Abstract

Unexpected, urgent, sometimes painful bowel movements after eating are common complaints among adults. Without a clear etiology, if pain is present and resolves with the movements, this is usually labeled "irritable bowel syndrome-diarrhea" based solely on symptoms. If this symptom-based approach is applied exclusively, it may lead physicians not to consider treatable conditions: celiac disease, or maldigestion due to bile acid malabsorption, pancreatic exocrine insufficiency, or an a-glucosidase (sucrase, glucoamylase, maltase, or isomaltase) deficiency. These conditions can be misdiagnosed as irritable bowel syndrome-diarrhea (or functional diarrhea, if pain is not present). Limited testing is currently available to confirm these conditions (antibody screens for celiac disease; fecal fat as a surrogate marker for pancreatic function). Therefore, empirical treatment with alpha amylase, pancreatic enzymes, or a bile acid-binding agent may simultaneously treat these patients and serve as a surrogate diagnostic test. This review will summarize the current evidence for bile acid malabsorption, and deficiencies of pancreatic enzymes or a-glucosidases as potential causes for postprandial diarrhea, and provide an algorithm for treatment options.

Links

Publisher Full Text

Authors

Money ME, Camilleri M

Institution

Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.

Source

The American journal of medicine 125:6 2012 Jun pg 538-44

MeSH

Adult
Bile Acids and Salts
Diagnosis, Differential
Diarrhea
Digestion
Drug Administration Schedule
Exocrine Pancreatic Insufficiency
Female
Food Hypersensitivity
Fructose
Gastrointestinal Agents
Glucosidases
Humans
Intestines
Irritable Bowel Syndrome
Malabsorption Syndromes
Medical History Taking
Pancrelipase
Postprandial Period
Syndrome
Treatment Outcome
alpha-Amylases

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

22624684