Proctocolectomy renders patients more prone to significant fluid and electrolyte disturbance due not only to the loss of the normal absorptive capacity of the colon, but also due to unique complications of the postoperative state. Other than causes of diarrhoea unrelated to ileostomy, ileal resection, partial small bowel obstruction, and regional enteritis represent the most common causes of ileostomy diarrhoea following conventional ileostomy. In addition, patients with intra-abdominal reservoirs are prone to develop a bacterial overgrowth syndrome. With reservoirs placed in a pelvic location, as part of an ileoanal procedure, defecatory frequency (with or without high faecal outputs) can also result from ineffective pouch evacuation, decreased pouch capacity or poor sphincteric function.
{"title":"Ileostomy diarrhoea.","authors":"A M Metcalf, S F Phillips","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Proctocolectomy renders patients more prone to significant fluid and electrolyte disturbance due not only to the loss of the normal absorptive capacity of the colon, but also due to unique complications of the postoperative state. Other than causes of diarrhoea unrelated to ileostomy, ileal resection, partial small bowel obstruction, and regional enteritis represent the most common causes of ileostomy diarrhoea following conventional ileostomy. In addition, patients with intra-abdominal reservoirs are prone to develop a bacterial overgrowth syndrome. With reservoirs placed in a pelvic location, as part of an ileoanal procedure, defecatory frequency (with or without high faecal outputs) can also result from ineffective pouch evacuation, decreased pouch capacity or poor sphincteric function.</p>","PeriodicalId":75717,"journal":{"name":"Clinics in gastroenterology","volume":"15 3","pages":"705-22"},"PeriodicalIF":0.0,"publicationDate":"1986-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14650358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J S Fordtran, C A Santa Ana, S G Morawski, G W Bo-Linn, L R Schiller
{"title":"Pathophysiology of chronic diarrhoea: insights derived from intestinal perfusion studies in 31 patients.","authors":"J S Fordtran, C A Santa Ana, S G Morawski, G W Bo-Linn, L R Schiller","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75717,"journal":{"name":"Clinics in gastroenterology","volume":"15 3","pages":"477-90"},"PeriodicalIF":0.0,"publicationDate":"1986-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14861628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1986-07-01DOI: 10.1016/S0300-5089(21)00739-2
Hans Fromm, Mauro Malavolti
Three types of bile acid-induced diarrhoea can be distinguished. The best documented and most common entity is represented by type I bile acid malabsorption, which occurs as the result of a pathologically, anatomically defined ileopathy. Type II bile acid malabsorption is found in the setting of a morphologically completely normal ileum. This primary disorder of bile acid transport, which has been described in only a few paediatric and adult patients, appears to be rare. The third variety of bile acid malabsorption is characterized by the history of a previous cholecystectomy and/or by the presence of other gastroenterological conditions. Severe bile acid malabsorption is relatively uncommon in the type III syndrome. Even in the presence of severe bile acid malabsorption, patients with this condition are rarely found to have secretory concentrations of faecal bile acids, and/or rarely respond satisfactorily to cholestyramine. Present data suggest that bile acids play no significant role in the pathogenesis of idiopathic diarrhoea. A careful history, the measurement of stool weight and pH, a therapeutic trial of cholestyramine and the performance of a bile acid test, such as a bile acid breath test, can be used to establish the diagnosis of bile acid diarrhoea. Cholestyramine is the treatment of choice and is virtually always effective in this syndrome.
{"title":"Bile Acid-Induced Diarrhoea","authors":"Hans Fromm, Mauro Malavolti","doi":"10.1016/S0300-5089(21)00739-2","DOIUrl":"https://doi.org/10.1016/S0300-5089(21)00739-2","url":null,"abstract":"<div><p>Three types of bile acid-induced diarrhoea can be distinguished. The best documented and most common entity is represented by type I bile acid malabsorption, which occurs as the result of a pathologically, anatomically defined ileopathy. Type II bile acid malabsorption is found in the setting of a morphologically completely normal ileum. This primary disorder of bile acid transport, which has been described in only a few paediatric and adult patients, appears to be rare. The third variety of bile acid malabsorption is characterized by the history of a previous cholecystectomy and/or by the presence of other gastroenterological conditions. Severe bile acid malabsorption is relatively uncommon in the type III syndrome. Even in the presence of severe bile acid malabsorption, patients with this condition are rarely found to have secretory concentrations of faecal bile acids, and/or rarely respond satisfactorily to cholestyramine. Present data suggest that bile acids play no significant role in the pathogenesis of idiopathic diarrhoea. A careful history, the measurement of stool weight and pH, a therapeutic trial of cholestyramine and the performance of a bile acid test, such as a bile acid breath test, can be used to establish the diagnosis of bile acid diarrhoea. Cholestyramine is the treatment of choice and is virtually always effective in this syndrome.</p></div>","PeriodicalId":75717,"journal":{"name":"Clinics in gastroenterology","volume":"15 3","pages":"Pages 567-582"},"PeriodicalIF":0.0,"publicationDate":"1986-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92250110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Diarrhoea due to Circulating Agents","authors":"Jean-Claude Rambaud, Matthieu Hautefeuille, Agnès Ruskone, Pascal Jacquenod","doi":"10.1016/S0300-5089(21)00741-0","DOIUrl":"https://doi.org/10.1016/S0300-5089(21)00741-0","url":null,"abstract":"","PeriodicalId":75717,"journal":{"name":"Clinics in gastroenterology","volume":"15 3","pages":"Pages 603-629"},"PeriodicalIF":0.0,"publicationDate":"1986-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137090329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cholera.","authors":"G H Rabbani","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75717,"journal":{"name":"Clinics in gastroenterology","volume":"15 3","pages":"507-28"},"PeriodicalIF":0.0,"publicationDate":"1986-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14649660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gastroenterologists often have to deal with patients with chronic diarrhoea. The vast majority will suffer from functional bowel syndrome. A few will present with a clear-cut organic disease. If chronic diarrhoea remains unexplained after extensive testing, if daily stool volume is high (greater than 500 g/24 h) and if the patient is female, factitious diarrhoea should be considered. Melanosis coli on sigmoidoscopy, cathartic colon on barium enema examination, a positive room search and chemical detection of the presence of specific laxatives in urine or stool may lead to the correct diagnosis. Treatment and management of such patients is difficult. Denial is the usual response to confrontation. Counselling and guidance by psychiatrists or psychologists is often not accepted by the patient. In many cases the role of the physician may be limited to preventing further potentially dangerous diagnostic and therapeutic interventions.
{"title":"Factitious diarrhoea.","authors":"K Ewe, U Karbach","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Gastroenterologists often have to deal with patients with chronic diarrhoea. The vast majority will suffer from functional bowel syndrome. A few will present with a clear-cut organic disease. If chronic diarrhoea remains unexplained after extensive testing, if daily stool volume is high (greater than 500 g/24 h) and if the patient is female, factitious diarrhoea should be considered. Melanosis coli on sigmoidoscopy, cathartic colon on barium enema examination, a positive room search and chemical detection of the presence of specific laxatives in urine or stool may lead to the correct diagnosis. Treatment and management of such patients is difficult. Denial is the usual response to confrontation. Counselling and guidance by psychiatrists or psychologists is often not accepted by the patient. In many cases the role of the physician may be limited to preventing further potentially dangerous diagnostic and therapeutic interventions.</p>","PeriodicalId":75717,"journal":{"name":"Clinics in gastroenterology","volume":"15 3","pages":"723-40"},"PeriodicalIF":0.0,"publicationDate":"1986-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14650359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1986-07-01DOI: 10.1016/S0300-5089(21)00734-3
John S. Fordtran, Carol A. Santa Ana, Stephen G. Morawski, George W. Bo-Linn, Lawrence R. Schiller
{"title":"Pathophysiology of Chronic Diarrhoea: Insights Derived from Intestinal Perfusion Studies in 31 Patients","authors":"John S. Fordtran, Carol A. Santa Ana, Stephen G. Morawski, George W. Bo-Linn, Lawrence R. Schiller","doi":"10.1016/S0300-5089(21)00734-3","DOIUrl":"https://doi.org/10.1016/S0300-5089(21)00734-3","url":null,"abstract":"","PeriodicalId":75717,"journal":{"name":"Clinics in gastroenterology","volume":"15 3","pages":"Pages 477-490"},"PeriodicalIF":0.0,"publicationDate":"1986-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92219949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Diarrhoea associated with carbohydrate malabsorption.","authors":"W F Caspary","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75717,"journal":{"name":"Clinics in gastroenterology","volume":"15 3","pages":"631-55"},"PeriodicalIF":0.0,"publicationDate":"1986-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14860755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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