Diarrhea Health Article

Diagnosis

Most cases of acute diarrhea never need diagnosis or treatment, as many are mild and produce few problems. But patients with fever over 102°F (38.9°C), signs of dehydration, bloody bowel movements, severe abdominal pain, known immune disease, or recent use of antibiotics need prompt medical evaluation.

When diagnostic studies are needed, the most useful are stool culture and examination for parasites; however these are often negative and a cause cannot be found in a large number of patients. The earlier cultures are performed, the greater the chance of obtaining a positive result. Stool samples of patients who had used antibiotics in the preceding two months need to be examined for the toxins that cause antibiotic-associated colitis. Tests are also available to check stool samples for microscopic amounts of blood and for cells that indicate severe inflammation of the colon. Examination with an endoscope is sometimes helpful in determining severity and extent of inflammation. Tests to check changes in blood chemistry (potassium, magnesium, etc.) and a complete blood count (CBC) may be performed.

Chronic diarrhea is quite different, and most patients with this condition will receive some degree of testing. Many exams are the same as for an acute episode, as some infections and parasites cause both types of diarrhea. A careful history to evaluate medication use, dietary changes, family history of illnesses, and other symptoms is necessary. Key points in determining the seriousness of symptoms are weight loss of over 10 lb (4.5 kg), blood in the stool, and nocturnal diarrhea (symptoms that awaken the patient from sleep). A combination of stool, blood, and urine tests may be needed in the evaluation of chronic diarrhea; in addition a number of endoscopic and x-ray studies are frequently required.

Diet

Treatment is ideally directed toward correcting the cause; however, the first aim is to prevent or treat dehydration and nutritional deficiencies. When possible, food intake should be continued even in patients with acute diarrhea. A physician should be consulted as to what type and how much food is permitted. Low-fat diets or more easily digestible fat is useful in some patients. The BRAT diet, which limits food intake to bananas, rice, applesauce, and toast, can help to resolve diarrhea. These foods provide soluble and insoluble fiber without irritation. If the toast is slightly burnt, the charcoal can help sequester toxins and pull them from the body.

The patient should drink plenty of fluids, however, in severe cases hospitalization to provide intravenous fluids may be necessary. A physician should be notified if the patient is dehydrated, and if oral replacement is suggested then commercial (Pedialyte and others) or homemade preparations can be used. The World Health Organization (WHO) has provided this easy recipe for home preparation, which can be taken in frequent small sips:

• table salt: 3/4 teaspoon
• baking powder: 1 teaspoon
• orange juice: 1 cup
• water: 1 quart or liter

Supplements

Nutrient replacement also plays a role in preventing and treating diarrhea. Zinc especially appears to have an effect on the immune system, and deficiency of this mineral can lead to chronic diarrhea. Also, zinc replacement improves growth in young patients.

Dietary supplements that are generally beneficial in the treatment of digestive disorders include:

• vitamin C: 50-500 mg daily
• vitamin B₆: 50-150 mg daily
• magnesium aspartate: 400 mg daily
• vitamin E: 400 IU daily
• glutamine: 3,000 mg daily
• garlic, deodorized: 2,000 mg daily
• deghycirrhizinated licorice: chew as needed

Probiotics

Probiotics refers to treatment with beneficial microbes either by ingestion or through a suppository. Studies and the clinical use of probiotics have shown their utility in the resolution of diarrhea, especially antibiotic-associated diarrhea. Beneficial microbes include the bacteria Lacto-bacillus acidophilus and L. bifidus and the yeast Saccharomyces boulardii. To treat diarrhea, the patient can eat one cup of yogurt (containing active Lactobacillus acidophilus cultures) daily. Alternatively, one or two acidophilus capsules may be taken at each meal or at bedtime.

Acupuncture

Shallow acupuncture, when the needles are inserted superficially and rapidly removed, was more therapeutic than drugs in children with acute or chronic diarrhea. In another study, acupuncture eliminated symptoms and normalized stools in children with chronic diarrhea who had not responded to conventional or Chinese medicines.

Herbals and Chinese medicines

Herbal remedies for diarrhea include meadowsweet, goldenseal, and chamomile taken as an infusion throughout the day.

Chinese patent medicines used for treating diarrhea include:

• Xiang Sha Liu Jun Wan (Six-Gentlemen Pill with Aucklandia and Amomum)
• Fu Zi Li Zhong Wan (Prepared Aconite Pill to Regulate the Middle)
• Si Shen Wan (Four-Miracle Pill)
• Wu Mei Wan (Mume Pill)
• Jian Pi Wan (Strengthen the Spleen Pill)
• Shen Ling Bai Zhu Wan (Ginseng, Poria, and Atractylodes Macrocephala Pill)