著者: M R Blake, J M Raker, K Whelan
雑誌名: Aliment Pharmacol Ther. 2016 Oct;44(7):693-703. doi: 10.1111/apt.13746. Epub 2016 Aug 5.
Abstract/Text
BACKGROUND: The Bristol Stool Form Scale (BSFS) is a 7-point scale used extensively in clinical practice and research for stool form measurement, which has undergone limited validity and reliability testing.
AIM: To determine the validity and reliability of the BSFS in measuring stool form in healthy adults and patients with diarrhoea-predominant irritable bowel syndrome (IBS-D).
METHODS: One hundred and sixty-nine healthy volunteers provided a stool sample and used the BSFS to classify stool form, which was compared with measured stool water content and with values from 19 patients with IBS-D. Eighty-six volunteers used the BSFS to classify 26 stool models to determine accuracy and reliability.
RESULTS: Volunteers' classifications of stool type correlated with stool water (Spearman's rho = 0.491, P < 0.001), which increased in hard (Types 1-2), normal (Types 3-5) and loose stools (Types 6-7) (P < 0.001). The BSFS detected differences in stool form between healthy volunteers (mean 3.7, s.d. 1.5) and IBS-D patients (mean 5.0, s.d. 1.2) (P < 0.001). Overall, 977/1204 (81%) stool models were correctly classified (substantial accuracy, κ = 0.78), although <80% of Types 2, 3, 5 and 6 were classified correctly. On 852/1118 (76%) occasions, volunteers classified covert duplicate models to the same stool type (substantial reliability, κ = 0.72), but with only moderate reliability for Types 2 (63%, κ = 0.57) and 3 (62%, κ = 0.55).
CONCLUSIONS: The BSFS demonstrated substantial validity and reliability, although difficulties arose around clinical decision points (Types 2, 3, 5, 6) that warrant investigation in larger clinical populations. Potential for improving validity and reliability through modifications to the BSFS or training in its use should be explored.
© 2016 John Wiley & Sons Ltd.
PMID
27492648 Aliment Pharmacol Ther. 2016 Oct;44(7):693-703. doi: 10･･･
著者: Lawrence R Schiller, Darrell S Pardi, Robin Spiller, Carol E Semrad, Christina M Surawicz, Ralph A Giannella, Guenter J Krejs, Michael J G Farthing, Joseph H Sellin
雑誌名: J Gastroenterol Hepatol. 2014 Jan;29(1):6-25. doi: 10.1111/jgh.12392.
Abstract/Text
Diarrhea is best defined as passage of loose stools often with more frequent bowel movements. For clinical purposes, the Bristol Stool Form Scale works well to distinguish stool form and to identify loose stools. Laboratory testing of stool consistency has lagged behind. Acute diarrhea is likely to be due to infection and to be self-limited. As diarrhea becomes chronic, it is less likely to be due to infection; duration of 1 month seems to work well as a cut-off for chronic diarrhea, but detailed scientific knowledge is missing about the utility of this definition. In addition to duration of diarrhea, classifications by presenting scenario, by pathophysiology, and by stool characteristics (e.g. watery, fatty, or inflammatory) may help the canny clinician refine the differential diagnosis of chronic diarrhea. In this regard, a careful history remains the essential part of the evaluation of a patient with diarrhea. Imaging the intestine with endoscopy and radiographic techniques is useful, and biopsy of the small intestine and colon for histological assessment provides key diagnostic information. Endomicroscopy and molecular pathology are only now being explored for the diagnosis of chronic diarrhea. Interest in the microbiome of the gut is increasing; aside from a handful of well-described infections because of pathogens, little is known about alterations in the microbiome in chronic diarrhea. Serological tests have well-defined roles in the diagnosis of celiac disease but have less clearly defined application in autoimmune enteropathies and inflammatory bowel disease. Measurement of peptide hormones is of value in the diagnosis and management of endocrine tumors causing diarrhea, but these are so rare that these tests are of little value in screening because there will be many more false-positives than true-positive results. Chemical analysis of stools is of use in classifying chronic diarrhea and may limit the differential diagnosis that must be considered, but interpretation of the results is still evolving. Breath tests for assessment of carbohydrate malabsorption, small bowel bacterial overgrowth, and intestinal transit are fraught with technical limitations that decrease sensitivity and specificity. Likewise, tests of bile acid malabsorption have had limited utility beyond empirical trials of bile acid sequestrants.
© 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.
PMID
24117999 J Gastroenterol Hepatol. 2014 Jan;29(1):6-25. doi: 10.1･･･
著者: Ramesh P Arasaradnam, Steven Brown, Alastair Forbes, Mark R Fox, Pali Hungin, Lawrence Kelman, Giles Major, Michelle O'Connor, Dave S Sanders, Rakesh Sinha, Stephen Charles Smith, Paul Thomas, Julian R F Walters
雑誌名: Gut. 2018 Aug;67(8):1380-1399. doi: 10.1136/gutjnl-2017-315909. Epub 2018 Apr 13.
Abstract/Text
Chronic diarrhoea is a common problem, hence clear guidance on investigations is required. This is an updated guideline from 2003 for the investigations of chronic diarrhoea commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG). This document has undergone significant revision in content through input by 13 members of the Guideline Development Group (GDG) representing various institutions. The GRADE system was used to appraise the quality of evidence and grading of recommendations.
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
PMID
29653941 Gut. 2018 Aug;67(8):1380-1399. doi: 10.1136/gutjnl-2017･･･
著者: T M Bayless
雑誌名: Hosp Pract (Off Ed). 1989 Jan 15;24(1):117-22, 124-6, 131-2 passim.
Abstract/Text
PMID
2492029 Hosp Pract (Off Ed). 1989 Jan 15;24(1):117-22, 124-6, 1･･･
著者: P Bytzer, M Stokholm, I Andersen, B Lund-Hansen, O B Schaffalitzky de Muckadell
雑誌名: Scand J Gastroenterol. 1990 Jun;25(6):572-8.
Abstract/Text
All patients referred for diarrhoea over a 2-year period were studied to determine the relative frequency of organic diarrhoea and functional disorder. One hundred and nine patients had diarrhoea of established aetiology at admission. Two hundred and one patients with diarrhoea of unestablished aetiology at admission were interviewed about symptoms, and faecal output was measured. An organic or other explanation was eventually found in 78 patients (39%), whereas the bowel symptoms were categorized as functional or transient in 58%. Chronic diarrhoea of unknown origin was seen in 3%. Only 40% of the patients referred for diarrhoea had faecal output greater than 200 g/day. A reliable differentiation between organic and functional diarrhoea based solely on history and a physical examination at admission was not possible, as the initial diagnostic guess was only confirmed in 42% of the patients. More sensitive and specific indicators of functional diarrhoea are needed before the patients can be safely classified without the need for thorough diagnostic study.
PMID
2359988 Scand J Gastroenterol. 1990 Jun;25(6):572-8.
著者: M U Ahmed, N C Sarker, E Haque, M A Hasan
雑誌名: Bangladesh Med Res Counc Bull. 1976 Jun;2(1):8-11.
Abstract/Text
The relationship of chronic diarrhoeal diseases in adults on socio-economic condition, parasitic infestation and degree of anaemia have been investigated. The disease was more prevalent in poor socio-economic group of people. Most of the patients had mixed parasitic infestations. Anaemia was present in all the cases. Difference in the degree of anaemia was not significant amongst the patients having either Ascaris or hookworm infestation.
PMID
1037200 Bangladesh Med Res Counc Bull. 1976 Jun;2(1):8-11.
著者: M R Kotwal, H A Durrani, S N Shah
雑誌名: J Indian Med Assoc. 1978 Feb 16;70(4):77-80.
Abstract/Text
PMID
670749 J Indian Med Assoc. 1978 Feb 16;70(4):77-80.
著者: S Manatsathit, S Israsena, N Kladcharoen, P Sithicharoenchai, S Roenprayoon, P Suwanakul
雑誌名: Southeast Asian J Trop Med Public Health. 1985 Sep;16(3):447-52.
Abstract/Text
Fifty-five Thai patients with chronic diarrhoea were prospectively studied to find out the underlying causes. The aetiology was identified in 38.2%, uncertain in 29.1%, and unknown in 32.7% of the patients. In the group with a definitive aetiologic diagnosis, parasitic and infective causes were commoner than non-infective causes. Amoebiasis and giardiasis were more frequent than expected, such that empirical therapeutic trial with an antiprotozoal may be justified if initial routine investigations fail to uncover the cause of the diarrhoea. No significant clinical features were noted between the infective and the non-infective groups. Overall, repeated stool microscopy using the concentration technique was the most useful single investigation in approaching the chronic diarrhoea problem.
PMID
4095610 Southeast Asian J Trop Med Public Health. 1985 Sep;16(3･･･
著者: N W Read, G J Krejs, M G Read, C A Santa Ana, S G Morawski, J S Fordtran
雑誌名: Gastroenterology. 1980 Feb;78(2):264-71.
Abstract/Text
We studied 27 patients with severe chronic diarrhea for which extensive investigations carried out at other institutions had failed to reveal a diagnosis. They were studied by standard diagnostic methods as well as by careful fecal analysis and intestinal perfusion. If they were incontinent of feces, anal sphincter function tests were performed. Although many were suspected of having pancreatic cholera syndrome, this diagnosis could not be established in a single patient. The most common diagnosis that could be established was surreptitious ingestion of drugs (laxatives in 7 patients and diuretics in 2). Other specific diagnoses included ulcerative colitis in 2 patients, allergy to beef in 1, and bacterial overgrowth of the small intestine in 1. Thus, we were able to establish a specific diagnosis in 13 patients. Of the remaining 14 patients, 8 had findings suggestive of irritable bowel syndrome, and 2 others had anal sphincter dysfunction as the major cause of their disability. The other 4 undiagnosed patients had severe secretory (3 patients) or osmotic (1 patient) diarrhea. Follow-up interviews at 6 mo-6 yr failed to reveal evidence of a cause for diarrhea that had been overlooked during our studies. The diagnostic approach to patients with unexplained diarrhea is discussed. The importance of a search for surreptitious drug ingestion and accurate measurement of bowel movement frequency and stool weight is emphasized.
PMID
7350049 Gastroenterology. 1980 Feb;78(2):264-71.
著者: Sarah Ballou, Jesse Katon, Prashant Singh, Vikram Rangan, Ha Neul Lee, Courtney McMahon, Johanna Iturrino, Anthony Lembo, Judy Nee
雑誌名: Clin Gastroenterol Hepatol. 2019 Apr 4;. doi: 10.1016/j.cgh.2019.03.046. Epub 2019 Apr 4.
Abstract/Text
BACKGROUND AND AIMS: Depression is a major health issue in the United States and is highly comorbid with gastrointestinal conditions. We collected data from the National Health and Nutrition Examination Survey (NHANES), a representative sample of the US population, to study the relationship between depression and bowel habits.
METHODS: Using data from the NHANES (2009-2010), we identified 495 depressed and 4709 non-depressed adults who filled out the Bowel Health Questionnaire. Depression was defined according to a validated questionnaire. We used multivariable analysis, controlling for clinical and demographic variables, to evaluate the relationship between mood and bowel habits.
RESULTS: In our weighed sample, 24.6% of depressed individuals and 12.6% of non-depressed individuals reported disordered bowel habits. Chronic diarrhea was significantly more prevalent in depressed individuals (15.53%; 95% CI, 11.34%-20.90%) than non-depressed individuals (6.05%; 95% CI, 5.24%-6.98%; P = .0001). Chronic constipation was also more common in depressed individuals (9.10%; 95% CI, 7.02%-11.69%) than non-depressed individuals (6.55%; 95% CI, 5.55%-7.70% CI; P = .003). Mean depression scores in patients with chronic diarrhea (4.9 ± 5.8) and with chronic constipation (4.4 ± 4.93) were significantly higher than mean depression scores for individuals with normal bowel habits (3.2 ± 4.6) (P < .001). Moderate and severe depression were significantly associated with chronic diarrhea but not chronic constipation. Only mild depression was significantly associated with chronic constipation.
CONCLUSIONS: In an analysis of the NHANES database, we found a higher proportion of depressed individuals to have chronic diarrhea and constipation than non-depressed individuals; chronic diarrhea was more strongly associated with depression. Our findings provide support for the relationship between mood and specific bowel habits, accounting for multiple co-variables in a large sample of the general US population.
Copyright © 2019 AGA Institute. Published by Elsevier Inc. All rights reserved.
PMID
30954714 Clin Gastroenterol Hepatol. 2019 Apr 4;. doi: 10.1016/j･･･
著者: K D Fine, L R Schiller
雑誌名: Gastroenterology. 1999 Jun;116(6):1464-86.
Abstract/Text
This literature review and the recommendations therein were prepared for the American Gastroenterological Association Clinical Practice and Practice Economics Committee. The paper was approved by the committee on September 27, 1998.
PMID
10348832 Gastroenterology. 1999 Jun;116(6):1464-86.
著者:
雑誌名: Gastroenterology. 1999 Jun;116(6):1461-3.
Abstract/Text
This document presents the official recommendations of the American Gastroenterological Association (AGA) on the Evaluation and Management of Chronic Diarrhea. It was approved by the Clinical Practice and Practice Economics Committee on September 27, 1998, and by the AGA Governing Board on November 8, 1998.
PMID
10348831 Gastroenterology. 1999 Jun;116(6):1461-3.
著者: Alberto Pilotto, Marilisa Franceschi, Dino Vitale, Augusto Zaninelli, Francesco Di Mario, Davide Seripa, Franco Rengo, FIRI (Fondazione Italiana Ricerca sull'Invecchiamento), SOFIA Project Investigators
雑誌名: Am J Gastroenterol. 2008 Nov;103(11):2816-23. doi: 10.1111/j.1572-0241.2008.02107.x. Epub 2008 Aug 21.
Abstract/Text
OBJECTIVES: To evaluate the prevalence of diarrhea and its association with drug use in elderly outpatients.
METHODS: The study was carried out by 133 general practitioners (GPs) who referred to 24 geriatric units in Italy. The demographic data, disability, gastrointestinal symptoms, and current medications were evaluated using a structured interview, including the evaluation of the activities of daily living (ADL), the instrumental activities of daily living (IADL), and the gastrointestinal symptoms rating scale (GSRS).
RESULTS: The study included 5,387 elderly subjects who regularly completed the structured interview. In total, 488 patients (9.1% of the whole population, 210 men and 278 women, mean age 75.6 +/- 6.2 yr, range 65-100 yr) reported diarrhea, that is, items 11 and 12 of the GSRS, during the 7-day period before the interview. The prevalence of diarrhea significantly increased with older age (P = 0.025), the severity of ADL (P < 0.0001) and IADL disability (P < 0.0001), and the number of drugs taken (P = 0.0002). A multivariate analysis demonstrated that the presence of diarrhea was significantly associated with the use of antibiotics (odds ratio [OR] 4.58, 95% confidence interval [CI] 1.95-10.73), proton pump inhibitors (OR 2.97, 95% CI 2.03-4.35), allopurinol (OR 2.19, 95% CI 1.26-3.81), psycholeptics (OR 1.82, 95% CI 1.26-2.61), selective serotonin reuptake inhibitors (OR 1.71, 95% CI 1.01-2.89), and angiotensin II receptor blockers (OR 1.46, 95% CI 1.08-1.99), also accounting for sex, age, and the use of antidiarrheal agents and drugs for functional gastrointestinal disorders.
CONCLUSION: Diarrhea is a common problem in elderly outpatients. Its prevalence increases with old age, the severity of disability, and the number of drugs. Monitoring the presence of diarrhea and its complications in elderly patients who need treatments with drugs significantly associated with diarrhea may be clinically useful.
PMID
18721240 Am J Gastroenterol. 2008 Nov;103(11):2816-23. doi: 10.1･･･
著者: George F Longstreth, W Grant Thompson, William D Chey, Lesley A Houghton, Fermin Mearin, Robin C Spiller
雑誌名: Gastroenterology. 2006 Apr;130(5):1480-91. doi: 10.1053/j.gastro.2005.11.061.
Abstract/Text
Employing a consensus approach, our working team critically considered the available evidence and multinational expert criticism, revised the Rome II diagnostic criteria for the functional bowel disorders, and updated diagnosis and treatment recommendations. Diagnosis of a functional bowel disorder (FBD) requires characteristic symptoms during the last 3 months and onset > or =6 months ago. Alarm symptoms suggest the possibility of structural disease, but do not necessarily negate a diagnosis of an FBD. Irritable bowel syndrome (IBS), functional bloating, functional constipation, and functional diarrhea are best identified by symptom-based approaches. Subtyping of IBS is controversial, and we suggest it be based on stool form, which can be aided by use of the Bristol Stool Form Scale. Diagnostic testing should be guided by the patient's age, primary symptom characteristics, and other clinical and laboratory features. Treatment of FBDs is based on an individualized evaluation, explanation, and reassurance. Alterations in diet, drug treatment aimed at predominant symptoms, and psychotherapy may be beneficial.
PMID
16678561 Gastroenterology. 2006 Apr;130(5):1480-91. doi: 10.1053･･･
著者: Matthew J H Shale, Julian R F Walters, David Westaby
雑誌名: Gastrointest Endosc. 2011 Apr;73(4):757-64. doi: 10.1016/j.gie.2010.11.037. Epub 2011 Feb 2.
Abstract/Text
BACKGROUND: The optimal endoscopic investigation of diarrhea in patients under age 50 without specific features of right-sided colonic/ileal disease is inadequately defined.
OBJECTIVE: To assess the potential additional yield of colonoscopy over flexible sigmoidoscopy (FS) in this group.
DESIGN: Retrospective cohort study.
SETTING: Two teaching hospital endoscopy units.
PATIENTS: This study involved all patients under age 50 who had a colonoscopy between 1997 and 2007 to investigate diarrhea, without high-risk features of right-sided colonic/ileal disease, inflammatory bowel disease (IBD), or rectal bleeding.
INTERVENTION: Colonoscopy and biopsy.
MAIN OUTCOME MEASUREMENTS: Diagnostic yield of colonoscopy over FS with biopsy.
RESULTS: Colonoscopic appearances were abnormal in 126 of 625 eligible patients (20%); 72% of abnormalities were within reach of FS. The most common endoscopic abnormality was suspected inflammation in 60 patients (10% overall), reportedly confined to the proximal colon or ileum in 22 patients (37% of this group). Histology from areas of suspected inflammation revealed features of IBD in 68% of patients, but results were normal in the remainder. In the 22 patients with suspected isolated proximal disease, 8 patients (36%) had normal histology results, and a further 6 had left-side colon biopsies demonstrating IBD. In patients with macroscopically normal colons, histological evidence of IBD or microscopic colitis occurred in 14 and 12 patients, respectively, with changes in the left side of the colon in 93% of patients. In this patient group, 85% of IBD or microscopic colitis could have been detected by FS and biopsy. The negative predictive value of FS with biopsy was 98% for IBD and 99% for microscopic colitis.
LIMITATIONS: Retrospective study.
CONCLUSION: FS is adequate for the investigation of diarrhea in patients under age 50 who lack other features, but its yield depends on biopsy of the left side of the colon.
Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
PMID
21288510 Gastrointest Endosc. 2011 Apr;73(4):757-64. doi: 10.101･･･
著者: A Bertomeu, E Ros, V Barragán, L Sachje, S Navarro
雑誌名: J Clin Gastroenterol. 1991 Oct;13(5):531-6.
Abstract/Text
To investigate whether the clinical history and basic laboratory test results can differentiate between an organic or functional cause of chronic diarrhea and thus avoid unnecessary hospital admissions and invasive procedures, we reviewed the charts of 58 adult patients admitted during 6 years because of chronic diarrhea who had normal stool and colonic examinations. The final diagnoses were irritable bowel syndrome in 34 patients, organic diarrhea in 21, and unknown cause in three. The following clinical data did not help in the differential diagnosis: age, sex, duration of diarrhea, presence of continuous diarrhea, abdominal pain, stool frequency or volume, and presence of stool mucus. Significant weight loss, nocturnal diarrhea, and the absence of tenesmus were associated with an organic cause. One or more laboratory alterations (increased erythrocyte sedimentation rate, anemia, hypokalemia, and low serum albumin level) were found in 62% of patients with organic diarrhea but in only 3% of those with functional disease; p less than 0.001. In 20 of 21 patients with organic diarrhea, an syndromic diagnosis (fat malabsorption, n = 13; inflammatory bowel disease, n = 4; and secretory diarrhea, n = 3) could be obtained with three simple tests (stool fat, rectal biopsy, and fecal water osmolality and electrolyte determination, respectively). Our study confirms that a detailed history and a few simple laboratory data can help to distinguish between functional and organic diarrhea and so avoid extensive investigation. The syndromic diagnosis of organic diarrhea can also be approximated with relatively easy tests.
PMID
1744388 J Clin Gastroenterol. 1991 Oct;13(5):531-6.
著者: K R Palmer, C L Corbett, C D Holdsworth
雑誌名: Gastroenterology. 1980 Dec;79(6):1272-5.
Abstract/Text
As no adequate comparison of these widely used drugs has been made, we have performed a double-blind cross-over trial in 30 individuals with chronic diarrhea. Each underwent three randomized treatment periods of 4 wk duration. Patients were instructed to increase the daily dose gradually until control was achieved or side effects became intolerable. Stool frequency, consistency, urgency, and incontinence were then compared when a stable dose was reached. Though 2.3 capsules (4.6 mg) of loperamide, 2.3 capsules (103.5 mg) of codeine and 2.5 capsulses (12.5 mg) of diphenoxylate all reduced stool frequency to the same extent, diphenoxylate was significantly less effective in producing a solid stool. Before treatment 95% of patients experienced urgency, sometimes associated with fecal incontinence, often as their major diability. Loperamide and codeine were more effective in relieving this than was diphenoxylate. Side effects, particularly central nervous effects, were greatest with diphenoxylate and least with loperamide. Approximately equal numbers discontinued each preparation; poor control and central-nervous-system side effects were the usual reasons for stopping diphenoxylate and codeine, and abdominal pain and constipation for stopping loperamide. We conclude that both loperamide and codeine phosphate are superior to diphenoxylate in the symptomatic treatment of chronic diarrhea.
PMID
7002706 Gastroenterology. 1980 Dec;79(6):1272-5.
著者: T Pastrana, W Meißner
雑誌名: Schmerz. 2013 Apr;27(2):182-9. doi: 10.1007/s00482-013-1296-z.
Abstract/Text
Diarrhea is a distressing symptom which limits the quality of life in patients receiving palliative care and is associated with high morbidity and mortality. In patients with AIDS, it is a more common problem than for other entities (e.g., cancer). Loperamide is considered the first choice medication for the symptomatic treatment of diarrhea. This literature review examines the efficacy of loperamide in the symptomatic treatment of diarrhea in palliative care. Two databases (Medline and Embase) were searched through June 2012. A total of 286 studies were identified, but only 7 met the inclusion criteria (1 cohort and 6 experimental studies) in which loperamide (alone or in combination) was tested. There is a lack of significant studies which investigate the efficacy of loperamide in the symptomatic treatment of diarrhea. Two trials indicated superiority of loperamide over placebo. In comparison with octreotide, the results were contradictory. The combination of acetorphan with loperamide was more effective than acetorphan alone, but the combination of loperamide with diphenoxylate was inferior to octreotide. The identified studies revealed methodical problems. A definite recommendation for administration of loperamide can, therefore, not be derived from this work.The English full-text version of this article is available at SpringerLink (under "Supplemental").
PMID
23475156 Schmerz. 2013 Apr;27(2):182-9. doi: 10.1007/s00482-013-･･･
