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Query: UMLS:C0011991 (diarrhea)
 57,543 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Synthetic prostaglandins of the E series have cytoprotective and gastric antisecretory actions. Both actions are relevant to their therapeutic usefulness in treating and preventing gastrointestinal mucosal diseases. Controlled clinical studies have shown prostaglandins to be effective treatment for gastric and duodenal ulcer disease. Although used widely in dozens of foreign countries, however, prostaglandins have not been approved by the United States Food and Drug Administration for use in the treatment of peptic ulcer disease. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with an increased incidence of gastric and duodenal ulcers, gastrointestinal bleeding, and increased morbidity and mortality. Misoprostol, a prostaglandin E1 analogue, is effective in preventing and treating NSAID-induced mucosal damage and has been approved by the Food and Drug Administration for the prevention of NSAID-associated gastric ulcers. Controlled studies have not provided convincing evidence that H2-receptor antagonists or sucralfate prevents NSAID-induced gastric ulcer. Preliminary clinical studies indicate that some E-prostaglandins may also be effective in treating and/or preventing stress ulcer, cystic fibrosis, and hepatorenal syndrome and in improving graft survival in renal transplant patients receiving cyclosporine. Additionally, in vitro and animal studies suggest that prostaglandins may have therapeutic value in inflammatory bowel disease, and they may promote cartilage repair by an inhibitory action on interleukin-1. The latter finding could be of major relevance in preventing cartilage destruction in rheumatic patients. Significant side effects associated with the clinical use of prostaglandins include mild to moderate diarrhea and stimulation of uterine contraction during early pregnancy. Prostaglandins are effective for the treatment of peptic ulcer disease and, to date, are the only effective therapy for preventing the total spectrum of NSAID-induced mucosal damage. These compounds may also prove effective in treating various inflammatory disorders.
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PMID:Prostaglandins: an overview of the worldwide clinical experience. 181 16

The nutritional assessment by 24 hour-dietary recall, anthropometry and blood-components measurements was undertaken in 23 adult patients, 17 males and 6 females suffering of chronic diarrhea from pancreatitis (30%), inflammatory bowel disease (22%), short intestine syndrome (9%) and unknown diarrhea (35%). The nutritional assessment was done at the entry and repeated at the discharge of the hospitalization that averaged 35 days, during which the patients received specific medical treatment along with obstipating diets. The hospitalization resulted in overall improvement of the patients either clinically by reducing their defecation rate or nutritionally by increasing their protein-energy intake and the values of anthropometry and blood components (albumin, free-tryptophan and lymphocytes). When the patients where divided into two groups based on their fecal-fat output one could note the better nutritional response of the group showing steatorrhea than the non-steatorrhea group, with the serum albumin and the arm-muscle circumference being discriminatory between groups. However even in the better recovered patients the indicative values of a satisfactory nutritional status were not accomplished. Thus, these data suggest that besides the overall nutritional improvement seen in the studied chronic diarrhea patients the full-nutrition recovering would demand either or both a longer hospitalization and/or an early-aggressive nutritional support.
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PMID:[Nutritional implications on treatment and recovery of adult patients with chronic diarrhea]. 184 43

Gastrointestinal disease is a well recognized feature in patients with common variable immunodeficiency, and is often due to infection with a variety of organisms. Symptoms usually improve with appropriate antibiotic therapy and replacement gammaglobulin. We describe three middle-aged female patients with common variable immunodeficiency who had protracted diarrhoea and weight loss. Despite extensive investigation no infectious cause was found. All patients had granulomas distributed throughout the gastrointestinal tract, but no features of inflammatory bowel disease. There was a poor response to gammaglobulin replacement therapy, antibiotics or symptomatic treatment. We suggest that granulomatous enteropathy is another gastrointestinal manifestation of common variable immunodeficiency.
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PMID:Granulomatous enteropathy in common variable immunodeficiency: a cause of chronic diarrhoea. 185 60

An increasing number of patients with inflammatory bowel disease (IBD) have been observed over the past two to three decades at the Cleveland Clinic. This has allowed extensive follow-up and determination of long-term prognosis. The diseases are chronic, require medication over a long period of time, are frequently associated with the need for operation, and often have complications and recurrences. In addition, a substantial number of patients have onset disease at a young age and thus, the propensity for recurrences and complications makes IBD of significant clinical importance. The symptoms of IBD are chronic and usually include diarrhea and often malnutrition. Rectal bleeding is found in almost all patients with ulcerative colitis and in about 25% of patients with Crohn's disease. However, severe hemorrhage in IBD occurs in a small number (1-5%) of patients. When this occurs, it often does so as an episode which may be associated with severe illness systemically as well as creating diagnostic confusion. For patients with ulcerative colitis, the progressive severity of bleeding may be an important indication for surgery (colectomy); in Crohn's disease, patients with ileocolic location of disease are more likely to have severe hemorrhage, and may require resection as a result. Despite the similarities of Crohn's disease and ulcerative colitis, there are significant differences particularly in the long-term (greater than 10 years) follow-up. For patients with Crohn's disease, the major long-term problem is the need for surgery (2/3-3/4 of patients) and recurrence (+/- 50%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Lower gastrointestinal bleeding in inflammatory bowel disease. 188 72

The Authors report a case with watery chronic diarrhoea not related to malabsorption or to inflammatory bowel disease or to intestinal neoplasm. Colonic biopsy, performed during colonoscopy, with the histologic finding of collagenous material in the subepithelial space associated to epithelial alterations and to the presence of inflammatory cells, confirmed the diagnosis of this rare pathologic condition. The pathogenesis of the syndrome, however, is still unknown.
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PMID:[Collagenous colitis: a disease difficult to define]. 197 31

Determination of plasma levels of vasoactive intestinal polypeptide (VIP) has been used for screening patients with chronic diarrhea to identify potential neuroendocrine tumors. This 6-year blinded study from 1981 to 1986 examines the causes of elevated VIP levels in patients. In healthy volunteers ( n = 144), VIP concentrations ranged from 14 to 76 pg/mL (mean +/- SE, 28 +/- 12), whereas in chronic renal failure, 4 of 34 patients or 12% [serum creatinine 4.5 - 9.0 mg/dL (397-795 mumols/L)] had an elevation to greater than 100 pg/mL. No patient with idiopathic hepatic cirrhosis (n = 12) had elevation of serum concentration of this peptide. Among 588 consecutive unselected patients undergoing evaluation for chronic diarrhea (n = 362; 62%) or possible neuroendocrine tumor (n = 214; 36%), 23 patients (3.9%) had concentrations greater than 76 pg/mL. In this group, 5 patients had functioning (VIP, 160-5975 pg/mL) and 5 had nonfunctioning (VIP, 80-120 pg/mL) pancreatic islet cell carcinomas: all 10 patients had hepatic metastases. Other known cases of elevated levels of VIP, ranging from 80 to 340 pg/mL, included other neurogenic tumors (n = 3), small- bowel resection (n = 2), inflammatory bowel disease (n = 2), chronic renal failure (n = 1), and prolonged fasting (n = 1). Patients with diarrhea in which VIP-secreting tumors were identified had plasma vasoactive intestinal peptide concentrations greater than 140 pg/mL. In patients with chronic diarrhea, determination of plasma vasoactive intestinal peptide levels did identify tumors secreting this peptide, but the results from this referral institution did not show identification of these tumors early in their clinical course.
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PMID:Plasma vasoactive intestinal polypeptide concentration determination in patients with diarrhea. 198 54

Gastrointestinal involvement occurs frequently in essential mixed cryoglobulinemia, and most often involves the liver and spleen. Intestinal involvement is much less common and is generally felt to be a late and often catastrophic manifestation of the disease due to severe vasculitis. Occasionally, the disorder mimics inflammatory bowel disease, both clinically and radiographically. We recently cared for a patient with essential mixed cryoglobulinemia who developed persistent diarrhea. Endoscopic evaluation revealed scattered petechial lesions in the duodenum and colon as well as prominent lymphoid hyperplasia in the terminal ileum. Mucosal biopsies disclosed the presence of diffuse inflammation. We suggest that this patient's diarrhea was due to intestinal vasculitis and that prominent ileal lymphoid hyperplasia may be a manifestation of essential mixed cryoglobulinemia.
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PMID:Chronic diarrhea in essential mixed cryoglobulinemia: a manifestation of visceral vasculitis? 201 55

A total of 212 adult patients with infective diarrhoea and 27 with inflammatory bowel disease (IBD), admitted consecutively to an infectious disease unit, were studied in order to determine whether clinical features and laboratory measurements performed on admission identified cases of IBD. Long-standing diarrhoea, blood in the faeces, anaemia, leucocytosis, thrombocytosis, raised ESR and a reduced concentration of serum albumin were more common in patients with IBD (P less than 0.05). The most striking difference was in the platelet count with 59% patients with IBD and 1.6% patients with infective diarrhoea having platelet counts greater than 450 x 10(9)/l. A raised platelet count in a patient admitted to hospital with 'acute gastro-enteritis' suggests IBD.
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PMID:The platelet count as a simple measure to distinguish inflammatory bowel disease from infective diarrhoea. 207 5

Colonic mucosal samples were obtained every 4 weeks for 13 months from 6 clinically normal dogs and from 47 dogs with a clinical diagnosis of chronic inflammatory bowel disease. All samples were graded on a scale of 0-5, based upon the quantity of lymphocytes and plasma cells in the lamina propria, epithelial changes, and the presence of ulcers and erosions. A grade of less than or equal to 2.0 was considered normal and was assigned to 77 of 78 samples from clinically normal dogs and 28 of 48 samples from dogs with diarrhea. A transient increase in cellularity was noted in 1 sample from 1 control dog. Nineteen dogs with clinical disease had obvious histologic abnormalities. The grading scheme described provides the pathologist with an objective criterion for the microscopic evaluation of colonic mucosal samples obtained by endoscopic techniques and offers clinicians a method of assessing the dog's progress and response to therapy.
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PMID:A grading system for lymphocytic plasmacytic colitis in dogs. 209 78

The case is reported of a 39-year-old pregnant woman who presented with fever, abdominal complaints, and diarrhea. Laboratory investigation revealed mononucleosis in the peripheral blood. All microbiological studies were negative, with the exception of finding cytomegalovirus (CMV). Seroconversion was documented; the virus was cultured from urine and subsequently was demonstrated to be present in the inflamed mucosa of the rectum and distal sigmoid, which was found at sigmoidoscopy. This woman was delivered of a neonate with congenital CMV infection but without apparent malformations. The patient experienced recurrences of the bowel disease, in the first of which CMV could still be cultured from a biopsy specimen. In the follow-up period, an otherwise aspecific chronic inflammatory bowel disease remained present. No immunological abnormalities were found, and antibodies to human immunodeficiency virus were negative. This case demonstrates that inflammatory bowel disease can develop as a result of primary infection with CMV.
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PMID:Acute ulcerative proctocolitis associated with primary cytomegalovirus infection. 216 91


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