Management of Chronic Diarrhea
One fourth to half of all referrals to gastroenterologists is for irritable bowel syndrome due to its chronic abdominal pain and altered bowel habits. Treatment includes alteration of the diet to avoid gassy foods and fermentables, and possibly lactose and gluten when there is malabsorption. Fiber can be added.
Management of chronic diarrhea, first and regardless of the cause, must treat dehydration and electrolyte disturbances if present. This is done either via increased intake (oral and parenteral) or decreased output, via reducing intestinal motility.
- Oral fluids
- Intravenous fluids with electrolyte supplementation if needed
- Anti-diarrheal agents via inhibition of of motility and peristalsis, such as loperamide and eluxadoline (opioid agonist/antagonist); bile acid sequestrants, such as cholestyramine, colestipol, and colesevelam; or serotonin antagonists such as alosetron
- Anti-spasmodics such as dicyclomine and hyoscyamine
- Antidepressants for their anticholinergic properties which slow intestinal transit time
Other remedies include probiotics and fecal transplantation.
For the other causes of chronic diarrhea, treatment beyond what is cited above is individualized to the patient and the etiology:
Those with inflammatory conditions may be treated with a combined approach of immunosuppression via glucocorticoid steroids and anti-biological therapy.
Those with drug-related diarrhea are given a trial-and-error approach of substituting equally effective medications.
Those with microbial infections should be treated with antibiotics or anti-parasitic medications.