Unbound MEDLINE

Review: Management of postprandial diarrhea syndrome.

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.

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  • 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