Review: Management of Postprandial Diarrhea Syndrome

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• 作者：Mary E. Money ; MD^a ; ^b ; ; Michael Camilleri ; MD^c
• 关键词：Bile acid malabsorption ; Disaccharidase deficiency ; Functional diarrhea ; Glucosidase deficiency ; Glucosidase inhibition ; Irritable bowel syndrome ; Maldigestion ; Pancreatic insufficiency ; Postprandial diarrhea ; Trigger foods
• 刊名：The American Journal of Medicine
• 出版年：2012
• 出版时间：June, 2012
• 年：2012
• 卷：125
• 期：6
• 页码：538-544
• 全文大小：347 K

文摘

Unexpected, urgent, sometimes painful bowel movements after eating are common complaints among adults. Without a clear etiology, if pain is present and resolves with the movements, this is usually labeled ¡°irritable bowel syndrome-diarrhea?based solely on symptoms. If this symptom-based approach is applied exclusively, it may lead physicians not to consider treatable conditions: celiac disease, or maldigestion due to bile acid malabsorption, pancreatic exocrine insufficiency, or an a-glucosidase (sucrase, glucoamylase, maltase, or isomaltase) deficiency. These conditions can be misdiagnosed as irritable bowel syndrome-diarrhea (or functional diarrhea, if pain is not present). Limited testing is currently available to confirm these conditions (antibody screens for celiac disease; fecal fat as a surrogate marker for pancreatic function). Therefore, empirical treatment with alpha amylase, pancreatic enzymes, or a bile acid-binding agent may simultaneously treat these patients and serve as a surrogate diagnostic test. This review will summarize the current evidence for bile acid malabsorption, and deficiencies of pancreatic enzymes or a-glucosidases as potential causes for postprandial diarrhea, and provide an algorithm for treatment options.