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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?