15 Common Causes and How To Treat It

Written by WebMD Editorial Contributors

• What Is Diarrhea?
• Diarrhea Causes
• Diarrhea Symptoms
• Serious Symptoms of Diarrhea
• When to See a Doctor for Diarrhea
• Diarrhea Diagnosis
• Treatment for Diarrhea
• Relief From Diarrhea Symptoms
• When Diarrhea Won’t Go Away
• More

When you have diarrhea, your bowel movements (or stools) are loose and watery. It’s common and usually not serious.

Many people get diarrhea a few times a year. It normally lasts 2 to 3 days. Some people get it more often. That could be because they have irritable bowel syndrome (IBS) or other conditions.

Usually, diarrhea happens because of a virus that gets into your gut. Some people call it “intestinal flu” or “stomach flu.”

Other causes include:

• Allergies to certain foods
• Diseases of the intestines (such as Crohn’s disease or ulcerative colitis)
• Eating foods that upset the digestive system
• Infection by bacteria (the cause of most types of food poisoning) or other organisms
• Laxative abuse
• Running (Some people get “runner’s diarrhea” for reasons that aren’t clear. )
• Some cancers
• Surgery on your digestive system
• Trouble absorbing certain nutrients, also called “malabsorption”

Diarrhea may also follow constipation, especially for people who have irritable bowel syndrome (IBS).

You may have:

• Bloating in your belly
• Thin or loose stools
• Watery stools
• An urgent feeling that you need to have a bowel movement
• Nausea and throwing up

Most cases of diarrhea are nothing more than a brief inconvenience. But sometimes, they warn of a serious condition. Talk with your doctor if your child has diarrhea for more than 24 hours. If you have it for more than 3 days, make an appointment.

Also, be sure to let your doctor know about your diarrhea if you have cancer, or have had recent treatment for it.

More serious symptoms of diarrhea include:

• Blood or mucus in your stool
• Weight loss

If you have watery stools more than three times a day and you’re not drinking enough fluids, you could become dehydrated. That can be a serious problem if it’s not treated.

Call your doctor right away if you have:

• Blood in your diarrhea or black, tarry stools
• A fever that is high (above 101 F) or that lasts more than 24 hours
• Diarrhea lasting longer than 2 days
• Nausea or throwing up that prevents you from drinking liquids to replace lost fluids
• Severe pain in your belly (especially the right lower quadrant) or rear end
• Diarrhea after coming back from a foreign country

These can be warning signs of things like:

• Infection
• Inflammatory bowel disease
• Pancreatitis
• Colon cancer

Also, call your doctor right away if you have diarrhea and any of these signs of dehydration:

• Dark urine
• Smaller than usual amounts of urine or, in a child, fewer wet diapers than usual
• Rapid heart rate
• Headaches
• Dry skin
• Crankiness
• Confusion

Your doctor will ask about your medical history and what medications you take, as well as what you’ve eaten or had to drink recently. They will give you a physical exam to look for signs of dehydration or belly pain.

Certain tests can help pinpoint the cause of your diarrhea, including:

• Blood tests to look for certain diseases or disorders
• Colonoscopy, in rare cases, in which your doctor looks inside your colon with a thin, flexible tube that holds a tiny camera and light. They can also use this device to take a small sample of tissue. Or your doctor might need to do only a sigmoidoscopy, which looks at just the lower colon.
• Stool tests to look for bacteria or parasites

If your case is mild, you may not need to take anything. Adults can take an over-the-counter medicine such as bismuth subsalicylate or loperamide, which you can get as liquids or tablets.

You also need to stay hydrated. You should drink at least six 8-ounce glasses of fluids each day. Choose electrolyte replacement drinks or soda without caffeine. Chicken broth (without the fat), tea with honey, and sports drinks are also good choices. Instead of drinking liquids with your meals, drink liquids between meals. Sip small amounts of fluids often. Liquid probiotics may also help.

Your rectal area may become sore because of all the bowel movements that diarrhea brings. You may have itching, burning, or pain when you go to the bathroom.

For relief, take a warm bath or sitz bath. Afterward, pat the area dry (don’t rub) with a clean, soft towel. You may also try using a hemorrhoid cream or petroleum jelly on the affected area. If this continues for several days, you should contact your doctor.

If you still have diarrhea after 4 weeks, then you have chronic diarrhea.

To figure out the cause, your doctor will want to know your symptoms and medical history. You’ll get the most out of your appointment if you can tell them:

• How long you’ve had diarrhea
• Whether your diarrhea comes and goes, or is continuous
• If you think certain foods and situations make things better or worse
• If your stool looks bloody, oily, fatty, or watery
• Other symptoms you have and how long you’ve had them
• If you have a family history of chronic diarrhea
• Places you’ve traveled to recently
• Unusual foods you’ve tried in the last little while
• Any medication or supplements you’re taking
• If you’ve lost a lot of weight

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15 Common Causes and How To Treat It

Written by WebMD Editorial Contributors

• What Is Diarrhea?
• Diarrhea Causes
• Diarrhea Symptoms
• Serious Symptoms of Diarrhea
• When to See a Doctor for Diarrhea
• Diarrhea Diagnosis
• Treatment for Diarrhea
• Relief From Diarrhea Symptoms
• When Diarrhea Won’t Go Away
• More

When you have diarrhea, your bowel movements (or stools) are loose and watery. It’s common and usually not serious.

Many people get diarrhea a few times a year. It normally lasts 2 to 3 days. Some people get it more often. That could be because they have irritable bowel syndrome (IBS) or other conditions.

Usually, diarrhea happens because of a virus that gets into your gut. Some people call it “intestinal flu” or “stomach flu.”

Other causes include:

• Allergies to certain foods
• Diseases of the intestines (such as Crohn’s disease or ulcerative colitis)
• Eating foods that upset the digestive system
• Infection by bacteria (the cause of most types of food poisoning) or other organisms
• Laxative abuse
• Running (Some people get “runner’s diarrhea” for reasons that aren’t clear.)
• Some cancers
• Surgery on your digestive system
• Trouble absorbing certain nutrients, also called “malabsorption”

Diarrhea may also follow constipation, especially for people who have irritable bowel syndrome (IBS).

You may have:

• Bloating in your belly
• Thin or loose stools
• Watery stools
• An urgent feeling that you need to have a bowel movement
• Nausea and throwing up

Most cases of diarrhea are nothing more than a brief inconvenience. But sometimes, they warn of a serious condition. Talk with your doctor if your child has diarrhea for more than 24 hours. If you have it for more than 3 days, make an appointment.

Also, be sure to let your doctor know about your diarrhea if you have cancer, or have had recent treatment for it.

More serious symptoms of diarrhea include:

• Blood or mucus in your stool
• Weight loss

If you have watery stools more than three times a day and you’re not drinking enough fluids, you could become dehydrated. That can be a serious problem if it’s not treated.

Call your doctor right away if you have:

• Blood in your diarrhea or black, tarry stools
• A fever that is high (above 101 F) or that lasts more than 24 hours
• Diarrhea lasting longer than 2 days
• Nausea or throwing up that prevents you from drinking liquids to replace lost fluids
• Severe pain in your belly (especially the right lower quadrant) or rear end
• Diarrhea after coming back from a foreign country

These can be warning signs of things like:

• Infection
• Inflammatory bowel disease
• Pancreatitis
• Colon cancer

Also, call your doctor right away if you have diarrhea and any of these signs of dehydration:

• Dark urine
• Smaller than usual amounts of urine or, in a child, fewer wet diapers than usual
• Rapid heart rate
• Headaches
• Dry skin
• Crankiness
• Confusion

Your doctor will ask about your medical history and what medications you take, as well as what you’ve eaten or had to drink recently. They will give you a physical exam to look for signs of dehydration or belly pain.

Certain tests can help pinpoint the cause of your diarrhea, including:

• Blood tests to look for certain diseases or disorders
• Colonoscopy, in rare cases, in which your doctor looks inside your colon with a thin, flexible tube that holds a tiny camera and light. They can also use this device to take a small sample of tissue. Or your doctor might need to do only a sigmoidoscopy, which looks at just the lower colon.
• Stool tests to look for bacteria or parasites

If your case is mild, you may not need to take anything. Adults can take an over-the-counter medicine such as bismuth subsalicylate or loperamide, which you can get as liquids or tablets.

You also need to stay hydrated. You should drink at least six 8-ounce glasses of fluids each day. Choose electrolyte replacement drinks or soda without caffeine. Chicken broth (without the fat), tea with honey, and sports drinks are also good choices. Instead of drinking liquids with your meals, drink liquids between meals. Sip small amounts of fluids often. Liquid probiotics may also help.

Your rectal area may become sore because of all the bowel movements that diarrhea brings. You may have itching, burning, or pain when you go to the bathroom.

For relief, take a warm bath or sitz bath. Afterward, pat the area dry (don’t rub) with a clean, soft towel. You may also try using a hemorrhoid cream or petroleum jelly on the affected area. If this continues for several days, you should contact your doctor.

If you still have diarrhea after 4 weeks, then you have chronic diarrhea.

To figure out the cause, your doctor will want to know your symptoms and medical history. You’ll get the most out of your appointment if you can tell them:

• How long you’ve had diarrhea
• Whether your diarrhea comes and goes, or is continuous
• If you think certain foods and situations make things better or worse
• If your stool looks bloody, oily, fatty, or watery
• Other symptoms you have and how long you’ve had them
• If you have a family history of chronic diarrhea
• Places you’ve traveled to recently
• Unusual foods you’ve tried in the last little while
• Any medication or supplements you’re taking
• If you’ve lost a lot of weight

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Causes and treatment of diarrhea in adults

Translated from the Greek “diarrheo” means “I expire”. Anyone who has ever encountered this unpleasant problem should not explain the meaning of the word “diarrhea”. This syndrome causes a lot of inconvenience and unpleasant minutes and can be a symptom of serious diseases.

What is diarrhea?

Diarrhea – frequent loose stools (more than 3 times a day). A distinctive feature is watery stools, which are more than 90% liquid.

Diarrhea is a syndrome, not a disease. It indicates that the body has experienced a malfunction in the gastrointestinal tract. With various diseases, diarrheal syndrome has its own distinctive features.

Causes of diarrhea

Diarrhea is a symptom of many diseases and pathological conditions of the gastrointestinal tract (GIT).

The most common causes of diarrhea are viral infections (rotaviruses, noroviruses, adenoviruses and others) or bacterial infections such as dysentery, salmonellosis and others.

But diarrhea can also develop under the influence of drugs, such as antibiotics, antiarrhythmic drugs. May be the result of an individual intolerance to a particular food product, the so-called food allergy. Diarrhea can be provoked by errors in the diet or the abuse of fatty, heavy foods. It accompanies a number of chronic diseases of the gastrointestinal tract (gastritis, pancreatitis, ulcers) or is a manifestation of irritable bowel syndrome.

But it is important to know that if we are talking about adults, then they most often have diarrhea as a result of poisoning with spoiled or low-quality products, the so-called food poisoning. Usually, food poisoning has a vivid clinical picture: in addition to frequent loose stools, vomiting, weakness, and fever with high body temperature are observed. Develops rapidly, lasts from 1 to 3 days.

Often diarrhea in adults occurs during travel, especially if it is a trip to exotic countries. There is even a special term – traveler’s diarrhea, it affects up to 30% of all tourists visiting exotic countries. Intestinal upset in this case is associated with changing climatic conditions, adaptation to new water, food, spices, stress due to the flight, or lower hygiene standards in a number of countries.

Why is diarrhea dangerous for adults?

Acute diarrhea in adults is dangerous because it can become chronic. In this case, loose stools haunt a person every day for a month or more. This significantly affects the general well-being of a person, his performance, immunity and, of course, the quality of life. In this case, it is necessary to consult a doctor and undergo a comprehensive examination and treatment. Find out the cause of diarrhea and eliminate it!

Diarrhea is also dangerous due to the development of such complications as:
– Dehydration.
– Cardiac arrhythmias, convulsions, muscle pain.
– Cachexia – a state of extreme exhaustion of the body.

Help with diarrhea in adults

It is better to start treating diarrhea as soon as you understand that loose stools are not an isolated case. Depending on the causes of diarrhea, the doctor will prescribe a complex treatment, but here are the general rules that should be followed by all patients with diarrhea.

1. Start antidiarrheal drugs

Treatment should begin with drugs that have antidiarrheal activity, that is, they are ways to stop diarrhea. There are a huge number of antidiarrheals, but your choice should be on the one that is not only effective, but also safe. It is to such means that Adiarin belongs. This product is based on a fundamentally new active ingredient – tannat gelatin, which not only acts quickly and stops diarrhea, but also protects the intestines from the aggressive effects of the factors that provoked it (viruses, toxins, bacteria). It creates a special protective bio-barrier on the damaged mucous membrane of the small intestine, which stops inflammation, restores the integrity of the intestinal epithelium and normalizes its physiological functions, preventing the development of dehydration. In this case, the drug works only in the intestines and has no effect on the body as a whole.
After the condition improves and the frequency of liquid stools is reduced, it is the turn of enzyme preparations and probiotics. They help to restore the microflora and restore the ability of the stomach and intestines to function normally.

2. Drink more fluids

Diarrhea causes the body to lose a lot of water and electrolytes. You can make up for the lack of fluid with an enhanced water regime, but special rehydration solutions cope best with dehydration, because they contain the necessary salts and trace elements.

3. Keep a sparing diet

All “irritants” must be excluded from the diet: spicy, salty, sour, coarse fiber. Also limit everything that stimulates the production of bile (tomatoes, carrots, fatty, juices). Remove foods that cause gas formation: cabbage, milk, apples.

By following these guidelines, a typical episode of diarrhea will be over in a few days. But if diarrhea lasts longer than 5-7 days and you do not feel better, you should immediately consult a doctor.

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 AII, 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 less 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.C. 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. Disturbances in the intestinal microbial flora are characteristic of any type of diarrhea. 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, astringents and coating preparations. These include white clay, polyphepan, filtrum, smectite, subsalicylate and bismuth subnitrate.

Adsorbents are especially indicated for patients with hologenic diarrhea. Polyphepan, Filtrum or Smecta are 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.