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Transcript
HIGH VALUE CARE GI CONDITIONS
CHRONIC DIARRHEA
EDWARD LEVINE MD
OSUWMC
OCTOBER 11, 2014
HOW DO WE DEFINE DIARRHEA
VOLUME OF STOOL?
FREQUENCY OF STOOL?
CONSISTENCY OF STOOL?
HOW DO WE APPROACH DIARRHEA





PATHOPHYSIOLOGY
ACUTE DIARRHEA
CHRONIC DIARRHEA
SMALL BOWEL
COLONIC
ACUTE DIARRHEA  CHRONIC
DIARRHEA
CHRONIC DIARRHEA
CHRONIC DIARRHEA





IBS
IBD
CELIAC DISEASE
COLLAGENOUS COLITIS
C DIFF
? SIBO
MEDICAL RX FOR GAS
 DIETARY RESTRICTIONS – LACTOSE FREE
DIET, FRUCTOSE FREE DIET, GFD,FODMAP
DIET
 ENZYMES - BEANO
 CHARCOAL
 PROBIOTICS
 ANTIBIOTICS
GAS EATER UNDERWEAR
BUY AT WWW.UNDER-TEC.COM
EVALUATION FOR IBD
 CBC, IRON STUDIES, CR, LFT’S, TSH, CRP,
STOOL CULTURES
 COLONOSCOPY
 MRE/CTE
 CAPSULE ENDOSCOPY
TREATMENT OF IBD
TREATMENT OF IBD
CELIAC DISEASE
CELIAC DISEASE
COLLAGENOUS COLITIS
COLLAGENOUS COLITIS
CLOSTRIDIUM DIFFICILE
FMT
 NOT NEW!!!!!!!!!!!
 FIRST DESCRIPTION FROM CHINA IN THE 4TH
CENTURY, INGESTION OF FECES RX’ED FOR A
VARIETY OF CONDITIONS
 “…CONSUMPTION OF FRESH, WARM, CAMEL
FECES HAS BEEN RECOMMENDED BY
BEDOUINS AS A REMEDY FOR BACTERIAL
DYSENTERY; ITS EFFICACY WAS CONFIRMED
BY GERMAN SOLDIERS IN AFRICA IN WWII
 FIRST USE IN MAINSTREAM MEDICINE WAS IN
1958 TO TREAT C DIFF
FMT
 DISTAL GI TRACT CONTAINS A DIVERSE ARRAY
OF MICROORGANISMS, OF WHICH BACTERIA IS
THE MOST DOMINANT WITH AT LEAST 1 X 10
14TH BACTERIA, PREDOMINANTLY ANAEROBES
WITH THOUSANDS OF DIFFERENT SPECIES,
MANY OF WHICH HAVEN’T BEEN CULTURED
 BACTERIA INTERACT WITH THE INTESTINAL
MUCOSA IN A VARIETY OF WAYS
van
Diversity in Patients before and after Infusion of Donor Feces, as Compared with Diversity in
Healthy Donors.
Els Van Nood et al. NEJM. 2013; 368:407415
without Relapse for Recurrent Clostridium difficile Infection.
Els Van Nood et al. NEJM. 2013; 368:407415
van Nood E et al. N Engl J Med 2013;368:407-415
FMT
 FMT FOR IBD
 26 YO MALE WITH HX OF CROHN’S COLITIS, HX
OF PERIANAL DISEASE
 FAILED MESALAMINE, PDN, IMURAN
 C DIFF NEG
 INSURANCE CO DENIED BIOLOGICS
 FMT TRIED AFTER IRB APPROVAL
DIARRHEA CASE OF REFRACTORY IBD
 56 YO AMBULATORY MALE WITH UC ON
IMURAN AND MESALAMINE. TREATED FOR
PNEUMONIA WITH ATB’S. DEVELOPS SX OF UC
REFRACTORY TO ORAL STEROIDS.
 NEXT STEPS?