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    Home > Active Ingredient News > Digestive System Information > How to choose medicine for adult chronic diarrhea?

    How to choose medicine for adult chronic diarrhea?

    • Last Update: 2021-05-21
    • Source: Internet
    • Author: User
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    It is only for medical professionals to read for reference.
    Etiological treatment + antidiarrheal + probiotics + fluid supplement support treatment.

    Around us, some friends have chronic diarrhea due to inflammatory bowel disease, chronic pancreatitis, and irritable bowel syndrome.

    Chronic diarrhea is a common symptom of the digestive system and a common reason for outpatient visits in gastroenterology clinics.

    Diarrhea means that the frequency of bowel movements is significantly higher than usual (>3 times/day), the feces are thin, the water content is increased (>85%), and it may be accompanied by mucus, pus or undigested food.

    Chronic diarrhea is defined as recurrent diarrhea with a course of> 4 weeks or an intermittent period of 2 to 4 weeks.

    Chronic diarrhea affects the patient's physical strength, mental state, nutrient absorption, and daily work, greatly reduces the patient's quality of life, and causes a greater social burden.

    So, how to treat chronic diarrhea in adults? Drug treatment of chronic diarrhea in adults includes etiological treatment, antidiarrheal treatment, probiotics, and fluid support treatment.

    1.
    Drug treatment method ▌ Etiology treatment Choose different treatment methods according to the cause of the disease.

    Inflammatory bowel disease: Inflammatory bowel disease includes ulcerative colitis and Crohn's disease.

    Therapeutic application of local and systemic anti-inflammatory drugs such as mesalazine, corticosteroids, immunomodulators (azathioprine, 6-mercaptopurine, methotrexate), biological agents, etc.

    Infectious diarrhea: antimicrobial therapy, the treatment of lactose malabsorption after infection.

    For example, antibacterial drugs can be used for chronic bacillary dysentery, and for the treatment of intestinal opportunistic infections such as Clostridium difficile.

    Celiac disease: gluten-free diet (avoid barley, wheat, rye, etc.
    as raw materials); vitamin and mineral substitution; assessment of bone mineral density.

    Lactose intolerance: Avoid foods containing lactose (such as dairy products, ice cream) and use lactase supplements.

    Pancreatic insufficiency: modified fat diet, supplemented pancreatic enzymes and suppressed gastric acid.

    ▌ Antidiarrheal treatment Antidiarrheal drug treatment is only symptomatic treatment and should not be used for a long time.

    Pay attention to the effect of antidiarrheal drugs on other combined medications.

    Opioid and its derivative preparations: such as loperamide hydrochloride, diphenoxylate, compound camphor tincture, etc.

    Loperamide can delay intestinal transit by acting on intestinal smooth muscle opioid receptors, thereby significantly reducing the frequency of bowel movements and increasing stool hardness in patients with irritable bowel syndrome.
    It is recommended for patients with post-meal diarrhea and/or bowel incontinence.
    Long-term application reports.

    Montmorillonite powder: It has a layered structure and non-uniform charge distribution.

    It fixes and inhibits the viruses, bacteria and the toxins they produce in the digestive tract; it covers the mucosa of the digestive tract; and combines with glycoproteins in the digestive tract mucosa to repair and improve the mucosal barrier in terms of quality and quantity.
    The defensive function of the attack factor can reduce the excessive sensitivity of the colon and restore the absorption and secretion function of the epithelial tissue of the gastrointestinal tract.

    The double eight-sided montmorillonite is not absorbed by the gastrointestinal tract and does not enter the blood circulation.
    Together with the fixed attack factors, it is excreted from the body along with the peristalsis of the digestive tract itself.

    It is currently a widely used antidiarrheal medicine.

    Adsorbents: For example, medicinal carbon can absorb water, gas, pathogenic microorganisms and poisons in the intestinal tract through the adsorption of drugs on the surface, preventing them from being absorbed by the intestinal mucosa or damaging the intestinal mucosa to play an antidiarrheal effect.

    Astringents: such as tannins, which form a protective layer by coagulating proteins to protect the intestinal tract from harmful factors and reduce secretion.

    ▌ Patients with probiotics chronic diarrhea are often accompanied by intestinal microecological imbalance.
    Probiotics preparations are beneficial to reconstruct the intestinal microecological balance, restore the protective effect of the intestinal natural barrier, and improve the symptoms of diarrhea.

    After entering the intestinal tract, probiotics can competitively inhibit pathogenic bacteria and reduce the colonization of harmful bacteria in the intestinal tract.

    The probiotics in probiotic preparations are living microorganisms, and their effectiveness depends on the strain, dosage and viability of the microorganisms contained in the preparation.

    Chronic diarrhea is prone to abuse of antibiotics due to its long course, which affects the intestinal flora of patients.

    Antibiotic-related diarrhea is a common complication of antibiotic use.

    Probiotics mainly include Lactobacillus and Bifidobacterium, which can play a role in preventing antibiotic-related diarrhea.

    Meta analysis shows that Saccharomyces boulardii can effectively reduce the risk of antibiotic-related diarrhea in children and adults.

    ▌ Rehydration support treatment Due to long-term fluid loss, patients with chronic diarrhea are often accompanied by water and electrolyte disorders, especially hypokalemia.

    Oral liquid rehydration is recommended for mild to moderate patients; for severe and frequent vomiting or unable to eat, or for patients with significant weight loss or exhaustion, intravenous rehydration is recommended; for severely malnourished patients, they should be given nutritional support in time.

    Glutamine is a non-essential amino acid that protects and repairs the intestinal mucosal barrier.
    Glutamine can stimulate the growth of gastrointestinal mucosa, promote the synthesis and secretion of secretory immunoglobulin A, and improve cellular immunity and intestinal barrier.

    Patients with chronic chronic diarrhea causing malnutrition should pay attention to timely supplementation of glutamine when supplementing amino acids.

    2.
    Classical prescription analysis ■ Prescription 1 mesalazine enteric-coated tablets 1g orally 3 times a day of clostridium butyricum viable capsules 1260mg orally twice a day Indications: patients with ulcerative colitis.

    Drug analysis: Mesalazine inhibits the release of prostaglandins and leukotrienes, inhibits inflammatory cells and their secretion of inflammatory factors, and inhibits the inflammatory activity of ulcerative colitis, thereby reducing intestinal mucosal damage.

    Live Clostridium butyricum can regulate the immune function of the intestinal tract, and it can also release the short-chain fatty acid-butyric acid in the intestines, which plays a role by improving the barrier function of the intestinal tract.

    Mesalazine combined with probiotics has a synergistic effect in the treatment of ulcerative colitis, which can significantly improve the therapeutic effect.

    ■ Prescription 2 levofloxacin tablets 500mg once a day orally once a day Indications: patients with chronic bacillary dysentery.

    Medication analysis: Levofloxacin is a quinolone drug, a kind of ofloxacin levorotatory, its antibacterial activity is increased to about 2 times of ofloxacin, after medication, it has a good inhibitory effect on bacterial DNA gyrase activity and prevents bacterial DNA replication.
    In addition, levofloxacin has a broad antibacterial spectrum and has good antibacterial effects against Shigella and other Enterobacteriaceae bacteria.
    After one week of medication, the clinical cure rate reaches more than 95%.

    It is effective in treating chronic bacillary dysentery.

    ■ Prescription 3 Pancreatic Enzyme Enteric-coated Capsules 0.
    3g 3 times a day Oral Indications: Patients with pancreatic exocrine insufficiency and steatorrhea.

    Medication analysis: Chronic pancreatitis is a chronic inflammatory disease of the pancreas, which is a progressive and irreversible destruction of pancreatic tissue, which in turn leads to pancreatic exocrine insufficiency.

    Pancreatin plays a key role in the digestion of macromolecular nutrients.
    When the amount of pancreatin secreted to the duodenum after a meal is insufficient to maintain the normal digestion process, pancreatic exocrine insufficiency occurs.

    85% of patients with chronic pancreatitis will develop exocrine pancreatic insufficiency in 5-10 years.

    Pancreatic enzyme enteric-coated capsules contain amylase, lipase, protease and other digestive enzymes, especially the content of lipase, up to 10,000 units, which can promote the digestion and absorption of fat and effectively reduce the accumulation of undigested food in the intestine.
    Reduce intestinal flora products (especially gas), and then have a significant improvement effect on the defecation and exhaust of pancreatic exocrine insufficiency, and can alleviate steatorrhea caused by pancreatic exocrine insufficiency to varying degrees.

    Pancreatin enteric-coated capsules should be swallowed whole with water when eating, do not crush or chew.

    If it is difficult to swallow the whole capsule (such as children or the elderly), you can carefully open the capsule, mix the pancreatin microparticles with the liquid (if juice) and drink the same, but the mixture should be taken immediately and cannot be stored.

    ■ Prescription 4 Montmorillonite powder 3g orally 3 times a day, 420 mg of bifidobacterium triple viable capsules orally twice a day Indications: Patients with diarrhea-type irritable bowel syndrome.

    Drug analysis: Montmorillonite powder is a highly effective gastrointestinal mucosal protective drug.
    After oral administration, the drug can evenly cover the entire intestinal cavity, adsorb a variety of pathogens, and fix it on the surface of the intestinal cavity, and then excrete it with intestinal peristalsis. At the same time, the mucosal barrier of the digestive tract enhances its defense against viruses, bacteria and other attack factors.

    The Bifidobacterium triple viable capsule is a compound preparation composed of Bifidobacterium, Enterococcus faecalis and Lactobacillus acidophilus.
    On the one hand, it can form a biological barrier of the intestinal mucosa and competitively inhibit the invasion and colonization of various pathogenic bacteria; On the one hand, the lactic acid and acetic acid produced by the metabolism of Bifidobacterium and Lactobacillus acidophilus in the intestine can lower the pH value of the intestine and inhibit the growth and reproduction of pathogenic bacteria.

    It is worth noting that, for the combined use of montmorillonite powder and probiotic preparations, you can take montmorillonite powder first, and then use probiotic preparations, at least 1 to 2 hours between the two medicines.

    Montmorillonite powder combined with bifidobacterium triple viable capsules has a good effect on the treatment of diarrhea-type irritable bowel syndrome.
    After 4 weeks of medication, it can effectively improve symptoms, improve curative effects, and is safe to use.

    ■ Prescription 5 Bifidobacterium triple viable bacteria capsules 420mg twice a day Oral indications: patients with chronic diarrhea due to intestinal flora imbalance.

    Medication analysis: With the widespread use of antibiotics, especially long-term large-scale abuse, dysbacteriosis accounts for an increasing proportion of diarrhea.

    When dysbacterial diarrhea occurs, in addition to discontinuing antibiotics, probiotics should also be taken.

    Bifidobacterium triple viable bacteria capsules are not absorbed after oral administration, and can quickly and completely reach the surface of the large intestine to proliferate, restore the intestinal microecology, and correct the imbalance of intestinal flora.

    Bifidobacterium triple viable bacteria capsules should not be taken at the same time with antibiotics and adsorbents.

    Reference materials: [1] Chinese Medical Association, Chinese Medical Association Journal, Chinese Medical Association Gastroenterology Branch, Chinese Medical Association General Practice Branch, Chinese Medical Association "Chinese Journal of General Practitioners" Editorial Board, basic diagnosis and treatment of digestive system diseases Guidelines Compilation Expert Group.
    Guidelines for Primary Diagnosis and Treatment of Chronic Diarrhea (2019) [J].
    Chinese Journal of General Practitioners, 2020, 19(11): 973-982.
    [2] Xia Lu, Wu Kaichun.
    Attach importance to primary medical and health institutions Standardized diagnosis and treatment of chronic diarrhea[J].
    Chinese Journal of General Practitioners, 2020,19(11):967-969.
    [3],.
    Progress in clinical research on the prevention and treatment of digestive system diseases with microecological agents[J].
    Gastroenterology, 2019, 24(11): 691-694.
    [4] Si Jigang, Li Aijie.
    Reasonable and standardized use of montmorillonite powder[J].
    Journal of Pediatric Pharmacy, 2018, 24(8): 62- 64.
    [5] Wu Kaichun, Liang Jie, Ran Zhihua, et al.
    Consensus opinions on the diagnosis and treatment of inflammatory bowel disease (2018·Beijing)[J].
    Chinese Journal of Practical Internal Medicine, 2018, 38(9): 796-813 .
    [6] Liu Hui, Zhang Yujie, Wu Kaichun.
    Current status and progress of clinical research on inflammatory bowel disease[J].
    Journal of Clinical Internal Medicine, 2021, 38(2): 90-93.
    [7] Luo Shudan, Zhan Li, Yang Juan, et al.
    The clinical efficacy of probiotics combined with mesalazine in the treatment of ulcerative colitis and its influence on serum inflammation indexes[J].
    Chinese Journal of Microecology, 2020, 32(2): 200-203.
    [8] Tang Wenfu.
    Consensus opinions on the diagnosis and treatment of chronic pancreatitis with integrated traditional Chinese and western medicine (2020)[J].
    Chinese Journal of Integrated Traditional Chinese and Western Medicine on Digestion, 2020, 28(10): 731-739.
    [9] Zhao Jingan, Zou Wenbin, Liao Zhuan.
    Pancreatic enzyme replacement Application of therapy in chronic pancreatitis[J].
    Chinese Journal of Practical Internal Medicine, 2018, 38(7): 607-610.
    [10] Gastrointestinal Functional Disease Collaboration Group, Chinese Medical Association Digestion Gastrointestinal Dynamics Group of the Chinese Society of Diseases.
    2020 Chinese irritable bowel syndrome expert consensus opinion[J].
    Chinese Journal of Digestion, 2020, 40(12): 803-818.
    [11] Wei Xiaoxu, Zhang Ling.
    Probiotic preparations Analysis of the clinical efficacy of combined montmorillonite powder in the treatment of diarrhea-type irritable bowel syndrome[J].
    Chinese Community Physician, 2020, 36(25): 75-76.
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