Management of Chronic Diarrhea in Primary Care: The Gastroenterologists' Advice

Medicinal grade opium tincture for severe diarrhea: effect revisited in observational study

PURPOSE OF REVIEW

Chronic diarrhea is a common disorder that interferes with normal daily activities and results in poor quality of life. Fecal urgency and incontinence often necessitate clinical consultation, but the pathophysiological mechanisms are difficult to differentiate in a clinical setting. Therefore, drugs targeting the opioid receptors, such as diphenoxylate and loperamide, are typically used, as they reduce both gut motility and secretion.

RECENT FINDINGS

For severe diarrhea, morphine-containing extemporaneous opium tincture drops have recently been reprofiled to a pharmaceutical. The drug is indicated for severe diarrhea in adults when other antidiarrheals do not give sufficient fecal emptying control. The pronounced effect is due to the liquid formulation with rapid onset as a drug dissolution step is avoided. A recent prospective, noninterventional study (CLARIFY) of patients treated with opioid drops demonstrates a rapid and sustained therapeutic effect. Tolerance does not develop for the antidiarrheal effect and no dependence was observed after discontinuation.

SUMMARY

This mini-review discusses the use of opium derivates for treatment of diarrhea, with an emphasis on opium drops as a new medicinal grade opium for the use as additional treatment of severe diarrhea, emphasizing its mechanism of action and evaluation of the risk-benefit ratio in the clinical setting.

Investigating associations between urinary phthalate metabolite concentrations and chronic diarrhea: findings from the National Health and Nutrition Examination Survey, 2005-2010

This study aimed to explore the relationship between chronic diarrhea and urinary phthalate metabolite concentrations in US adults from the 2005-2010 NHANES study. After adjusting for potential confounding factors, logistic regression was used to explore the relationship between phthalates (PAEs) concentrations and chronic diarrhea, Bayesian kernel machine regression (BKMR), and quantile g calculation (quantile-based g calculation, qgcomp) which was used to study the combined and independent effects of PAEs on gastrointestinal infections. In the current study, 4260 adult participants over the age of 20 from the NHANES study were included, of whom 542 (12.72%) were assessed as having chronic diarrhea. In multivariate logistic regression analysis, after adjusting for all relevant covariates, the results showed that urinary phthalate metabolite concentrations were significantly associated with the risk of chronic diarrhea (P<0.001). Various PAEs were risk factors for chronic diarrhea, among which MiBP (OR=1.419, 95% CI: 1.416-1.423) and MCPP (OR=1.237, 95% CI: 1.235-1.239) were more significant. The BKME results showed a significant increase in the risk of chronic diarrhea with increasing total levels of the PAEs mixture. Mixed exposure to PAEs can promote the occurrence of chronic diarrhea, and the effect was more pronounced in obese people. Notably, most PAEs showed some degree of protection in overweight people. The risk effect of PAEs was more significant in the middle-aged and older population than in the younger population.