What are the side effects of NyQuil. How common is diarrhea among NyQuil users. Who is most at risk for experiencing diarrhea when taking NyQuil. How can NyQuil-induced diarrhea be managed. What are the alternative treatments for cold and flu symptoms.

The Link Between NyQuil and Diarrhea: Insights from FDA Data

NyQuil, a popular over-the-counter medication for cold and flu symptoms, has been the subject of a recent phase IV clinical study analyzing its side effects. The study, based on FDA data and conducted by eHealthMe, reveals an unexpected connection between NyQuil use and the occurrence of diarrhea in some patients.

Out of 1,540 people who reported side effects while taking NyQuil, 70 individuals (4.55%) experienced diarrhea. This finding highlights the importance of understanding potential adverse reactions, even with commonly used medications.

Who is Most Affected by NyQuil-Induced Diarrhea?

The study indicates that certain demographic groups may be more susceptible to experiencing diarrhea as a side effect of NyQuil:

• Gender: Females appear to be more likely to report this side effect
• Age: Individuals aged 60 and older seem to be at higher risk
• Duration of use: Those who have been taking the drug for less than one month are more prone to this side effect

While these factors may increase the likelihood of experiencing diarrhea, it’s important to note that individual reactions can vary significantly.

Understanding NyQuil’s Active Ingredients and Their Effects

NyQuil contains a combination of active ingredients, each serving a specific purpose in alleviating cold and flu symptoms. The primary components are:

• Acetaminophen: Pain reliever and fever reducer
• Dextromethorphan: Cough suppressant
• Doxylamine: Antihistamine
• Pseudoephedrine: Decongestant

While these ingredients are effective in treating cold symptoms, they can also lead to various side effects, including diarrhea in some cases.

How Do NyQuil’s Ingredients Potentially Cause Diarrhea?

The exact mechanism by which NyQuil may cause diarrhea is not fully understood. However, several theories exist:

1. Pseudoephedrine can increase gut motility, potentially leading to loose stools
2. Acetaminophen may affect the gut microbiome, disrupting normal digestive processes
3. Individual sensitivities to one or more ingredients could trigger gastrointestinal disturbances

It’s crucial to remember that while diarrhea is a reported side effect, it is not experienced by the majority of NyQuil users.

Managing NyQuil-Induced Diarrhea: Practical Tips and Considerations

If you experience diarrhea while taking NyQuil, consider the following steps:

• Stay hydrated by drinking plenty of fluids
• Consume easily digestible foods
• Consider temporarily discontinuing NyQuil use (consult with a healthcare provider first)
• Explore alternative cold and flu treatments

In most cases, NyQuil-induced diarrhea is self-limiting and resolves once the medication is stopped. However, persistent or severe symptoms warrant medical attention.

Alternative Treatments for Cold and Flu Symptoms

For those who experience adverse reactions to NyQuil or prefer alternative treatments, several options are available:

• Single-ingredient medications targeting specific symptoms
• Natural remedies such as honey for cough relief
• Rest and hydration to support the body’s natural healing processes
• Nasal irrigation for congestion relief

Always consult with a healthcare provider before starting any new treatment regimen, especially if you have pre-existing health conditions or are taking other medications.

The Importance of Personalized Medicine in Cold and Flu Treatment

The varying reactions to NyQuil and other cold medications underscore the importance of personalized medicine. What works well for one individual may not be suitable for another, highlighting the need for tailored treatment approaches.

Factors Influencing Individual Responses to Cold Medications

• Genetic factors affecting drug metabolism
• Pre-existing health conditions
• Age and gender
• Concurrent medications and potential interactions

Understanding these factors can help healthcare providers and patients make more informed decisions about cold and flu treatments, potentially reducing the risk of adverse effects like diarrhea.

The Role of Phase IV Clinical Studies in Drug Safety

Phase IV clinical studies, like the one conducted on NyQuil, play a crucial role in monitoring drug safety and effectiveness in real-world settings. These studies provide valuable insights that may not be apparent during pre-market clinical trials.

Benefits of Phase IV Studies:

• Identification of rare side effects
• Assessment of long-term safety and efficacy
• Detection of potential drug interactions
• Evaluation of cost-effectiveness in real-world settings

By participating in these studies or reporting side effects to healthcare providers, patients contribute to the ongoing improvement of medication safety and efficacy.

Navigating Cold and Flu Season: Balancing Symptom Relief and Side Effect Risk

As cold and flu season approaches, it’s essential to weigh the benefits of symptom relief against the potential risks of medication side effects. Here are some strategies to consider:

• Start with the lowest effective dose of any medication
• Monitor for any unusual symptoms or side effects
• Consider non-pharmacological interventions as first-line treatments
• Consult with a healthcare provider for personalized advice

By taking a thoughtful approach to cold and flu management, you can minimize the risk of experiencing adverse effects like diarrhea while still effectively managing your symptoms.

The Future of Cold and Flu Treatment: Emerging Research and Innovations

As our understanding of cold and flu viruses evolves, so too does the landscape of treatment options. Researchers are continuously exploring new avenues for more effective and safer medications.

Promising Areas of Research:

• Targeted antiviral therapies
• Immunomodulatory treatments
• Novel drug delivery systems for improved efficacy and reduced side effects
• Personalized medicine approaches based on genetic profiling

These advancements hold the potential to revolutionize cold and flu treatment, potentially offering more effective relief with fewer side effects like diarrhea.

As we continue to navigate the complex world of cold and flu treatments, staying informed about potential side effects and emerging research is crucial. By understanding the risks and benefits of medications like NyQuil, patients can make more informed decisions about their health and well-being. Remember, when in doubt, always consult with a healthcare professional for personalized advice and guidance.

Nyquil and Diarrhea, a phase IV clinical study of FDA data

Diarrhea is found among people who take Nyquil, especially for people who are female, 60+ old, have been taking the drug for < 1 month.

The phase IV clinical study analyzes which people take Nyquil and have Diarrhea. It is created by eHealthMe based on reports of 1,540 people who have side effects when taking Nyquil from the FDA, and is updated regularly. You can use the study as a second opinion to make health care decisions.

Phase IV trials are used to detect adverse drug outcomes and monitor drug effectiveness in the real world. With medical big data and AI algorithms, eHealthMe is running millions of phase IV trials and makes the results available to the public. Our original studies have been referenced on 600+ medical publications including The Lancet, Mayo Clinic Proceedings, and Nature.

On May, 14, 2023

1,540 people reported to have side effects when taking Nyquil.
Among them, 70 people (4. 55%) have Diarrhea.

What is Nyquil?

Nyquil has active ingredients of acetaminophen / dextromethorphan / doxylamine / pseudoephedrine. It is often used in cold symptoms. eHealthMe is studying from 1,731 Nyquil users for its effectiveness, alternative drugs and more.

What is Diarrhea?

Diarrhea is found to be associated with 4,919 drugs and 5,576 conditions by eHealthMe.

Number of Nyquil and Diarrhea reports submitted per year:

Time on Nyquil when people have Diarrhea *:

Click here to view

Gender of people who have Diarrhea when taking Nyquil*:

Click here to view

Age of people who have Diarrhea when taking Nyquil *:

Click here to view

Common drugs people take besides Nyquil *:

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Common side effects people have besides Diarrhea *:

Click here to view

Common conditions people have *:

Click here to view

* Approximation only. Some reports may have incomplete information.

Do you take Nyquil and have Diarrhea?

Check whether Diarrhea is associated with a drug or a condition

How to use the study?

You can discuss the study with your doctor, to ensure that all drug risks and benefits are fully discussed and understood.

Related studies

How severe was Diarrhea and when was it recovered:

• Diarrhea in Nyquil

Expand to all the drugs that have ingredients of

acetaminophen / dextromethorphan / doxylamine / pseudoephedrine:

• Diarrhea and drugs with ingredients of acetaminophen / dextromethorphan / doxylamine / pseudoephedrine (58 reports)

Alternative drugs to, pros and cons of Nyquil:

• Nyquil (1,731 reports)

Common Nyquil side effects:

• Fatigue (feeling of tiredness): 108 reports

Browse all side effects of Nyquil:

abcdefghijklmnopqrstuvwxyz

Diarrhea treatments and more:

• Diarrhea (635,844 reports)

COVID vaccines that are related to Diarrhea:

• Diarrhea in Moderna COVID Vaccine
• Diarrhea in Pfizer BioNTech Covid Vaccine
• Diarrhea in Johnson and Johnson Covid Vaccine

Common drugs associated with Diarrhea:

• Prednisone: 31,577 reports
• Aspirin: 28,546 reports
• Humira: 27,396 reports
• Metformin: 25,489 reports
• Otezla: 24,088 reports
• Revlimid: 23,781 reports
• Methotrexate: 22,508 reports
• Omeprazole: 20,344 reports
• Lisinopril: 17,320 reports
• Amlodipine: 16,563 reports

All the drugs that are associated with Diarrhea:

• Diarrhea (4,919 drugs)

Common conditions associated with Diarrhea:

• Multiple myeloma: 27,552 reports
• Rheumatoid arthritis: 27,466 reports
• High blood pressure: 26,538 reports
• Crohn’s disease: 22,299 reports
• Multiple sclerosis: 22,186 reports
• Psoriasis: 20,189 reports
• Primary pulmonary hypertension: 17,289 reports
• Pain: 16,423 reports

All the conditions that are associated with Diarrhea:

• Diarrhea (5,576 conditions)

How the study uses the data?

The study uses data from the FDA. It is based on acetaminophen / dextromethorphan / doxylamine / pseudoephedrine (the active ingredients of Nyquil) and Nyquil (the brand name). Other drugs that have the same active ingredients (e.g. generic drugs) are not considered. Dosage of drugs is not considered in the study.

Who is eHealthMe?

With medical big data and proven AI algorithms, eHealthMe provides a platform for everyone to run phase IV clinical trials. We study millions of patients and 5,000 more each day. Results of our real-world drug study have been referenced on 600+ medical publications, including The Lancet, Mayo Clinic Proceedings, and Nature. Our analysis results are available to researchers, health care professionals, patients (testimonials), and software developers (open API).

WARNING, DISCLAIMER, USE FOR PUBLICATION

WARNING: Please DO NOT STOP MEDICATIONS without first consulting a physician since doing so could be hazardous to your health.

DISCLAIMER: All material available on eHealthMe.com is for informational purposes only, and is not a substitute for medical advice, diagnosis, or treatment provided by a qualified healthcare provider. All information is observation-only. Our phase IV clinical studies alone cannot establish cause-effect relationship. Different individuals may respond to medication in different ways. Every effort has been made to ensure that all information is accurate, up-to-date, and complete, but no guarantee is made to that effect. The use of the eHealthMe site and its content is at your own risk.

If you use this eHealthMe study on publication, please acknowledge it with a citation: study title, URL, accessed date.

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Cold and flu warning: The dangers of too much acetaminophen

Cold and flu season is here.

Peruse the aisles of a local pharmacy or grocery store and you will find more than 30 over-the-counter medications available to treat the symptoms of fever, headache, sore throat, and achy muscles. Many of these “multi-symptom” products contain acetaminophen, the active ingredient in Tylenol. This means cold and flu sufferers who are using multiple combination cough and cold remedies may inadvertently be taking more acetaminophen than they intend — and putting themselves at risk for a serious complication: acetaminophen-induced liver toxicity.

Acetaminophen is the most commonly available pain-relieving and fever-reducing medication. It is an ingredient in more than 600 over-the-counter and prescription medications, and it has a remarkable safety profile: the dose at which potential toxicity occurs (8,400 milligrams, or mg) is dramatically higher than the amount that most adults need to effectively treat their symptoms (650 to 1,000 mg). Moreover, acetaminophen does not cause the unwanted effects that are associated with non-steroidal anti-inflammatory drugs (NSAIDs) or prescription opioids. As a result, acetaminophen is known as a very safe and effective over-the-counter medication for the treatment of pain and fever, and is taken by millions of people.

The problem with too much acetaminophen

Nevertheless, you may not realize that acetaminophen is an active ingredient in a combination medication unless you read the label carefully. For example, NyQuil, Theraflu, and Percocet (oxycodone with acetaminophen) all contain acetaminophen. Unfortunately, using multiple products that contain acetaminophen can result in accidental misuse and overuse, as well as potential liver damage.

Acetaminophen is primarily processed in the liver. The liver breaks down most of the acetaminophen in a normal dose and eliminates it in the urine. But a small portion of the drug is converted to a byproduct that is toxic to the liver cells. If you take too much acetaminophen — all at once or over a period of several days — this toxic breakdown product can build up and cause damage to the liver.

In addition, there is some evidence that people with dehydration from vomiting or diarrhea, persistent fevers, or underlying liver problems may be at slightly increased risk of liver damage when taking normally safe doses of acetaminophen. The resulting symptoms of right-sided abdominal pain, nausea, vomiting, and general malaise may be mistaken for a worsening flu-like illness instead of being recognized as warning signs of liver damage.

McNeil Pharmaceuticals, the maker of Tylenol, has disseminated instructions for the safe use of this product since the 1990s. Advertisements and medication labels warn of the dangers of misusing this medication. The recommended maximum daily dose of acetaminophen in adults has decreased from 4,000 mg (two extra-strength tablets four times daily) to 3,000 mg (two extra-strength tablets three times daily) since the original preparation became available. (Of note, there are also updated warning instructions on the use of products for children with various amounts of acetaminophen, namely infant drops, children’s liquid suspension, and chewable tablets.) The Food and Drug Administration (FDA) has strongly recommended that combination products not contain more than 325mg of acetaminophen per tablet or capsule, and that prescribers not order combination products containing more than 325 mg of acetaminophen.

What this means for your cold and flu season

Acetaminophen is a safe and very effective drug. The vast majority of all patients who take this medication to treat common symptoms of pain and fever will find relief with appropriate use. However, even when in the fog of cold or flu symptoms, be careful to read the label of any cough, cold, or pain medication for the amount of acetaminophen in the drug so that you don’t inadvertently take too much. If unsure, ask a pharmacist for assistance in how to safely use combination medications that include acetaminophen.

Finally, keep in mind that in most cases, viral illnesses such as the common cold and flu generally get better on their own with rest, fluids, and time.

Four variants of pathogenesis and therapy of diarrhea

5-ASA — 5 aminosalicylic acid

ATP – adenosine triphosphate

BK – Crohn’s disease

IBD – inflammatory bowel disease

DIC – disseminated intravascular coagulation

SCFA – short chain fatty acids

MSC — mesenchymal stem cells

NSAIDs – non-steroidal anti-inflammatory drugs

NET – neuroendocrine tumor

OD – acute diarrhea

AII – acute intestinal infection

SNV – malabsorption syndrome

CO – mucous membrane

SOTK – small intestine mucosa

IBS – irritable bowel syndrome

TC – small intestine

FKP – fecal calprotectin

TNF – tumor necrosis factor

cAMP – cyclic adenosine monophosphate

JAK – ulcerative colitis

Diarrhea is one of the most common bowel disorders. According to WHO, diarrheal diseases cause more than 2 million deaths per year [1]. Therefore, the issues of pathogenesis, diagnosis and treatment of diseases occurring with this dysfunction of the intestine do not lose their relevance [2].

Any diarrhea is a clinical manifestation of the predominance of water and electrolyte secretion over absorption in the intestine. The ability of the small and large intestines to absorb water and electrolytes is surprising in its complexity and accuracy in achieving the final result. Every day, a person consumes about 2 liters of water with food. The volume of endogenous fluid entering the intestinal cavity as part of digestive secrets reaches an average of 7 liters. From 70 to 80% of it is absorbed in the small intestine (TC). During the day, from 1 to 2 liters of water enters the large intestine, 90% of it is absorbed and only 100-200 ml is lost with feces. Even a small change in the volume of fluid in the stool leads to constipation or diarrhea.

Water is absorbed through the cell membrane of epitheliocytes. The membrane consists of 2 layers of lipids. The transfer of water through it is carried out with the help of an active mechanism, carried out with the help of sodium ions (Na ⁺ ) and potassium (K ⁺ ). Transferring every 3 Na ⁺ requires transferring 2 K ⁺ in the opposite direction. This pump is provided by adenosine triphosphate (ATP) with the help of ATPase.

Glucose has a stimulating effect in the organization of active water transport with the help of sodium. Improving the absorption of sodium and water with the help of glucose is facilitated by a special cell membrane protein called the glucose co-transporter. This effect was discovered by Robert Crane in the 60s of the last century and was awarded the Nobel Prize in Medicine. His discovery led to the creation of an effective method of treating severe dehydration in patients with cholera and other intestinal infections using oral rehydration with special glucose-salt solutions.

In the pathogenesis of diarrhea, the gradient of intravascular and intra-intestinal osmotic pressure, intestinal exudation and the rate of transit of intestinal contents also play a role [3]. Each of these factors is of leading importance in specific bowel diseases. This explains their clinical features. In table. 1 shows variants of the pathogenesis of various types of diarrhea.

Table 1. Variants of the pathogenesis of various types of diarrhea

Secretory diarrhea. The most common mechanism of diarrhea is the predominance of secretion over absorption of ions and water in the intestine. The main secretion activators are bacterial toxins and enteropathogenic viruses. They increase the activity of adenylate cyclase in the intestinal wall, which causes the formation of cyclic AMP (cAMP), which initiates the secretion of sodium and water into the intestinal lumen. Bile and fatty acids, NSAIDs, gastrointestinal hormones (secretin, vasoactive intestinal peptide), prostaglandins, serotonin and calcitonin, as well as laxatives containing anthraglycosides (senna leaf, buckthorn bark, rhubarb) also have the ability to stimulate the secretion of ions and water into the intestinal lumen. ) and castor oil.

Secretory diarrhea is characterized by profuse watery stools (usually more than 1 L/day).

Osmolar diarrhea. It develops due to an increase in the osmotic pressure of the chyme. An increase in osmotic pressure in the intestinal cavity is observed with digestive and absorption disorders (diseases of the stomach, biliary tract, pancreas, celiac disease, disaccharidase deficiency, etc.). The products of hydrolytic breakdown of nutrients retained in the intestinal cavity increase the osmolarity of the chyme, cause water retention and its additional inflow into the intestinal lumen.

Other causes of osmolar diarrhea are osmotically active substances: saline laxatives containing magnesium and phosphorus ions, antacids, sorbitol, etc.

In case of osmolar diarrhea, unformed copious stools, more than 300 g/day, with remnants of undigested muscle fibers, lumps of starch and drops of fat.

Exudative diarrhea. Occurs in inflammatory bowel disease (IBD) due to exudation of water, electrolytes and protein into the intestine through damaged intestinal mucosa (mucosa). This type of diarrhea is seen in CD, UC, intestinal tuberculosis, salmonellosis, dysentery, malignant diseases, and coronary bowel disease.

In exudative diarrhea, loose stools, often with blood and pus, accompanied by abdominal pain.

Dyskinetic diarrhea. The cause of dyskinetic (hyper- or hypokinetic) diarrhea is an increase or decrease in propulsive bowel function. An increase in the transit rate is facilitated by neurohumoral factors, laxatives and antacid drugs containing magnesium salts. The hyperkinetic type of diarrhea is characteristic of IBS and NET. The duration of transit increases in patients with scleroderma and blind loop syndrome.

With dyskinetic diarrhea, stools are frequent and loose, but the daily amount usually does not exceed 300 g; the appearance of stool is preceded by cramping pain in the abdomen, which subsides after defecation.

Thus, the pathogenesis of diarrhea is complex and includes several factors, each of which predominates in different diseases.

The clinical features of diarrhea depend on its cause, duration, severity and location of intestinal involvement. Distinguish between acute and chronic diarrhea.

Acute diarrhea (OD). Diarrhea is considered acute if its duration does not exceed 2 weeks and there is no evidence of systematic similar episodes in the anamnesis. In most patients, OD is caused by intestinal infections. Usually O.D. proceeds easily and stops on its own. Therefore, the decision on the need for an accurate diagnosis of the cause of acute diarrhea depends on the severity and duration of the disease.

The clinical picture depends on the causative agent of acute intestinal infection (AII). Features are the appearance of other symptoms. These include vomiting, abdominal pain, fever, and blood in the stool.

Infectious OD is characterized by general malaise, fever, lack of appetite, and sometimes vomiting. Abdominal pain is caused by bacteria that produce cytotoxins that damage epithelial cells. High fever is more characteristic of invasive infections that cause an inflammatory response. In case of severe inflammation, erosions and ulcers appear in the intestines and, consequently, bloody diarrhea.

Bloody liquid stools, indicating damage to the intestinal mucosa by pathogenic microbes, is especially characteristic of Flexner’s shigellosis, campylobacteriosis and hemorrhagic colitis caused by E. coli with enteropathogenic properties [4]. It should be borne in mind that acute bloody diarrhea may be the first manifestation of UC, especially if it continues against the background of antibiotic therapy or excluded AEI.

The combination of diarrhea with persistent abdominal pain, fever, erythema nodosum, joint pain and other systemic manifestations is characteristic of CD and yersiniosis (pseudotuberculosis). Yersinia and their antigens are detected in the first 7-10 days of illness in the biological material of the patient during culture or using immunodiagnostic methods. Antibodies to Yersinia appear after 2 weeks of illness and are detected during serological studies [5].

OD is caused by drugs, especially antibiotics. In most cases, antibiotic-associated diarrhea resolves on its own after discontinuation of the drug or a few days after probiotic therapy.

Sudden profuse watery diarrhea, sometimes with a small amount of blood, with high fever is a sign of pseudomembranous colitis associated with Cl. difficile .

Patients with diarrhea lasting more than 1 week should be tested for giardia, other parasites, and cryptosporidium. In the absence of the effect of treatment, common variable hypogammaglobulinemia and other immunodeficiencies should be excluded, and patients with cryptosporidiosis, cyclosporidiosis, or isosporiasis should be tested for HIV infection. Some forms of OD can be caused by enteroviruses.

The characteristic features of acute viral enteritis are a) the absence of blood and inflammatory cells in the feces; b) lack of effect from antibacterial therapy; c) the ability to spontaneous recovery.

Chronic diarrhea (CD). Diarrhea is considered chronic if it persists for more than 3 weeks. In table. 2 lists the causes of HD and the diseases in which it occurs. The reason for H.D. are diseases that cause digestive and absorption disorders, inflammation of the colon and colon, endocrine disorders, circulatory failure and some drugs.

Table 2. Causes of H.D. and diseases in which it occurs

The diagnostic path from the symptom of diarrhea to the nosological diagnosis is shown in the figure. The diagnostic algorithm is based on macroscopic, microscopic and laboratory examination of feces. This approach to establishing the correct diagnosis makes it possible to establish IBD of known (AII, parasitic, etc.) and unknown (CD, UC, etc.) etiology, as well as other diseases, one of the clinical manifestations of which is diarrhea.

Diagnosis algorithm for diarrhea. MSCT – multislice computed tomography; MRI – magnetic resonance imaging; PET – positron emission tomography.

Pay attention to the consistency of feces, smell, volume, presence of blood, pus, mucus or fat in it. A laboratory study of feces makes it possible to identify drops of fat (steatorrhea), muscle fibers (creatorrhoea) and clumps of starch (amilorrhea), i.e., to confirm the connection of diarrhea with impaired intestinal digestion and absorption, as well as to detect eggs of worms, giardia and amoeba.

A characteristic sign of IBD is a large number of leukocytes in feces [6] and an increased concentration of fecal calprotectin — FCP (more than 50 µg/g feces) [7]. With elevated values ​​of these tests, differential diagnosis of IBD is carried out using the necessary laboratory and instrumental techniques. With normal values ​​of inflammation markers, differential diagnosis of diseases is carried out, one of the manifestations of which was diarrhea (celiac disease, hypolactasia or other types of disaccharidase deficiency, common variable hypogammaglobulinemia, Whipple’s disease, IBS). Patients with celiac disease usually have underweight and anemia. The final diagnosis is established with the help of serological tests – the study of antibodies to tissue transglutaminase and the histological examination of the small (duodenal) intestinal mucosa – TSTK [8]. People with hypolactasia avoid whole milk. To diagnose lactase deficiency, lactase activity in biopsy samples of duodenal mucosa is examined using the Biohit express test, based on the assessment of the color scale of the test system [9]. To diagnose sucrase, maltase, and trehalase deficiency, biochemical methods are used to determine carbohydrases in biopsy specimens of TMS [8].

IBS usually develops in young people, is associated with stress; while the stool is frequent, usually after a meal, scanty and never contains blood. Possible weight loss in these patients is associated with stress.

In NSAID-associated enteropathy, the cause of CD is erosive and ulcerative changes in the gastric and intestinal mucosa, due to suppression of the synthesis of cytoprotectors. For diagnosis, in addition to esophagogastroduodenoscopy, it is necessary to perform deep antegrade and / or retrograde enterography. Sometimes, destructive changes in the mucosa associated with NSAIDs can only be visualized using a video capsule.

Association of diarrhea with systemic diseases is established on the basis of anamnestic information. Diagnostic difficulties arise in those rare cases when diarrhea is the first manifestation of a systemic disease or dominates the clinical picture. In patients with hyperthyroidism, the manifestation of the disease in the form of prolonged diarrhea is also possible, while the symptoms of thyrotoxicosis (permanent sensation of heat, irritability or weight loss, despite a good appetite, etc.) may recede into the background and not attract the attention of the patient himself.

The cause of HD in patients who underwent vagotomy, resection of the stomach or intestines with the formation of a blind loop or short TC is excessive bacterial contamination of T. C. The syndrome of bacterial overgrowth in the TC is also often found in patients with diabetes mellitus, scleroderma due to a violation of the motor function of the TC. Patients with chronic alcoholism and frequent relapses of chronic pancreatitis, as well as after pancreatic resection, develop a deficiency of all pancreatic enzymes and, as a result, diarrhea with steatorrhea. This assumption can be confirmed by the results of a study of feces for the content of elastase. This pancreatic enzyme is not destroyed in the intestine and its concentration below 200 µg/g of feces suggests a pancreatogenic etiology of HD.

Physical examination of patients with CD is important to assess the degree of dehydration, malabsorption, and association with systemic disease. For example, tachycardia may be a manifestation of latent hyperthyroidism, heart murmurs characteristic of pulmonary artery or tricuspid valve stenosis may be a consequence of carcinoid syndrome, and the presence of isolated or peripheral neuropathy may be a manifestation of diabetes mellitus. Scleroderma may be suspected based on facial features and hand skin changes. The presence of food intolerance in patients with CD may be due to disaccharidase deficiency or food allergy. Diagnostic difficulties are resolved by examining the concentration of immunoglobulin E in blood serum and carbohydrases in TC biopsies.

In some patients, excessive flow of bile into the large intestine plays a decisive role in the pathogenesis of HD. The cause is hypokinesia of the gallbladder, cholecystectomy, or malabsorption of bile salts in the ileum in CD. Two mechanisms are involved in the pathogenesis of diarrhea: intestinal hypersecretion and an increase in the rate of transit of intestinal contents caused by bile acids. They stimulate the propulsive function of the intestine and activate the adenylate cyclase-cAMP system, which causes increased secretion of sodium and water into the intestinal lumen. As a result, hologenic diarrhea develops. It is confirmed by an increased content of bile acids in feces [10].

The hallmark of hologenic diarrhea is bright yellow or green stool due to its high content of bile acids.

Diarrhea resistant to treatment can be caused by NET – vipoma, somatostatinoma, gastrinoma, carcinoid, etc. Vipoma produces vasoactive intestinal peptide, which causes hypersecretion of water and electrolytes in the TC, i.e. secretory diarrhea (Werner-Morrison syndrome). NET is usually found in the pancreas, adrenal gland, or intestines. Verification of the diagnosis is helped by a blood test of chromogranin, A, a NET marker. If the level of chromogranin A is >130 ng/ml (the norm is 100 ng/ml), it is necessary to search for it, which is very difficult due to the small size of the tumor and is available only to the most modern methods of radiation and endoscopic diagnostics.

Features of treatment. The treatment of an illness with diarrhea should be determined by its nosological form, however, the type of diarrhea should also be taken into account. In table. 3 shows the features of therapy depending on the pathogenesis (type) of diarrhea.

Table 3. Features of the treatment of intestinal diseases depending on the pathogenesis of diarrhea

Diet. In bowel diseases accompanied by diarrhea, dietary nutrition should help to inhibit peristalsis, reduce the secretion of water and electrolytes into the intestinal lumen. The set of products must correspond in composition and quantity of nutrients to the enzymatic capabilities of the pathologically altered TC. Depending on the severity of the process, the principle of mechanical and chemical sparing is observed. In the acute period of diarrhea, foods that enhance the motor-evacuation and secretory functions of the intestine are excluded from the diet (Table 4).

Table 4. Foods that aggravate diarrhea

In diseases caused by food intolerance, an elimination diet is indicated. Patients with celiac disease must follow a gluten-free diet for life: exclude foods containing rye, wheat and barley from the diet. In case of lactase deficiency, depending on the severity, a hypo- or alactose diet is prescribed. Mushrooms are contraindicated in patients with trehalase deficiency; in case of maltase deficiency, products containing starch are limited.

Rehydration. Rehydration therapy is the mainstay of treatment for acute diarrheal infections [11]. Its tasks are 1) correction of violations of water-electrolyte metabolism and acid-base state; 2) restoration of disturbed hemodynamics and microcirculation; 3) elimination of hypoxia of organs and tissues; 4) elimination or prevention of the development of the syndrome of disseminated intravascular coagulation (DIC) of blood; 5) detoxification in order to remove toxins and decay products of substances from the patient’s body.

Rehydration therapy is carried out in two ways: intravenous and oral. In 85-95% of patients with AEI, treatment can be carried out orally, and only 5-15% of patients require intravenous rehydration. Intravenous, or oral, rehydration therapy is carried out in two stages: 1st stage – rehydration in order to eliminate existing fluid and salt losses; 2nd – rehydration to correct ongoing fluid and salt losses. Isotonic polyionic crystalloid solutions are used, since dehydration in adult patients with AII is always isotonic. These include trisol, quartasol, chlosol, acesol. They are much more effective than normal saline solution, 5% glucose solution and Ringer’s solution. Colloidal solutions (hemodez, rheopolyglucin) are used for detoxification in the absence of dehydration [4, 11].

For oral therapy, solutions of glucosolan, citroglucosalan, rehydron are used, containing, in addition to boiled water, salts of sodium, potassium, bicarbonate (or hydrocitrate) and glucose.

In 2001, UNICEF and WHO showed that solutions containing 75 mEq/L sodium and 75 mmol/L glucose with an osmolarity of 245 mosm/L are particularly effective.

Alvogen ORS effervescent tablets contain glucose in combination with salts. They are used to replenish the sodium and water content in the body during vomiting and diarrhea. Studies show a reduction in the frequency of stools and a reduction in the duration of diarrhea with the use of this drug. Its components are glucose, citric acid, sodium bicarbonate, polyethylene glycol, common salt, potassium chloride, and palatability enhancers. Solutions containing, in addition to salts, amino acids, dipeptides, and maltodextrin are also used. Their efficiency is higher. They are administered at a rate of 1-1.5 l/h in the same amounts as for intravenous rehydration.

The volume of fluid administered orally is determined by the degree of dehydration and the body weight of the patient. The volumetric rate of administration of solutions is 1-1.5 l/h, the volume of liquid in dehydration of I degree is 30-40 ml/kg, II-III degree is 40-70 ml/kg at the 1st stage of treatment. Its duration is usually 1.5-3 hours, the duration of the 2nd stage is 2-3 days, sometimes 5-7 days.

At a low rate and a smaller volume of rehydration therapy, dehydration may increase, hemodynamic insufficiency progresses, pulmonary edema, pneumonia, DIC and anuria develop.

Glucose and other solutions that stimulate sodium absorption in the TC are still not used enough for oral rehydration therapy. In addition, oral rehydration based on glucose-electrolyte solutions does not reduce fluid loss with feces and the duration of diarrhea, and therefore is not always effective [11].

Further development of rehydration therapy is associated with an increase in the absorption function of the colon. It is known that sodium is absorbed in the large intestine against electrochemical gradients and the amount of water absorbed in this part of the intestine can reach 5 l/day. Therefore, the colon can compensate for fluid losses lost in the TC in acute diarrhea, in particular in cholera. This is achieved with the help of short chain fatty acids (SCFA). The latter are formed in the large intestine from poorly absorbed carbohydrates, such as cornstarch, during microbial metabolism. According to research by J. Phillips et al. (1995), 50-70% of it is not digested into TC. In healthy individuals, it enters the large intestine, where it is converted by microbes into SCFA, which are able to stimulate the absorption of water and electrolytes by colonocytes.

Metabolic therapy for metabolic disorders. Reduced serum protein concentration is eliminated by transfusion of mixtures of amino acids, dry plasma. Enteral nutrition (polysorb, nutridrink, nutren, etc.) has a good effect. Disorders of water and electrolyte metabolism are eliminated by intravenous administration of panangin and calcium gluconate, administered in a 5% glucose solution. At the same time, a complex of vitamins of group B, nicotinic acid and vitamins from the fat-soluble group are prescribed: A, D, K and E.

Antibacterial preparations. At O.D. bacterial etiology, antibiotics, antimicrobial agents from the group of quinolones, fluoroquinolones, sulfanilamide preparations, nitrofuran derivatives and antiseptics are used.

Anti-inflammatory drugs. Treatment of B.K. and UC is based on the use of 5-aminosalicylic acid preparations – 5-ASA (sulfasalazine, mesalazine), immunosuppressants (azathioprine, imuran), glucocorticosteroids and anti-TNF antibodies (infliximab, adalimumab and golimumab). The most effective golimumab is a fully human monoclonal antibody with a high affinity for TNF.

The use of MSCs has become a new therapeutic strategy for the treatment of IBD. They have immunomodulatory, anti-inflammatory properties and great regenerative potential, which makes them promising for clinical use [12].

Bacterial preparations. Any type of diarrhea is characterized by disturbances in the intestinal microbial flora. Therefore, one of the new directions in the treatment of diarrheal diseases is the creation of biological preparations capable of restoring the disturbed intestinal microbial flora. These include pharmacologically significant doses of normal representatives of the intestinal flora (probiotics), products that promote their reproduction in the intestine, or metabolic products of normal flora that provide morphokinetic function and colonization resistance (prebiotics). Prebiotics can be delivered to the body as synbiotics, which include live probiotic bacteria and complex supplements used by the microbiota as a source of energy and growth. Finally, it is possible to use probiotics – derivatives (postbiotics) – selective components of bacterial metabolism – butyrate and other SCFAs, as well as non-viable bacterial cells, components of their cell walls and DNA [13].

Symptomatic agents. This group includes adsorbents, binders and coating preparations. These include white clay, polyphepan, filtrum, smecta, subsalicylate and bismuth subnitrate.

Adsorbents are especially indicated for patients with hologenic diarrhea. Polyphepan, Filtrum or Smecta is prescribed in the interdigestive period, 3-4 times a day. In addition, patients should be prescribed choleretic agents in order to prevent asynchronous intake of bile TC with food.

Motility regulators. Imodium is often used to treat diarrhea. It reduces intestinal tone and motility due to binding to its opioid receptors. The antidiarrheal effect of the drug is directed to the µ-opioid receptors of the enteric system. With O.D. the initial dose of the lingual form of imodium is 2 tablets, then 1 tablet is prescribed after each act of defecation in case of loose stools until the number of defecation acts is reduced to 1-2 per day. Imodium is contraindicated in patients with bloody diarrhea, since in inflammatory diseases of any etiology there is a danger of toxic dilatation of the intestine.

In case of hyperkinetic diarrhea, myotropic antispasmodics mebeverine (duspatalin), pinaverium bromide (dicetel) and dopamine receptor antagonists (metoclopramide) are indicated.

Absorption stimulants. SCFA and somatostatin have a stimulating effect on intestinal absorption.

SCFAs stimulate the proliferation and differentiation of intestinal mucosal cells and are the main source of energy that ensures the active absorption of sodium and water ions by epithelial cells. The source of SCFA is dietary fiber – food components that are not digested by the digestive enzymes of the body, but are processed by the intestinal microflora (cellulose, pectins, inulin, corn starch, etc.). Of these, in the large intestine, in the process of fermentation by anaerobic microbial flora, SCFAs are formed – propionic (propionate), acetic (acetate) and butyric (butyrate) acids.

Based on SCFA, an INN preparation was created: calcium butyrate + inulin (Zakofalk NMX). It contains calcium butyrate (307 mg), inulin (250 mg), corn starch, maltodextrin, cellulose. The technology of this dietary supplement uses a molecularly targeted method for delivering butyric acid (SCFA) and inulin (prebiotic) using a polymer multimatrix system (NMX). It allows to achieve a high concentration of active therapeutic components of the drug in all parts of the colon. Assign 3-4 tablets per day after meals for 4 weeks or longer.

Somatostatin increases the rate of absorption of water and electrolytes, reduces the concentration of vasoactive intestinal peptides in the blood. It is an inhibitor of the synthesis of active secretory agents, including peptides and serotonin, helps to reduce secretion, motor activity and, consequently, reduces the frequency of bowel movements and fecal mass.

Octreotide, a synthetic analogue of somatostatin, is used subcutaneously at 100 mcg 3 times a day for severe secretory and osmotic diarrhea of ​​various origins.

In conclusion, it should be reiterated that in each specific case, the doctor must find out whether the diarrhea is acute or chronic, establish the etiology and pathogenesis of diarrhea (infection, malabsorption, dysmotility, etc.), establish the diagnosis of the disease, the symptom of which is diarrhea , and prescribe the optimal therapy, taking into account the pathogenesis of diarrhea.

Diarrhea – health articles

Diarrhea (diarrhea) – rapid, repeated loose stools. Diarrhea is usually accompanied by pain, rumbling in the abdomen, flatulence. Diarrhea is a symptom of many infectious diseases and inflammatory processes of the intestine, dysbacteriosis, and neurogenic disorders. Therefore, the diagnosis and treatment of the underlying disease plays an important role in the prevention of complications. The loss of large amounts of fluid during sudden diarrhea leads to a violation of the water-salt balance and can cause heart and kidney failure.

Causes and symptoms of the disease

There are acute and chronic forms of diarrhea. Acute diarrhea is associated with intestinal infection and has a viral, bacterial and parasitic nature, lasting up to 4 weeks. Chronic diarrhea is associated with diseases of the digestive system and lasts more than 4 weeks.

Acute diarrhea is transmitted by the fecal-oral route by ingestion of food and water contaminated with microorganisms. The causative agents of diarrhea are: bacteria (E. coli, salmonella, dysentery bacteria, cholera vibrio), viruses (rotaviruses, adenoviruses, enteroviruses) and protozoa (Giardia, dysenteric amoeba).

Acute intestinal infection caused by Escherichia coli occurs with moderate symptoms of general intoxication: chills, weakness, loss of appetite, fever up to 38 C, paroxysmal pain in the lower abdomen, false urge to defecate, loose stools up to 10 times a day. Symptoms last no more than a week.

Diarrhea caused by salmonella, dysentery bacteria is severe. Frequent watery stools up to 10-30 times a day, mixed with blood and pus. Abdominal pain, false urge to defecate. During and after defecation, tenesmus occurs – a pulling nature of pain in the rectal area, the temperature rises to 40 C. Due to dehydration of the body, tachycardia occurs, a decrease in blood pressure, dry skin, and weakness.

Diarrhea caused by parasitic pathogens (ameba, giardia) develops gradually and is manifested by bloody diarrhea, constant pain in the abdomen.

Diagnosis

To make a diagnosis, bacteriological examination of feces, analysis of feces for eggs of worms, analysis of feces for occult blood, examination of feces for dysbacteriosis is necessary.

Coprocytogram – will help to identify the inflammatory process in the intestines, and the degree of digestion of food. A complete blood count is necessary to determine signs of acute or chronic inflammation, the presence of anemia. In chronic diarrhea, a colonoscopy is performed, sigmoidoscopy is performed to exclude the pathology of the colon.

To assess the motor function of the intestine, to identify organic changes in the intestine, an X-ray examination is performed, and the doctor may also prescribe an ultrasound scan of the abdominal cavity and small pelvis.