Burning diarrhea causes. How does acute diarrhea manifest and what causes it? History and course of infection

Acute diarrhea is considered a dangerous disease that leads not only to complications, but also to death. Children, adults and others are at risk of developing the disorder. In most cases, when a minor cause becomes a factor, no special treatment is required. However, if additional serious symptoms occur, urgent medical attention is required.

Types of damage and upset stomach

Diarrhea is classified according to blood, mucus or foreign body inclusions. Depending on this factor, further manifestations of intestinal disorder vary. There are pathogens that infect the small intestine. This manifestation includes:

• bacteria;
• viruses;
• helminthic infestations.

With such factors of intestinal infection, indigestion occurs. The process of defecation is characterized by watery stools. Blood impurities in feces are rarely found during infectious lesions.

However, there are factors that affect the colon. In most cases, pathogens are classified as this type. Microorganisms penetrate the mucous epithelium of the intestine. In this case, the stool contains admixtures of mucus and blood. In this case, the diagnosis finds a large number of leukocytes.

In addition to damage to certain parts of the intestine, some pathogens disrupt the function of all parts. In this case, the stools are watery, and the patient feels manifestations of colitis.

Why does acute diarrhea occur?

In addition to lesions of the upper or lower intestine, the main causes of acute diarrhea are identified. In this case, the digestive organ is often exposed to substances, microorganisms, viruses and inflammation. This leads to indigestion, which causes loose stools.

Viral and bacterial infections

When pathogens enter the intestines, toxins are released. This helps to enhance the contractility of the organ. Such infections affect the small or large intestine. With cholera, the disease occurs in an acute form. The infection affects only the small intestine.

There is salmonellosis, which occurs in an acute form. The infection affects the digestive tract. Microorganisms cause a state of severe intoxication. Because of this, the entire body suffers.

The cause of acute diarrhea in adults is dysentery. In this case, general intoxication of the body is noted. Damage occurs to the distal colon. The infection destroys the intestinal lining.

Enterovirus infection is similar in its damaging effect to dysentery. However, the disease destroys not only the intestinal epithelium, but also other internal organs are at risk.

If intestinal flu is detected, loose stools rarely occur in adults. Diarrhea occurs with additional dysbacteriosis. Sometimes patients present with acute diarrhea, which is caused by a foodborne illness. This happens due to the consumption of products containing substances and elements unacceptable to the body. In products this occurs due to the activity of pathogenic bacteria.

Microflora disturbance

Dysbacteriosis is characterized as a change in the balance of positive and negative pathogenic organisms. The process develops due to long-term use of antibacterial agents. Otherwise, the patient has reduced immunity. Especially when combining treatment with chemotherapy or radiotherapy.

If the baby experiences intestinal upset, acute pain in the stomach and diarrhea, parents should immediately call an ambulance. In most cases, a child experiences diarrhea due to dysbiosis. However, there is a high risk of intestinal infections. Before the doctor arrives, you can provide first aid and maintain fluid balance.

Enzymopathy

With this disease, the production of certain enzymes is disrupted. In most cases, only those involved in digesting food. This becomes a factor in the development of acute diarrhea in adults. However, diseases of the digestive tract and nearby organs are isolated.

The process of fermentopathy is caused by:

• pancreatitis;
• gallstone;
• lactose deficiency.

Diseases due to impaired immunity

This manifestation of acute diarrhea includes pathologies in which lesions of the colon epithelium occur, depending on a malfunction in the immune system. In this case, Crohn's disease is isolated when a substance absorption disorder occurs. The pathology is accompanied by increased secretion of water. This leads to rapid passage of stool through the intestines.

In an adult, the appearance of acute diarrhea with reduced immunity is referred to as ulcerative colitis. This pathology occurs in a chronic form, and changes occur in the mucous epithelium of the digestive organ. Enteritis and enterocolitis are also considered factors in the occurrence of acute diarrhea due to impaired immunity.

Nervous and mental disorders

When a disturbance occurs in the nervous system, such disruptions lead to digestive problems. In this case, irritable bowel syndrome is isolated. This diagnosis of acute diarrhea is the absence of other signs and factors for the appearance of loose stools. The disorder continues for several months.

Other reasons

In some cases, acute diarrhea occurs due to poisoning with toxic substances. Such elements include:

• nitrates;
• heavy metals;
• pesticide;
• antibiotics.

Toxic substances have a negative effect on the intestinal microflora. Antibacterial agents are not classified as pesticides. However, due to frequent use, cell growth is impaired. At the same time, the number of positive microorganisms in the intestines decreases. This leads to dysbiosis.

Sometimes cancerous tumors are found in the digestive organ. In this case, diarrhea appears along with blood and mucus in the stool. This disorder occurs due to intolerance to fatty foods. In addition, pathological changes in the epithelium of the digestive organ have a great influence. In other cases, the appearance of loose stools is associated with the manifestation of chronic diseases of the internal organs.

Symptoms of acute diarrhea

Additional signs of diarrhea depend on the factor of occurrence or the individual characteristics of the body. In most cases, when acute diarrhea occurs in adults, the following symptoms occur:

• diarrhea at the most inopportune moment;
• frequent bowel movements;
• general malaise;
• state of lethargy and drowsiness;
• burning and itching in the anal area;
• pallor;
• decrease in urine volume;
• unpleasant odor;
• no appetite.

For any reason for indigestion, such symptoms may intensify. This depends on the degree and severity of the pathology. When weakness and general malaise begin to appear, the patient needs to replenish the water balance. If primary symptoms of dehydration occur, immediately seek medical help.

However, if the main symptoms occur, you need to pay attention to dizziness or fever. The pain syndrome can be located in the navel or hypochondrium. Treatment of additional symptoms separately is prohibited. It is especially forbidden to make independent decisions regarding the treatment of the disease. This will lead to complications. Otherwise, death will occur.

Treatment methods for loose stools

Diagnosis of acute diarrhea takes place in the form of a survey, examination and laboratory tests. Based on dry skin, vomiting, fever and pain, the disease is determined by a proctologist or infectious disease specialist. Patients who experience indigestion more than 4 times a day are diagnosed.

General blood and stool tests are used as laboratory tests. If a large number of leukocytes and erythrocytes are found in the feces, a microbiological examination of the masses is prescribed. Otherwise, diagnostics is continued using colonoscopy. This helps to identify inflammatory processes on the intestinal mucosa. A detailed picture of the disease of the digestive organ is carried out using radiography. After this, an accurate diagnosis is established. The doctor, based on the research results, prescribes a comprehensive treatment of acute diarrhea using medications and dietary nutrition.

Drug therapy

If it is diagnosed that acute diarrhea is due to infection, then antibiotics are prescribed. The following medications are prescribed:

• Furazolidone;
• Enterofuril.

If poisoning occurs, then sorbents are taken for acute diarrhea. Such medications reduce the manifestation of intoxication and help remove harmful substances. The products are used after meals.

Probiotic preparations are aimed at restoring intestinal microflora. In most cases, such therapy is prescribed for dysbiosis, and the drugs are aimed at maintaining immunity in good shape. In this case, enzyme agents are prescribed. Medicines are used for pancreatitis and exacerbation of pathology. Sometimes opioid drugs are used, which affect the contractility of the digestive organ.

To eliminate discomfort, antispasmodic medications are prescribed. In this case, the patient can combine some drugs that eliminate not only acute abdominal pain, but also relieve cramps. Otherwise, anti-inflammatory drugs are prescribed. Such medications are used for chronic diarrhea.

Diet therapy

If you take any food during acute diarrhea, this will lead to a worsening of the condition. During the diet, fermented milk products should be excluded from the diet. Lactose becomes an intolerant component for the patient. At the same time, you should not consume products with caffeine and alcohol.

When using drugs that slow down intestinal motility, do not take them during an exacerbation of colitis. Medicines cause the development of intoxication.

For acute diarrhea, you can eat cottage cheese, porridge with water, boiled dietary meat and bread crackers.

Drinks allowed include unsweetened black tea, green apple juice and jelly.

The occurrence of loose stools is associated with many factors. Therefore, the causes of acute diarrhea affect treatment methods and diagnostic methods. In most cases, development factors are associated with stomach diseases. If the abdominal pain intensifies, you need to seek help from a doctor. The prescribed treatment will help stop the development of the disease or infection.

The information on our website is provided by qualified doctors and is for informational purposes only. Don't self-medicate! Be sure to consult a specialist!

Gastroenterologist, professor, doctor of medical sciences. Prescribes diagnostics and carries out treatment. Expert of the group for the study of inflammatory diseases. Author of more than 300 scientific papers.

In itself, diarrhea in an adult is not a separate disease, but a symptom that occurs in a wide variety of ailments. Therefore, in order to successfully normalize stool, it is necessary to understand the causes of diarrhea in each specific case and, if possible, eliminate them.

What is diarrhea in adults?

Diarrhea (diarrhea) is a pathological condition when there is an increase in stool frequency in adults more than 3 times a day, as well as a change in its consistency: it becomes watery, maybe with mucus and bloody discharge. Acute diarrhea lasts up to 2 – 3 weeks. Chronic diarrhea lasts more than 21 days.

Classification of diarrhea by mechanism of occurrence

Sodium and chlorine ions accumulate in the intestinal lumen, which leads to an increase in osmotic pressure. High osmotic pressure causes additional water intake and a sharp increase in the volume of intestinal contents. Typically, this type of diarrhea is characterized by very large and loose stools, as well as loss of water and electrolytes.

In severe cases, without timely treatment, secretory diarrhea can lead to death due to acute fluid deficiency and the development of hypovolemic coma.

This type of diarrhea is observed with cholera, salmonellosis, viral intestinal infections, and hormonally active tumors. In addition, some laxatives and prostaglandins cause increased stool frequency in this way.

To some extent it is similar to the secretory one, since in this case the increased osmotic pressure also leads to excessive accumulation of water in the intestinal lumen and an increase in the volume of feces. However, here hyperosmolarity does not arise due to increased secretion of sodium and potassium ions, but due to the fact that the intestinal contents initially have high osmotic pressure. This type of diarrhea usually occurs in the case of rotavirus infection, as well as with an overdose of saline laxatives.

Inflammation develops in the lower intestines, which impairs the reabsorption of water. Observed in dysentery and amoebiasis.

Dilution of feces occurs due to additional release of blood, protein exudate, mucus or pus into the intestinal lumen. This type of diarrhea is typical for diseases accompanied by inflammation of the intestinal mucosa - Crohn's disease, intestinal tuberculosis, ulcerative colitis, etc.

Characterized by acceleration of intestinal motility. Typically observed in cases of stress, functional digestive disorders, diabetic enteropathy, amyloidosis, scleroderma.

Main causes of diarrhea in adults

The leading causes of diarrhea in adults are:

• food poisoning;
• excessive consumption of “heavy” foods;
• diseases of the digestive system, accompanied by inflammation of the intestinal walls (enteritis, enterocolitis);
• food allergies;
• enzyme deficiency;
• taking certain medications (for example, synthetic sweeteners, laxatives);
• sudden change in food style and conditions (travelers' diarrhea);
• intestinal flu and other infections;
• lead and mercury poisoning;
• stress.

When diarrhea is accompanied by a fever of up to 380C, vomiting, or diarrhea with blood or water, it is important to immediately consult a doctor in order to receive adequate treatment and avoid the development of serious complications.

Why is frequent diarrhea dangerous?

If stools are watery and frequent, you are more likely to develop dehydration and electrolyte loss, which can be fatal. For this reason, you should immediately see a doctor and immediately provide assistance to the sick person if the following symptoms are observed:

• dry mucous membranes;
• increased heart rate;
• chapped lips;
• rare or complete absence of urination;
• decreased blood pressure;
• the appearance of muscle cramps;
• disturbance of consciousness.

Be sure to consult a doctor in the following situations:

• diarrhea does not stop for 3 or more days;
• bowel dysfunction occurs and develops without reason;
• in addition to diarrhea, yellowness of the sclera and skin, intense abdominal pain, sleep disturbance and high fever are observed;
• stools are dark black or green, mixed with blood.

First aid for diarrhea

If you experience diarrhea and vomiting or diarrhea and fever, it is better to consult a doctor as soon as possible, since these symptoms may indicate the development of a serious illness, for example, acute intestinal poisoning. First aid until the patient is examined by a doctor is to prevent dehydration and significant loss of minerals. In this regard, experts, in case of diarrhea, recommend the following:

1. Drink plenty of minerals. For this purpose, Regidron (and its analogues) is best suited. If it is absent, then you can take lightly salted water or saline solution.
2. Stick to a strict diet. When diarrhea begins, it is better to generally abstain from 1 – 2 or more meals, unless the doctor recommends otherwise. To relieve intestinal inflammation, you can drink tea or decoctions of anti-inflammatory herbs.

Treatment of diarrhea: diet

Complete treatment for diarrhea includes the following dietary recommendations.

1. It is allowed to eat such foods as white crackers, slimy porridges, vegetable purees, steamed and boiled fish, lean meats, rice water, and tea.
2. It is prohibited to eat spicy, salty, sour foods, or foods containing large amounts of coarse fiber. In addition, milk, brown bread and anything that can cause increased gas formation and “fermentation” are not recommended.
3. In the first days, foods that stimulate the release of bile are excluded from the diet: eggs, fatty meat, butter, etc.

Gradually, the list of permitted products is expanding, and the patient, as stool normalizes, can switch to a normal diet. In situations where diarrhea is caused by enzyme deficiency or any chronic intestinal diseases, systematic diet is one of the most effective means of therapy.

How to treat dehydration with acute or chronic diarrhea

As a rule, glucose-saline solutions are prescribed until stool normalization. They replenish the loss of mineral salts and fluids in the body. The most well-known drugs in this group are Regidron, Gastrolit, Citroglucosan. In the absence of them on hand, you can independently prepare and use the following solution: for 1 liter of water, take ½ teaspoon of baking soda, 1 teaspoon of salt, ¼ teaspoon of potassium chloride, and also add 4 tbsp. l. Sahara. Instead of potassium chloride, you can take a decoction of dried apricots (dried apricots).

How to treat diarrhea with medications

The most common drugs used to treat diarrhea are:

The best prevention of diarrhea is maintaining personal hygiene, eating only high-quality foods and timely treatment of various chronic intestinal diseases.

Acute diarrhea in adults is a common complaint in family practice. The most common cause of acute diarrhea is viral gastroenteritis, a disease that does not require special treatment and goes away on its own. With the increase in the number of foreign trips, concomitant diseases and food poisoning, the role of bacterial causes of acute diarrhea is increasing. History taking and examination should be aimed at identifying risk factors and signs of inflammatory diarrhea and severe dehydration. Most patients do not require laboratory testing, and stool culture is usually not necessary. Treatment is aimed at preventing and treating dehydration. Additional diagnostics are required for severe dehydration, persistent fever, the presence of blood in the stool, patients with immunosuppression, or suspected epidemic or hospital infection. Oral rehydration and early nutrition are the preferred treatment for dehydration. If there is blood in the stool, drugs that inhibit peristalsis are contraindicated. For patients with watery diarrhea, loperamide/simethicone can be prescribed as symptomatic treatment. Probiotics may speed up recovery. When prescribed correctly, antibiotics are effective in treating shigellosis, campylobacteriosis, infection Clostridium difficile, diarrhea travelers and protozoal infections. Prevention of acute diarrhea includes hand hygiene, safe food preparation, vaccinations and access to clean water.

Acute diarrhea is the passage of stools with increased water content, increased volume and frequency of stools for less than 14 days. 1 Every year, 2.5 million people worldwide die from diarrhea. 2 In developed countries, infectious causes of acute diarrhea are usually associated with contaminated food and water. 5 In developed countries, technological progress and increased mass production of food have paradoxically led to the persistence of food-borne infections despite high standards of food production. 6

RECOMMENDATION	POWER OF RECOMMENDATION	LINKS
In patients with acute diarrhea, stool cultures are needed only if there is visible blood in the stool, severe dehydration, signs of inflammatory disease, duration greater than 3-7 days, immunosuppression, or suspected nosocomial infection.
Testing for Clostridium difficule toxins A and B is indicated for patients with unclear diarrhea that develops after more than 3 days of hospitalization
In developed countries, routine testing for helminth eggs and enterobiasis in acute diarrhea is not indicated. Testing for worm eggs and enterobiasis is indicated if the patient is at risk (diarrhea for more than 7 days, contact with kindergarten children, travel to mountainous areas, AIDS, homosexual contacts, local epidemics associated with contaminated water, blood in the stool, leukocytes in the stool)
Treatment of acute diarrhea begins with rehydration, preferably orally.
The combination of loperamide with simethicone works faster and more effectively than these drugs individually for acute nonspecific diarrhea and discomfort from increased gas formation.
Antibiotics (usually a fluoroquinolone) reduce the duration and severity of traveler's diarrhea.

Differential diagnosis of acute diarrhea

Clinically, acute diarrhea is divided into two pathophysiological syndromes: the so-called. “noninflammatory” (usually viral, less severe diarrhea) and “inflammatory” (severe diarrhea, usually caused by invasive or toxin-producing bacteria). 7, 8 Table 1 compares noninflammatory and inflammatory acute diarrhea. 7, 8

Table 1. Non-inflammatory and inflammatory diarrheal syndromes

FACTOR	NON-INFLAMMATORY	INFLAMMATORY
Etiology		Typically invasive or toxin-producing bacteria
Pathophysiology	Usually increases intestinal secretion, less often - causes a significant violation of the integrity of the intestinal mucosa	More often it causes a violation of the integrity of the intestinal mucosa, which can lead to the penetration of bacteria into the tissue and destruction of the mucosa
History and examination	Nausea, vomiting, normothermia, intestinal cramps, large volume of stool, lack of blood in stool, watery stool	Fever, abdominal pain, tenesmus, decreased stool volume, blood in stool
Laboratory data	There are no leukocytes in the stool	White blood cells in stool
Common pathogens	Enterotoxigenic Escherichia coli, Clostridium perfringens, Bacillus cereus, Staphylococcus aureus, Rotavirus, Norovirus, Giardia, Cryptosporidium, Vibrio cholerae	Salmonella (non-Typhi), Shigella, Campylobacter, Shiga toxin-producing E. coli, enteroinvasive E. coli, Clostridium difficile, Entamoeba histolytica, Yersinia
Additionally	Usually proceeds relatively mildly	Usually more severe
	May lead to severe dehydration, especially in malnourished patients

Viral infection is the most common cause of acute diarrhea. 9 Bacterial infections are more commonly associated with travel, comorbidities, and foodborne illnesses. If the pathogen can be identified, in the United States it most often turns out to be Salmonella, Campylobacter, Shigella and Shiga toxin producing Escherichia coli(enterohemorrhagic E. coli). 10

History and examination for acute diarrhea

History of acute diarrhea

You should find out from the patient the time of onset, duration, severity and frequency of diarrhea; it is especially important to know the nature of the stool (watery, mixed with blood, mucus, pus, bile). The doctor also needs to be aware of the presence of signs of dehydration - decreased urine volume, thirst, dizziness, changes in mental status. Vomiting is more typical for a viral disease or when a preformed bacterial toxin enters the gastrointestinal tract (toxicoinfection). Symptoms indicating invasive bacterial (inflammatory) diarrhea are fever, tenesmus, severe blood in the stool. 11

Children attending day care, nursing home patients, food handlers, and recently hospitalized patients are at risk for developing infectious diarrhea. Pregnant women have a 12-fold increased risk of developing listeriosis 12; listeriosis is contracted by eating cold meat, soft cheeses, and raw milk. 13 In a patient with acute diarrhea, information should be collected on infectious contacts, use of antibiotics and other drugs. Anal and oral-anal intercourse predisposes to direct rectal inoculation of the pathogen and fecal-oral transmission.

Also important is a history of gastrointestinal diseases and surgical interventions, endocrine diseases, pelvic irradiation and factors causing immunosuppression, including HIV infection, long-term use of corticosteroids, chemotherapy and immunoglobulin A deficiency. Anamnestic data on diarrhea are shown in table 2 1, 7, 8, 14 , 15 , and clinical symptoms depending on the pathogen are shown in Table 3. 1, 14

Table 2. Important medical history for acute diarrhea

ANAMNESIS		PATHOGEN
No fever, abdominal pain, bloody diarrhea		Shiga toxin-producing Escherichia coli
Blood in the stool		Salmonella, Shigella, Campylobacter, Shiga toxin-producing E. coli, Clostridium difficile, Entamoeba histolytica, Yersinia
Hiking, drinking raw water		Giardia
Food that can transmit the pathogen
	Fried rice	Bacillus cereus
	Raw ground meat or grain sprouts	Shiga toxin-producing E. coli (eg, E. coli O157:H7)
	Raw milk	Salmonella, Campylobacter, Shiga toxin-producing E. coli, Listeria
	Seafood, especially raw shellfish	Vibrio cholerae, Vibrio parahaemolyticus
	Lightly processed beef, pork, poultry	Staphylococcus aureus, Clostridium perfringens, Salmonella, Listeria (beef, pork, poultry), Shiga toxin-producing E. coli (beef and pork), B. cereus (beef and pork), Yersinia (beef and pork), Campylobacter (poultry) )
Visit to kindergarten		Rotavirus, Cryptosporidium, Giardia, Shigella
Fecal-oral sexual contact
Hospitalization		C. difficile, treatment side effects
HIV, immunosuppression		Cryptosporidium, Microsporida, Isospora, Cytomegalovirus, complex Mycobacterium avium intracellulare, Listeria
Diseases that cause diarrhea		Endocrine: hyperthyroidism, adrenal insufficiency, carcinoid tumors, medullary thyroid cancer
		Gastrointestinal: ulcerative colitis, Crohn's disease, irritable bowel syndrome, celiac disease, lactase deficiency, ischemic colitis, colorectal cancer, short bowel syndrome, malabsorption, gastrinoma, VIPoma, intestinal obstruction, paradoxical diarrhea with constipation
		Others: appendicitis, diverticulitis, HIV infection, systemic infections, amyloidosis, adnexitis
Iatrogenic diarrhea		Antibiotics (especially broad spectrum), laxatives, antacids (magnesium and calcium), chemotherapy, colchicine, pelvic radiation therapy
		Less common: proton pump inhibitors, mannitol, NSAIDs, ACE inhibitors, cholesterol-lowering drugs
Persistent diarrhea with weight loss		Giardia, Cryptosporidium, Cyclospora
Pregnancy		Listeria
Recent antibiotic use		C. difficile
Receptive anal sex with/without pain in the rectum and with/without proctitis		Herpes simplex virus, chlamydia, gonorrhea, syphilis
Rectal pain and proctitis		Campylobacter, Salmonella, Shigella, E. histolytica, C. difficile, Giardia
Rice-water stool		V. cholerae
Group disease after eating the same food		Food poisoning
			Onset of illness within 6 hours after eating: Staphylococcus, B. cereus (usually vomiting)
			Onset of illness 8-16 hours after eating: C. perfringens type A (usually diarrhea)
Travel to developing countries		The most common pathogen is enterotoxigenic E. coli
		The following pathogens may also occur: Shigella, Salmonella, E. histolytica, Giardia, Cryptosporidium, Cyclospora, intestinal viruses

Table 3. Clinical symptoms for various pathogens

PATHOGEN	T	STOMACH PAIN	NAUSEA AND VOMITING	INFLAMMATORY CHANGES IN FECA	BLOOD IN STOOL	HEME-POSITIVE STOOLS
Bacteria
Campylobacter						Quite often
Clostridium difficile
Salmonella						Quite often
Shiga toxin-producing Escherichia coli
Shigella						Quite often
Vibrio	Quite often	Quite often	Quite often	Quite often	Quite often	Quite often
Yersinia
Parasitic
Cryptosporidium	Quite often	Quite often
Cyclospora	Quite often	Quite often
Entamoeba histolytica			Quite often	Quite often	Quite often
Giardia
Viral
Norovirus	Quite often

References in the list of references 1 and 14

Physical examination for acute diarrhea

The main purpose of examination for acute diarrhea is to determine the degree of dehydration of the patient. Signs of dehydration are a general unhealthy appearance, dry mucous membranes, slow capillary refill, tachycardia, orthostatic changes in blood pressure and heart rate. An increase in temperature is usually characteristic of inflammatory diarrhea. Abdominal examination is necessary to assess the degree of pain and exclude an acute abdomen. A rectal examination may be useful in assessing stool consistency, the presence of blood in the stool, and the severity of rectal pain.

Laboratory tests for acute diarrhea

Watery diarrhea usually resolves quickly on its own, so further testing is not required. 1, 16 In general, laboratory diagnosis is needed in patients with severe dehydration, severe disease, blood in the stool, immunosuppression, or suspected nosocomial infection.

Hidden blood in stool

The extent to which the presence of occult blood in the stool affects pretest probability is currently unclear. However, the stool occult blood test is a quick and inexpensive test; if it is positive and leukocytes or lactoferrin are detected in the stool, a diagnosis of inflammatory diarrhea is more likely. 17 The stool occult blood test in developed countries has 71% sensitivity and 79% specificity for the presence of inflammatory diarrhea; in developing countries, sensitivity decreases to 44% and specificity to 72%. 18

Leukocytes and lactoferrin in stool

Analysis of stool for leukocytes presents some difficulties, the main of which are the storage and processing of biomaterial, standardization and interpretation of laboratory data. Sensitivity and specificity can vary greatly between laboratories. All these factors have led to the increasingly rare use of this test today. 18

Lactoferrin is a white blood cell marker that is released from damaged or dying cells; lactoferrin increases during bacterial infection. 19 Commercial immunoassays for lactoferrin are more accurate and less susceptible to variability compared to the analysis for leukocytes in stool, their sensitivity exceeds 90%, and their specificity exceeds 70%. 20 Therefore, the fecal lactoferrin test is the test of choice when screening stool for the presence of leukocytes. 21

Stool culture for acute diarrhea

Uncontrolled administration of stool culture for acute diarrhea is ineffective (the results are positive only in 1.6-5.6% of cases) 1 and leads to additional costs - $900-1200 for each positive culture. 22 If cultures are taken only in cases of positive stool tests for leukocytes, the price drops to $150. 23 If stool cultures are taken only in cases of obvious blood in the stool, the percentage of positive cultures increases to 30%. 24

Currently, there is no clear opinion on which patients with acute diarrhea should undergo stool culture. It would be reasonable to take stool cultures if there is obvious bloody diarrhea, severe dehydration, signs of inflammatory diarrhea, symptoms lasting more than 3-7 days, or immunosuppression. 25, 26 Stool culture is often prescribed for travelers' diarrhea, although empirical treatment is also possible for this pathology. 1, 11 In hospitalized patients, stool cultures are obtained in all of the above cases, plus if symptoms occur more than three days after hospitalization, or if there is an outbreak of infectious diarrhea in the hospital, in patients with HIV, with neutropenia, in patients over 65 years of age with concomitant diseases (terminal disease of the liver, kidneys, lungs, with leukemia, with hemiparesis caused by cardiovascular catastrophe, with inflammatory bowel diseases). 25

Diagnosis of infection Clostridium difficile

If diarrhea develops in patients hospitalized for more than three days, a stool test for the presence of toxins A and B is recommended. Clostridium difficile, the test turns out to be positive in 15-20% of cases. 25, 27 Moreover, the risk of exposure to Clostridium difficile increases by 7-10 times after antibiotic therapy of any duration, and the risk remains for one month after the end of antibiotic therapy, 2-3 months after the end of antibiotic therapy it remains increased by 3 times, 28 therefore testing for C. difficile toxins is recommended for those patients in whom diarrhea develops during the use of antibiotics or within three months after the end of antibiotic therapy, in addition, analysis for toxins is indicated for the development of diarrhea in patients with significant concomitant diseases, elderly and immunocompromised patients.

Worm eggs and enterobiasis in acute diarrhea

Routine testing for helminth eggs and enterobiasis in patients with acute diarrhea is not economically feasible, especially in developed countries. 29 Indications for this analysis may include a duration of diarrhea of ​​more than 7 days, especially if the patient has had contact with kindergarten children, travel to a mountainous area, if the patient has AIDS, or the patient is homosexual, in the presence of epidemics in the population associated with water contamination, if the patient has blood in the stool and there are white blood cells in the stool. 11 It is currently unclear whether it makes sense to send multiple stool samples for this test.

Endoscopy for acute diarrhea

The role of endoscopy in the diagnosis of acute diarrhea is small. Endoscopy may be indicated if the diagnosis cannot be made after obtaining the results of standard blood and stool tests, if empirical therapy is ineffective, and symptoms persist. 30 Colonoscopy with colon biopsy and culture may be useful in patients with diarrhea and suspected tuberculosis or diffuse colitis (as in clostridial colitis) and in the diagnosis of non-infectious causes of acute diarrhea - inflammatory bowel disease, ischemic colitis, NSAID-induced enteropathy, etc. cancer 31

Treatment of acute diarrhea

Rice. 1. Algorithm for the treatment of acute diarrhea. 1, 14, 20

Rehydration therapy for acute diarrhea

The first step in treating acute diarrhea is to treat dehydration, preferably by mouth. 1 First, you need to compensate for the lost fluid (the difference between the patient’s current weight and his weight before the illness). Next, you need to keep the patient in neutral water balance. Oral solutions for rehydration should contain a sufficient amount of salts and, necessarily, glucose, in order to better use the intestinal glucose-sodium transport mechanism.

In 2002, WHO approved oral rehydration solutions with reduced osmolarity (250 mOsm/L instead of 311 mOsm/L). Compared with standard solutions, reduced osmolarity solutions reduce stool volume, the number of episodes of vomiting, and the need for intravenous rehydration, 32 without causing hyponatremia. 33 At home, an oral rehydration solution can be prepared by dissolving half a teaspoon of salt, 6 teaspoons of sugar in 1 liter of water. If oral rehydration is ineffective, intravenous rehydration is used.

Feeding for acute diarrhea

Early initiation of feeding reduces bowel permeability caused by infection, shortens disease duration, and improves nutritional outcomes. 34,35 The latter is particularly important in developing countries where pre-existing malnutrition plays an important role. The BR diet (bananas, rice, orange juice and toast) and avoiding dairy products are often recommended, but there is currently little evidence for the effectiveness of these measures. The recommendation to abstain from solid food for 24 hours is also not supported by evidence. 36

Antidiarrheal drugs

For traveler's diarrhea, the anti-motility drug loperamide (Imodium) can reduce the duration of diarrhea by one day and increase the likelihood of clinical recovery at 24 and 48 hours when given concomitantly with antibiotics. 37, 38 The combination of loperamide plus simethicone relieves acute nonspecific diarrhea and discomfort caused by flatulence faster and more effectively than both drugs alone. 39

Loperamide can cause a dangerous prolongation of illness in some patients with blood in the stool and inflammatory diarrhea, so it should only be used when there is no blood in the stool. 40 In patients with fever and inflammatory diarrhea, bismuth subsalicylate (Pepto-Bismol) may be a safe alternative. There is no evidence of the effectiveness of kaolin/pectin, activated carbon, or attapulgin absorbents. The antisecretory drug racecadotril, widely used in Europe, is easier to tolerate and is as effective as loperamide, but is not available in the United States. 41

Antibiotic therapy for acute diarrhea

Acute diarrhea usually resolves spontaneously and is often viral in nature, so antibiotics are not prescribed in adults with mild diarrhea with watery stools. The widespread use of antibiotics leads to the emergence of resistant bacteria (e.g. campylobacter), destruction of normal flora and prolongation of the course of the disease (eg, superinfection with C. difficile), prolonged carriage (eg, prolonged shedding of Salmonella), induction of Shiga toxin secretion by E. coli and increased cost of treatment. Properly used antibiotics are effective in treating shigellosis, campylobacteriosis, C. difficile infection, traveler's diarrhea, and protozoal infections. Antibiotic therapy for traveler's diarrhea (usually a fluoroquinolone) reduces the severity and shortens the duration of the disease by 2-3 days. 1, 42 If the clinical presentation is suspicious for Shiga toxin-producing E. coli (blood in the stool, consumption of raw ground meat, local epidemic), antibiotics are contraindicated because they may increase the likelihood of hemolytic uremic syndrome. 43 Conservative treatment without antibiotics is less effective when diarrhea lasts more than 10-14 days; in this case, it is recommended to exclude protozoal infection. 1 Antibiotics are indicated for patients over 65 years of age, immunocompromised, with severe disease, and with sepsis. In table Table 4 shows antibiotic treatment regimens for acute diarrhea. 1, 14, 16, 44, 45

Table 4. Antibiotic therapy for acute diarrhea

PATHOGEN	EFFICIENCY TREATMENTS	DRUG CHOICE	ALTERNATIVE DRUGS	ADDITIONALLY
Bacteria
Campylobacter	Proven for dysentery and sepsis, possibly effective for enteritis		Erythromycin 500 mg 4 times a day for 3-5 days	A longer course may be required for immunocompromised patients
			Ciprofloxacin 500 mg 2 times a day for 5-7 days
Clostridium difficile	Proven	Metronidazole 500 mg 3 times a day for 10 days	Vancomycin per os 125 mg 4 times a day for 10 days	If diarrhea occurs during antibiotic treatment, the antibiotic should be discontinued if possible.
Enteropathogenic and enteroinvasive Escherichia coli	Possibly effective
Enterotoxigenic E. coli	Proven	Ciprofloxacin 500 mg 2 times a day for 3 days	Biseptol 160/800 mg 2 times a day for 3 days	Enterotoxigenic E. coli is the most common cause of traveler's diarrhea
			Azithromycin 500 mg once a day for 3-5 days
Salmonella, non-Typhi	For enteritis - doubtful, proven for severe infection, sepsis and dysentery		For severe cases: Ciprofloxacin 500 mg 2 times a day for 5-7 days	In addition to patients with severe disease, antibiotic therapy is indicated for patients younger than 12 months and older than 50 years, patients with prosthetic joints, heart valve pathologies, severe atherosclerosis, cancer, and uremia
			Biseptol 960 mg 2 times a day for 5-7 days
			Azithromycin 500 mg once a day for 5-7 days	For immunocompromised patients, the course is extended to 14 days
Shiga toxin-producing E. coli	Doubtful	No treatment required	No treatment required	The role of antibiotics is unclear; they are not usually prescribed because... they can cause hemolytic-uremic syndrome
				Avoid drugs that inhibit peristalsis
Shigella	Proven for dysentery	Ciprofloxacin 500 mg 2 times a day for 3 days or 2 grams once	Azithromycin 500 mg once a day for 3-5 days	The role of biseptol is limited due to the high percentage of resistance
				For immunocompromised patients, the course is extended to 7-10 days
			Ceftriaxone (Rocephin), 2- to 4-g single dose
Vibrio cholerae	Proven	Doxycycline 300 mg once	Azithromycin 1 gram once	Doxycycline and tetracycline are contraindicated in children, because may cause discoloration of teeth
			Tetracycline, 500 mg 4 times a day for 3 days
			Biseptol 960 mg 2 times a day for 3 days
Yersinia	For mild cases of the disease and enteritis, antibiotics are not indicated; for severe cases and bacteremia, antibiotics are indicated.		In severe cases:
			Doxycycline in combination with an aminoglycoside
			Biseptol 960 mg 2 times a day for 5 days
			Ciprofloxacin 500 mg 2 times a day for 7-10 days
Protozoans
Cryptosporidium	Maybe	Treatment is not necessary for immunocompetent patients or patients with AIDS with a CD4 count > 150 cells/mm3	For severe disease: nitazoxanide (Alinia) 500 mg 2 times a day for 3 days or longer for refractory disease in patients with AIDS
Cyclospora and Isospora	Proven	Biseptol 960 mg 2 times a day for 7-10 days
		HIV or immunosuppression: Biseptol 960 mg 2-4 times a day for 10-14 days, then 3 times a week as maintenance therapy
Entamoeba histolytica	Proven	Metronidazole 750 mg 3 times a day for 5-10 days plus paromomycin 25-35 mg/kg, divided into 3 doses a day for 5-10 days	Tinidazole 2 g per day for 3 days plus paromomycin 25-35 mg/kg, divided into 3 doses per day for 5-10 days	In severe cases and extraintestinal manifestations, including liver abscess, serological tests become positive
Giardia lamblia	Proven	Metronidazole 250-750 mg 3 times a day for 7-10 days	Tinidazole 2 g once	There may be relapses
	Proven	Albendazole 400 mg 2 times a day for 3 weeks		In patients with AIDS, highly active antiretroviral therapy, which achieves immune reconstitution, is sufficient to eradicate intestinal lesions.

Probiotics for acute diarrhea

The mechanism of action of probiotics is stimulation of the immune system and competition for binding sites on intestinal epithelial cells. Their use in children leads to a decrease in the severity and duration of the disease (on average by less than 1 day of illness). 46 Many types of bacteria are called “probiotics,” but in fact even related strains may have different clinical effects. Currently, evidence-based recommendations for the use of probiotics in adults have not yet been received. 16

Zinc preparations for acute diarrhea

Studies in children have shown that zinc supplements 20 mg for 10 days in children over two months of age play an important role in the treatment and prevention of acute diarrhea, especially in developing countries. A reduction in the risk of dehydration, severity and duration of a diarrheal episode has been shown to be approximately 20-40%. 47 In adults, more research is needed to demonstrate the beneficial effects of zinc.

Preventing Acute Diarrhea

Hygiene, hand washing, proper food preparation, and clean water are key factors in preventing acute diarrhea. 48 Public efforts to promote proper handwashing reduce the incidence of acute diarrhea by a third. 49 In developing countries, the development and use of new vaccines plays an important role. Currently, effective and safe vaccines against rotavirus, typhoid fever and cholera already exist, and vaccines against Campylobacter, enterotoxigenic E. coli and Shigella are being developed. To prevent epidemics, information about the occurrence of cases of certain dangerous infections must be brought to the attention of sanitary authorities. In the USA, such infections include cases of detection of V ibrio cholerae, Cryptosporidium, Giardia, Salmonella, Shigella and Shiga toxin-producing E. coli.

References:

1. Guerrant RL, Van Gilder T, Steiner TS, et al.; Infectious Diseases Society of America. Practice guidelines for the management of infectious diarrhea. Clin Infect Dis. 2001;32(3):331-351.

2. Kosek M, Bern C, Guerrant RL. The global burden of diarrhoeal disease, as estimated from studies published between 1992 and 2000. Bull World Health Organ. 2003;81(3):197-204.

3. Scallan E, Hoekstra RM, Angulo FJ, et al. Foodborne illness acquired in the United States. Emerging Infect Dis. 2011;17(1):7-15.

4. Scallan E, Griffin PM, Angulo FJ, Tauxe RV, Hoekstra RM. Foodborne illness acquired in the United States—unspecified agents. Emerging Infect Dis. 2011;17(1):16-22.

5. DuPont HL. Diarrheal diseases in the developing world. Infect Dis Clin North Am. 1995;9(2):313-324.

6. Hedberg CW, MacDonald KL, Osterholm MT. Changing epidemiology of food-borne disease: a Minnesota perspective. Clin Infect Dis. 1994;18(5):671-680.

7. Aranda-Michel J, Giannella RA. Acute diarrhea: a practical review. Am J Med. 1999;106(6):670-676.

8. Turgeon DK, Fritsche TR. Laboratory approaches to infectious diarrhea. Gastroenterol Clin North Am. 2001;30(3):693-707.

9. Jones TF, Bulens SN, Gettner S, et al. Use of stool collection kits delivered to patients can improve confirmation of etiology in foodborne disease outbreaks. Clin Infect Dis. 2004;39(10):1454-1459.

10. Centers for Disease Control and Prevention. Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food—10 states, 2009. MMWR Morb Mortal Wkly Rep. 2010;59(14):418-422.

11. DuPont HL. Guidelines on acute infectious diarrhea in adults. The Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol. 1997;92(11):1962-1975.

12. Hof H. History and epidemiology of listeriosis. FEMS Immunol Med Microbiol. 2003;35(3):199-202.

13. Janakiraman V. Listeriosis in pregnancy: diagnosis, treatment, and prevention. Rev Obstet Gynecol. 2008;1(4):179-185.

14. Thielman NM, Guerrant RL. Clinical practice. Acute infectious diarrhea. N Engl J Med. 2004;350(1):38-47.

15. Ilnyckyj A. Clinical evaluation and management of acute infectious diarrhea in adults. Gastroenterol Clin North Am. 2001;30(3):599-609.

16. Farthing M, Salam MA, Lindberg G, et al.; World Gastroenterology Organisation. Acute diarrhea in adults and children: a global perspective. J Clin Gastroenterol. 2013;47(1):12-20.

17. Guerrant RL, Shields DS, Thorson SM, Schorling JB, Gröschel DH. Evaluation and diagnosis of acute infectious diarrhea. Am J Med. 1985; 78(6B):91-98.

18. Gill CJ, Lau J, Gorbach SL, Hamer DH. Diagnostic accuracy of stool assays for inflammatory bacterial gastroenteritis in developed and resource-poor countries. Clin Infect Dis. 2003;37(3):365-375.

19. Chen CC, Chang CJ, Lin TY, Lai MW, Chao HC, Kong MS. Usefulness of fecal lactoferrin in predicting and monitoring the clinical severity of infectious diarrhea. World J Gastroenterol. 2011;17(37):4218-4224.

20. Choi SW, Park CH, Silva TM, Zaenker EI, Guerrant RL. To culture or not to culture: fecal lactoferrin screening for inflammatory bacterial diarrhea. J Clin Microbiol. 1996;34(4):928-932.

21. Hayakawa T, Jin CX, Ko SB, Kitagawa M, Ishiguro H. Lactoferrin in gastrointestinal disease. Intern Med. 2009;48(15):1251-1254.

22. Guerrant RL, Wanke CA, Barrett LJ, Schwartzman JD. A cost effective and efficient approach to the diagnosis and management of acute infectious diarrhea. Bull N Y Acad Med. 1987;63(6):484-499.

23. Gangarosa RE, Glass RI, Lew JF, Boring JR. Hospitalizations involving gastroenteritis in the United States, 1985: the special burden of the disease among the elderly. Am J Epidemiol. 1992;135(3):281-290.

24. Talan D, Moran GJ, Newdow M, et al.; EMERGEncy ID NET Study Group. Etiology of bloody diarrhea among patients presenting to United States emergency departments: prevalence of Escherichia coli O157:H7 and other enteropathogens. Clin Infect Dis. 2001;32(4):573-580.

25. Bauer TM, Lalvani A, Fehrenbach J, et al. Derivation and validation of guidelines for stool cultures for enteropathogenic bacteria other than Clostridium difficile in hospitalized adults. JAMA. 2001;285(3):313-319.

26. Manatsathit S, Dupont HL, Farthing M, et al.; Working Party of the Program Committee of the Bangkok World Congress of Gastroenterology 2002. Guideline for the management of acute diarrhea in adults. J Gastroenterol Hepatol. 2002;17(suppl):S54-S71.

27. Rohner P, Pittet D, Pepey B, Nije-Kinge T, Auckenthaler R. Etiological agents of infectious diarrhea: implications for requests for microbial culture. J Clin Microbiol. 1997;35(6):1427-1432.

28. Centers for Disease Control and Prevention. Vital signs: preventing Clostridium difficile infections. MMWR Morb Mortal Wkly Rep. 2012;61(9):157-162.

29. Siegel DL, Edelstein PH, Nachamkin I. Inappropriate testing for diarrheal diseases in the hospital. JAMA. 1990;263(7):979-982.

30. Shen B, Khan K, Ikenberry SO, et al.; ASGE Standards of Practice Committee. The role of endoscopy in the management of patients with diarrhea. Gastrointest Endosc. 2010;71(6):887-892.

31. Bellaiche G, Le Pennec MP, Slama JL, et al. The value of rectosigmoidoscopy and the bacteriologic culture of colon biopsies in the etiologic diagnosis of acute diarrhea of ​​adults. A prospective study of 65 patients in French. Ann Gastroenterol Hepatol (Paris). 1996;32(1):11-17.

32. Hahn S, Kim Y, Garner P. Reduced osmolarity oral rehydration solution for treating dehydration due to diarrhoea in children: systematic review. BMJ. 2001;323(7304):81-85.

33. Alam NH, Yunus M, Faruque AS, et al. Symptomatic hyponatremia during treatment of dehydrating diarrheal disease with reduced osmolarity oral rehydration solution. JAMA. 2006;296(5):567-573.

34. Duggan C, Nurko S. “Feeding the gut”: the scientific basis for continued enteral nutrition during acute diarrhea. J Pediatr. 1997;131(6):801-808.

35. Gadewar S, Fasano A. Current concepts in the evaluation, diagnosis and management of acute infectious diarrhea. Curr Opin Pharmacol. 2005;5(6):559-565.

36. De Bruyn G. Diarrhea in adults (acute). Am Fam Physician. 2008;78(4):503-504.

37. Taylor DN, Sanchez JL, Candler W, Thornton S, McQueen C, Echeverria P. Treatment of travelers' diarrhea: ciprofloxacin plus loperamide compared with ciprofloxacin alone. A placebo-controlled, randomized trial. Ann Intern Med. 1991;114(9):731-734.

38. Riddle MS, Arnold S, Tribble DR. Effect of adjunctive loperamide in combination with antibiotics on treatment outcomes in traveler’s diarrhea: a systematic review and meta-analysis. Clin Infect Dis. 2008;47(8):1007-1014.

39. Hanauer SB, DuPont HL, Cooper KM, Laudadio C. Randomized, double-blind, placebo-controlled clinical trial of loperamide plus simethicone versus loperamide alone and simethicone alone in the treatment of acute diarrhea with gas-related abdominal discomfort. Curr Med Res Opin. 2007;23(5):1033-1043.

40. DuPont HL, Hornick RB. Adverse effect of lomotil therapy in shigellosis. JAMA. 1973;226(13):1525-1528.

41. Matheson AJ, Noble S. Racecadotril. Drugs. 2000;59(4):829-835.

42. De Bruyn G, Hahn S, Borwick A. Antibiotic treatment for travelers' diarrhoea. Cochrane Database Syst Rev. 2000;(3):CD002242.

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45. McMahan ZH, DuPont HL. Review article: the history of acute infectious diarrhoea management—from poorly focused empiricism to fluid therapy and modern pharmacotherapy. Aliment Pharmacol Ther. 2007;25(7):759-769.

46. ​​Allen SJ, Martinez EG, Gregorio GV, Dans LF. Probiotics for treating acute infectious diarrhoea. Cochrane Database Syst Rev. 2010;(11): CD003048.

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48. World Health Organization. The treatment of diarrhoea. A manual for physicians and other senior health workers. 2005. http://whqlibdoc.who.int/publications/2005/9241593180.pdf. Accessed October 1, 2013.

49. Ejemot RI, Ehiri JE, Meremikwu MM, Critchley JA. Hand washing preventing for diarrhea. Cochrane Database Syst Rev. 2008;(1):CD004265.

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Acute diarrhea is a malfunction of the gastrointestinal tract, which is characterized by repeated release of liquid feces from the intestines. It develops in various diseases, including infectious ones, is painful and causes a lot of inconvenience.

The incidence of acute diarrhea is high and there are deaths depending on the etiology. High-risk groups include immunocompromised people, the elderly and newborns.

As a rule, diarrhea can be cured with the help of medications and folk remedies; there is no need to use specific therapy. The exception is patients with bloody diarrhea and other signs of intoxication. In such cases, patients are treated in a hospital setting, using special therapy and constantly monitoring the condition.

Acute diarrhea is characterized by bowel movements occurring three or more times a day, with loose or watery stools. If acute diarrhea in an adult lasts more than two weeks, it is called persistent, more than a month - chronic.

Diarrhea is a symptom of the disease. The condition for getting rid of the disease is an accurate diagnosis. Stool upset occurs as a result of food poisoning; such diarrhea is easier to deal with. Treatment is more difficult and longer if the cause is a dangerous infection.

Types of acute diarrhea

Acute diarrhea comes in several types, differing in symptoms, severity, treatment time and medications.

Secretory diarrhea occurs as a result of excess intake of electrolytes and water into the intestinal lumen. In rare cases, the cause is a decrease in the absorption functions of the intestine. Secretory occurs with cholera, salmonellosis. The appearance can be triggered by viruses, medications, biologically active substances, laxatives, and castor oil.

Hyperexudative diarrhea is accompanied by the release of blood and mucus from the intestines. Indicates the occurrence of an infectious-inflammatory disease or ulcerative colitis.

Hyperosmolar diarrhea begins due to impaired absorption of nutrients in the small intestine. Metabolic processes in the body are disrupted. Undigested food is found in loose and copious stools.

Manifestations of hyper- and hypokinetic diarrhea are frequent loose stools. These varieties occur in patients suffering from neuroses and irritable bowel syndrome.

Causes and symptoms of the condition

Viruses and bacteria are the main causes of acute diarrhea, which can enter the body in different ways. Sometimes diarrhea occurs due to nervousness. Preceded by a state of anxiety and stress. When drawing up a clear clinical picture, the doctor finds out the circumstances of infection or the onset of the disease. The affected small intestine results in watery, large stools caused by malabsorption. The affected large intestine is characterized by the presence of blood in the stool, and the urge occurs suddenly. Important factors to help determine the causes of diarrhea:

1. Recent travels.
2. Close communication with pets.
3. Drinking water from sources of unknown origin.
4. Foods eaten, especially vegetables and fruits.
5. Treatment with antibiotics.

The main symptoms of acute diarrhea:

• stomach ache;
• loose or watery stools;
• frequent and sudden urge to have bowel movements;
• blood, pus in stool;
• nausea, vomiting, belching;
• increased body temperature;
• weakness and fever.

If diarrheal symptoms are mild, medical intervention is not necessary. Bed rest, adsorbents and drinking plenty of water will help. In such cases, the usual concern is bowel movements several times in a row with a short interval of time, and slight pain in the abdominal area. There were no chills, fever, vomiting, or blood in the stool.

But if the temperature has risen, acute pain is present, there is a strong fever, intense vomiting does not stop and diarrhea does not stop for a long time, consultation with a specialist is required. In some cases, with severe infectious diseases, complete recovery is only possible in the hospital. In some forms, a complete medical and bacteriological examination is required. This condition is considered dangerous in older people and children.

Diarrhea causes dehydration of the body. A mild course of the disease involves replenishing fluid in the body naturally in the form of water, fruit juices, tea, broth, compote, and fruit juice. Excessive fluid loss and severe dehydration require intravenous infusions of water-salt solutions or oral formulations, which are no less effective.

At home, a prepared composition will help: half a teaspoon of salt, a teaspoon of soda, eight teaspoons of granulated sugar, a glass of orange juice are mixed, supplemented with water to one liter. It is recommended to drink the solution, supplemented with other types of liquid.

A remedy for severe acute diarrhea is an essential component of a home first aid kit. Diarrhea appears suddenly and can be stopped by taking medications. A first aid kit should be a constant companion on long journeys and minor trips. The need to stop particularly severe acute diarrhea on the road often arises. Lack of hygiene, poor quality food, and excessive anxiety can trigger the onset of the disease at any moment.

There are drugs containing the active substance - loperamide. Carrying stops after an hour after taking the pill. These include:

• loperamide;
• imodium;
• suprelol;
• lopedium;
• diara.

The remedies are applicable for diarrhea of ​​non-infectious origin caused by eating poor-quality food, stress, and changes in climatic conditions. If you have an infectious disease, use is contraindicated. The drugs are available in the form of capsules, tablets, drops. The dosage for an adult is initially 2 tablets, and one after each trip to the toilet. You can take up to eight capsules per day. Children's dose: 3 loperamide tablets per day. The drugs are first aid.

When diarrhea is caused by intoxication - bacterial, viral, allergic, enterosorbents come to the rescue, removing toxins and protecting the stomach walls from irritation.

1. Adults take Enterosgel 3 times a day, a tablespoon, children from seven to twelve years old - a dessert spoon, from two to seven - a teaspoon, infants - half a teaspoon.
2. Smecta is diluted in half a glass of water. Adults take up to six packets per day, four are enough for children, and one packet for children under two years of age.
3. Polysorb, Silix, Atoxil act on the body in a similar way; drug intake is calculated depending on the person’s weight.
4. Polyphepan is the optimal remedy for babies. Children under one year old are given one teaspoon diluted in 50 grams of water. For adults and children, dilute a tablespoon in the same amount of water.
5. Gastrolite helps normalize water and electrolyte balance. Contains: sodium and potassium chloride, sodium bicarbonate, chamomile extract, glucose. The daily dose for an adult is 1 liter, divided into several doses. Children 3-12 years old take 100 ml for the first 4 hours, then 50 ml, from one to three years - 50 ml, then 10 ml; infants are given the drug at the rate of 50 ml per kilogram of weight per day.
6. Filtrum-sti is used for viral diarrhea and acute food poisoning. Adults take 2 - 3 tablets 3 times a day, in children from 7 to 12 years old the dose is reduced to 1-2 tablets in three doses, from 4 to 7 years it is permissible to take 3 tablets per day, 1-3 years - ½ pills.
7. Activated carbon is taken at the rate of one tablet per ten kilograms of weight. Children are recommended to take no more than 3 tablets per dose.

For diarrhea of ​​infectious etiology, the following drugs are considered effective:

• Enterofuril;
• Phthalazol;
• Furazolidone;
• Enterol;
• Sulgin;
• Intetrix;
• Nifuroxoside;
• Stop diar.

If there is any doubt when choosing a medicine, you should consult a doctor for advice.

Possible complications

If an acute form occurs, self-medication can be dangerous. If symptoms are pronounced, medical intervention is required. Diarrhea leads to complications. First of all, dehydration of the body, leading to death.

Human systems and organs require fluid to function; if there is a lack of it, the body’s functioning will malfunction. It is necessary to ensure that a patient suffering from acute diarrhea constantly replenishes lost fluid.

If the condition worsens, rapid heartbeat, convulsions, partial loss of consciousness are observed, you should urgently call an ambulance.

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Diarrhea is a symptom that manifests itself in the form of loose, frequent (more than 3 times a day) stools and is accompanied by flatulence and pain in the abdominal area. It is divided into acute (which lasts up to two weeks) and chronic.

With diarrhea, the normal functioning of the gastrointestinal tract is disrupted, and this leads to the fact that the digestive process accelerates, the stool becomes liquefied and the number of bowel movements increases accordingly.

Types of diarrhea

Reasons

Most often, diarrhea occurs for the following reasons:

• Bacterial infections caused by E. coli, salmonella, dysentery, foodborne illnesses, cholera;
• Viral infections, which can cause rotavirus, adenovirus, enterovirus;
• Enzyme deficiency;
• Intestinal diseases;
• Tumors;

• Poisoning with nitrates, heavy metals, household chemicals;
• Taking medications: antibiotics, laxatives, cytostatics;
• Gastrointestinal bleeding;
• In pregnant women, hormonal changes may cause diarrhea;
• Diarrhea at 36–40 weeks of pregnancy may indicate that labor is approaching.

Associated symptoms

Diarrhea may be accompanied by:

What diseases may this indicate?

A symptom such as diarrhea may indicate the following pathologies:

• Infectious diseases: dysentery, salmonellosis;
• Endocrine diseases: thyrotoxicosis, diabetes mellitus;
• Diseases of the large intestine: various types of colitis, polyposis;
• Hormonally active neoplasms: thyroid carcinoma, gastrinoma;
• Diseases of the small intestine: Crohn's disease, celiac disease, Whipple's disease,;
• Disorders of the stomach after resection or with atrophic or;
• or ;
• Infectious diseases: dysentery, cholera.

The color and consistency of stool with diarrhea may indicate the disease:

• Heterogeneous stool with green specks and mucus indicates a viral or bacterial infection;
• Yellow, semi-formed stool indicates increased intestinal motility;
• Black diarrhea is a sign of bleeding from the stomach. It can also occur when eating products based on animal blood, blueberries, beets, or taking bismuth preparations;
• White diarrhea indicates problems with the liver or gall bladder.

Treatment of diarrhea

Treatment for diarrhea depends on what exactly caused it:

• If it is an infection, in this case the following are prescribed: antibiotics, drugs that slow down peristalsis, sorbents and enzymes;
• For enzymatic deficiency: enzymes;
• For diarrhea caused by taking medications, antifungal drugs, eubiotics and sorbents are prescribed;
• For intestinal diseases: glucocorticoid hormones, antibiotics.

It must be remembered that diarrhea is a symptom, and the cause of its occurrence must be eliminated.

In order to quickly relieve this symptom, you can use the following medications:

Traditional methods that help quickly get rid of diarrhea:

• Black pepper. In order to stop diarrhea, you need to take 7 peppercorns and drink it with enough water;
• Vodka with salt. To prepare the product, add 80 ml of vodka, 3 g of salt, stir and drink immediately;
• Loose leaf tea. Chew a pinch of black leaf tea slowly, then wash it down with water;

Complications

Since diarrhea is a symptom, the disease itself that causes it is dangerous. Its consequences are.