Intest Res.  2015 Oct;13(4):306-312. 10.5217/ir.2015.13.4.306.

Pharmacologic Agents for Chronic Diarrhea

• Lee KJ

• KMID: 2070745
• DOI: http://doi.org/10.5217/ir.2015.13.4.306

Abstract

Chronic diarrhea is usually associated with a number of non-infectious causes. When definitive treatment is unavailable, symptomatic drug therapy is indicated. Pharmacologic agents for chronic diarrhea include loperamide, 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists, diosmectite, cholestyramine, probiotics, antispasmodics, rifaximin, and anti-inflammatory agents. Loperamide, a synthetic opiate agonist, decreases peristaltic activity and inhibits secretion, resulting in the reduction of fluid and electrolyte loss and an increase in stool consistency. Cholestyramine is a bile acid sequestrant that is generally considered as the first-line treatment for bile acid diarrhea. 5-HT3 receptor antagonists have significant benefits in patients with irritable bowel syndrome (IBS) with diarrhea. Ramosetron improves stool consistency as well as global IBS symptoms. Probiotics may have a role in the prevention of antibiotic-associated diarrhea. However, data on the role of probiotics in the treatment of chronic diarrhea are lacking. Diosmectite, an absorbent, can be used for the treatment of chronic functional diarrhea, radiation-induced diarrhea, and chemotherapy-induced diarrhea. Antispasmodics including alverine citrate, mebeverine, otilonium bromide, and pinaverium bromide are used for relieving diarrheal symptoms and abdominal pain. Rifaximin can be effective for chronic diarrhea associated with IBS and small intestinal bacterial overgrowth. Budesonide is effective in both lymphocytic colitis and collagenous colitis. The efficacy of mesalazine in microscopic colitis is weak or remains uncertain. Considering their mechanisms of action, these agents should be prescribed properly.

Keyword

Chronic diarrhea; Loperamide; 5-hydroxytryptamine type 3 receptor antagonists; Bile acid sequestrants; Parasympatholytics

MeSH Terms

Abdominal Pain
Anti-Inflammatory Agents
Bile
Budesonide
Cholestyramine Resin
Citric Acid
Colitis, Collagenous
Colitis, Lymphocytic
Colitis, Microscopic
Diarrhea*
Drug Therapy
Humans
Irritable Bowel Syndrome
Loperamide
Mesalamine
Parasympatholytics
Probiotics
Receptors, Serotonin, 5-HT3
Serotonin
Anti-Inflammatory Agents
Budesonide
Cholestyramine Resin
Citric Acid
Loperamide
Mesalamine
Parasympatholytics
Receptors, Serotonin, 5-HT3
Serotonin

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