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2015 ; 13
(4
): 306-12
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English Wikipedia
Pharmacologic Agents for Chronic Diarrhea
#MMPMID26576135
Lee KJ
Intest Res
2015[Oct]; 13
(4
): 306-12
PMID26576135
show ga
Chronic diarrhea is usually associated with a number of non-infectious causes.
When definitive treatment is unavailable, symptomatic drug therapy is indicated.
Pharmacologic agents for chronic diarrhea include loperamide, 5-hydroxytryptamine
type 3 (5-HT3) receptor antagonists, diosmectite, cholestyramine, probiotics,
antispasmodics, rifaximin, and anti-inflammatory agents. Loperamide, a synthetic
opiate agonist, decreases peristaltic activity and inhibits secretion, resulting
in the reduction of fluid and electrolyte loss and an increase in stool
consistency. Cholestyramine is a bile acid sequestrant that is generally
considered as the first-line treatment for bile acid diarrhea. 5-HT3 receptor
antagonists have significant benefits in patients with irritable bowel syndrome
(IBS) with diarrhea. Ramosetron improves stool consistency as well as global IBS
symptoms. Probiotics may have a role in the prevention of antibiotic-associated
diarrhea. However, data on the role of probiotics in the treatment of chronic
diarrhea are lacking. Diosmectite, an absorbent, can be used for the treatment of
chronic functional diarrhea, radiation-induced diarrhea, and chemotherapy-induced
diarrhea. Antispasmodics including alverine citrate, mebeverine, otilonium
bromide, and pinaverium bromide are used for relieving diarrheal symptoms and
abdominal pain. Rifaximin can be effective for chronic diarrhea associated with
IBS and small intestinal bacterial overgrowth. Budesonide is effective in both
lymphocytic colitis and collagenous colitis. The efficacy of mesalazine in
microscopic colitis is weak or remains uncertain. Considering their mechanisms of
action, these agents should be prescribed properly.