Question

Management of Chronic Diarrhoea.

Hint:

The management of chronic diarrhoea is multifaceted and depends on addressing the underlying cause, rehydration, and symptom control.

Answer 1

The management of chronic diarrhoea depends on the underlying cause and aims to control symptoms, address the root cause, and improve the patient’s quality of life.
1. General Measures:
- Dietary Modifications: A low-fat, easily digestible diet may be recommended for patients with malabsorption or inflammatory conditions. For lactose intolerance, a lactose-free diet should be initiated.
- Rehydration: Oral rehydration solutions (ORS) or intravenous fluids are essential to prevent dehydration, particularly in children and the elderly.
2. Pharmacological Treatment:
- Antidiarrhoeal Medications:
- Loperamide: Reduces motility in cases of functional diarrhoea like IBS.
- Bismuth subsalicylate: Can be used for symptomatic relief in cases of infection or irritation.
- Octreotide: In cases of diarrhoea due to neuroendocrine tumors or short bowel syndrome, octreotide can reduce secretory diarrhoea.
3. Specific Treatment Based on Etiology:
- Infectious Causes:
- Antibiotics: If a bacterial infection like Salmonella or Shigella is identified, appropriate antibiotics (e.g., ciprofloxacin or azithromycin) should be prescribed.
- Antiparasitic Treatment: If parasitic infections such as Giardia are diagnosed, drugs like metronidazole or tinidazole are used.
- Antivirals: In viral cases like rotavirus or norovirus, supportive care and hydration are typically the mainstay of treatment.
- Inflammatory Causes:
- Corticosteroids: For Crohn’s disease or ulcerative colitis, corticosteroids like prednisolone can reduce inflammation and control diarrhoea.
- Immunosuppressive Agents: Drugs like azathioprine, methotrexate, and biologics (e.g., TNF inhibitors) may be used for refractory inflammatory bowel disease.
- Pancreatic Insufficiency:
- Pancreatic Enzyme Replacement Therapy (PERT): For patients with chronic pancreatitis, enzyme supplements (e.g., Creon) are necessary to aid digestion and reduce diarrhoea.
4. Management of Complications:
- Electrolyte Imbalance: Monitoring and correcting electrolyte imbalances like hypokalemia or hyponatremia is important in chronic diarrhoea.
- Anemia: Iron supplementation may be necessary if chronic diarrhoea leads to malabsorption of nutrients.
5. Surgical Treatment:
- In severe cases where conservative management fails, especially in conditions like short bowel syndrome or Crohn’s disease, surgical interventions like bowel resection or ileostomy may be required.
6. Psychosocial Support:
- Cognitive-behavioral therapy (CBT): For functional disorders like IBS, psychological support can help manage the stress and anxiety that contribute to diarrhoea symptoms.