows that a retrospective assisted evaluation of the CDAI is as accurate as the traditional prospective evaluation.
Asunto(s)
Enfermedad de Crohn/clasificación , Dolor Abdominal/clasificación , Antidiarreicos/uso terapéutico , Enfermedades del Colon/clasificación , Enfermedades del Colon/fisiopatología , Enfermedad de Crohn/fisiopatología , Difenoxilato/uso terapéutico , Heces , Estado de Salud , Humanos , Enfermedades del Íleon/clasificación , Enfermedades del Íleon/fisiopatología , Loperamida/uso terapéutico , Registros Médicos , Estudios Prospectivos , Estudios RetrospectivosAsunto(s)
Fibras de la Dieta/uso terapéutico , Incontinencia Fecal/terapia , Anciano , Anciano de 80 o más Años , Atropina/uso terapéutico , Terapia Combinada , Difenoxilato/uso terapéutico , Combinación de Medicamentos , Ingestión de Alimentos/fisiología , Incontinencia Fecal/etiología , Femenino , Fármacos Gastrointestinales/uso terapéutico , Humanos , Loperamida/uso terapéuticoRESUMEN
OBJECTIVE: To compare the effect of octreotide (a long-acting somatostatin analog) to that of antidiarrheal therapy plus placebo on large-volume refractory AIDS-associated diarrhea. DESIGN: A randomized controlled trial. SETTING: Referral-based clinic and hospital in a tertiary care center. PATIENTS: Twenty male patients with AIDS and refractory diarrhea, with stool volume > 1000 ml/day who failed to improve after initial supportive management. All patients finished the study. INTERVENTIONS: Patients were randomly given either octreotide in doses of 100, 200 and 300 micrograms subcutaneously every 8 h, or high doses of loperamide and diphenoxylate orally plus placebo subcutaneously for 10 days. MAIN OUTCOME MEASURES: Bowel movements and stool volume were registered before and every day after treatment by the patients themselves and the nursing personnel. RESULTS: Patients from both groups were similar for age, time of AIDS diagnosis, duration of diarrhea and etiology. Baseline mean bowel movements per day (9.4 +/- 2.8 in the octreotide group versus 10 +/- 3.1 in controls) and baseline mean stool volume (2753 +/- 840 versus 2630 +/- 630 ml/day, respectively) were similar in both groups before therapy (P < 0.05). Mean bowel movements per day after 10 days of therapy was 2.1 +/- 1.6 in the octreotide group versus 7 +/- 3 in controls (P < 0.05). Mean stool volume after 10 days of therapy was 485 +/- 480 in the octreotide group versus 1080 +/- 420 ml/day in controls (P < 0.05). Complete response (stool volume < 250 ml/day) was observed in two patients from the octreotide group and none from controls; partial response (decrease > 50% in stool volume) in four and two; and no response (decrease < 50% or no change) in four and eight (P < 0.05), respectively. Side-effects occurred in eight out of 10 octreotide patients and three out of 10 controls (P < 0.05), but none were significant to result in discontinuation of medication. CONCLUSION: Octreotide proved to be superior to conventional therapy in this short-term treatment of large-volume refractory AIDS-associated diarrhea.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Diarrea/tratamiento farmacológico , Octreótido/uso terapéutico , Adulto , Edad de Inicio , Diarrea/etiología , Difenoxilato/uso terapéutico , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Humanos , Loperamida/uso terapéutico , Masculino , Persona de Mediana Edad , Octreótido/efectos adversos , Placebos , Factores de TiempoRESUMEN
The successful management of fecal incontinence requires an understanding of anorectal function, careful delineation of the disorder by a detailed history and physical examination, and specialized studies of anorectal and pelvic floor function in selected patients. These studies include anorectal manometry, dynamic radiographic studies of the anorectum, pelvic floor neurophysiologic tests and anal endosonography. Therapeutic options include dietary modifications, behavioral programs, pharmacologic agents and surgery. Currently available diagnostic tests should result in optimal management of these patients.
Asunto(s)
Incontinencia Fecal/fisiopatología , Incontinencia Fecal/terapia , Anciano , Canal Anal/fisiopatología , Niño , Dieta , Difenoxilato/uso terapéutico , Enema , Incontinencia Fecal/cirugía , Femenino , Humanos , Loperamida/uso terapéutico , Masculino , Manometría , Persona de Mediana Edad , Diafragma Pélvico/inervación , Diafragma Pélvico/fisiopatología , Radiografía , Recto/diagnóstico por imagen , Recto/fisiopatologíaRESUMEN
Most patients experience a high stool frequency immediately following the closure of the temporary ileostomy after total colectomy and ileoanal pouch reconstruction. Adaptation occurs within the ensuing weeks to reach a plateau in about three months. Increasing volumes of liquid nutrients were injected, twice daily for two months, into the pelvic pouch through a mucous ileal fistula proximal to the pouch before closing the temporary ileostomy. With this method the number of evacuations per 24 hours was significantly reduced during the first few weeks following the reestablishment of intestinal continuity, compared with a control group (average, 8.5 vs. 18.2, respectively). Patients also had better continence and less urgency to defecate. We suggest this technique in patients undergoing pelvic ileal reconstruction with temporary ileostomy.
Asunto(s)
Atropina/uso terapéutico , Colectomía , Colitis Ulcerosa/cirugía , Difenoxilato/uso terapéutico , Fármacos Gastrointestinales/uso terapéutico , Ileostomía , Loperamida/uso terapéutico , Premedicación , Adaptación Fisiológica/efectos de los fármacos , Atropina/farmacología , Colitis Ulcerosa/tratamiento farmacológico , Colitis Ulcerosa/fisiopatología , Defecación/efectos de los fármacos , Difenoxilato/farmacología , Combinación de Medicamentos , Fármacos Gastrointestinales/farmacología , Motilidad Gastrointestinal/efectos de los fármacos , Humanos , Loperamida/farmacología , Cuidados Posoperatorios , Proctocolectomía RestauradoraAsunto(s)
Atropina/efectos adversos , Difenoxilato/efectos adversos , Queratoconjuntivitis Seca/inducido químicamente , Atropina/administración & dosificación , Atropina/uso terapéutico , Diarrea/tratamiento farmacológico , Difenoxilato/administración & dosificación , Difenoxilato/uso terapéutico , Combinación de Medicamentos , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Current Crohn's disease activity indices are not suitable for survey research because they rely on information from the laboratory or physical examination. We used data from a multicenter controlled trial of adjuvant sulfasalazine to develop an index of Crohn's disease activity based on information which could be obtained exclusively by interview. The study population consisted of 89 actively symptomatic patients seen on 1082 occasions in eight medical centers. Multiple regression analyses identified three variables which predicted the ratings of physicians: stool frequency, abdominal pain and sense of well-being. The new index correlated very well (r = 0.87, p less than 0.001) with the Crohn's Disease Activity Index from which it was derived. The index may be used in epidemiologic studies to accurately place patients into quartiles of disease severity which correspond to similar quartiles of the CDAI.
Asunto(s)
Enfermedad de Crohn/fisiopatología , Encuestas Epidemiológicas , Abdomen , Antidiarreicos/uso terapéutico , Atropina/uso terapéutico , Peso Corporal , Diarrea/etiología , Difenoxilato/uso terapéutico , Combinación de Medicamentos/uso terapéutico , Métodos Epidemiológicos , Estado de Salud , Humanos , Dolor/etiología , Proyectos de InvestigaciónRESUMEN
Drug effects on the intestine are traditionally explained in terms of action on the muscle layers and the nerves that control them. This is particularly true in the case of the opioids but research starting two decades ago has identified the intestinal mucosa as the site of action of the antidiarrhoeal opioids. Continued research using the intestinal mucosa offers a fresh approach to solving some old problems. For example it could lead to more confident predictions to be made about the wanted and unwanted effects of opioid drugs on the intestine and may help to find better drug treatments for alleviating withdrawal diarrhoea in addicts. Eventually it may help to explain how the general process of opioid dependence occurs at a cellular level.
Asunto(s)
Intestinos/efectos de los fármacos , Narcóticos/farmacología , Antidiarreicos/farmacología , Antidiarreicos/uso terapéutico , Agua Corporal/metabolismo , Diarrea/tratamiento farmacológico , Difenoxilato/farmacología , Difenoxilato/uso terapéutico , Humanos , Mucosa Intestinal/efectos de los fármacos , Mucosa Intestinal/metabolismo , Intestinos/inervación , Loperamida/farmacología , Loperamida/uso terapéutico , Músculo Liso/efectos de los fármacos , Músculo Liso/inervación , Narcóticos/efectos adversos , Narcóticos/uso terapéutico , Norepinefrina/fisiología , Trastornos Relacionados con Opioides/fisiopatología , Receptores Opioides/efectos de los fármacos , Síndrome de Abstinencia a Sustancias/fisiopatologíaAsunto(s)
Incontinencia Fecal , Atropina/uso terapéutico , Biorretroalimentación Psicológica , Difenoxilato/uso terapéutico , Combinación de Medicamentos/uso terapéutico , Electromiografía , Incontinencia Fecal/diagnóstico , Incontinencia Fecal/tratamiento farmacológico , Incontinencia Fecal/etiología , Incontinencia Fecal/fisiopatología , Incontinencia Fecal/cirugía , Incontinencia Fecal/terapia , Humanos , Loperamida/uso terapéutico , Manometría , Radiografía , Recto/diagnóstico por imagen , Recto/fisiopatologíaRESUMEN
A case of small intestinal amyloidosis that has a myriad punctate mucosal relief pattern of minute filling defects and barium flecks is presented with pathological correlation. Amyloidosis is added to the differential diagnosis of this radiographic small bowel appearance.