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HIGH VALUE CARE GI CONDITIONS CHRONIC DIARRHEA EDWARD LEVINE MD OSUWMC OCTOBER 11, 2014.

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Presentation on theme: "HIGH VALUE CARE GI CONDITIONS CHRONIC DIARRHEA EDWARD LEVINE MD OSUWMC OCTOBER 11, 2014."— Presentation transcript:

1 HIGH VALUE CARE GI CONDITIONS CHRONIC DIARRHEA EDWARD LEVINE MD OSUWMC OCTOBER 11, 2014

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3 HOW DO WE DEFINE DIARRHEA VOLUME OF STOOL? FREQUENCY OF STOOL? CONSISTENCY OF STOOL?

4 HOW DO WE APPROACH DIARRHEA  PATHOPHYSIOLOGY  ACUTE DIARRHEA  CHRONIC DIARRHEA  SMALL BOWEL  COLONIC

5 ACUTE DIARRHEA  CHRONIC DIARRHEA

6 CHRONIC DIARRHEA

7  IBS  IBD  CELIAC DISEASE  COLLAGENOUS COLITIS  C DIFF

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11 ? SIBO

12 MEDICAL RX FOR GAS  DIETARY RESTRICTIONS – LACTOSE FREE DIET, FRUCTOSE FREE DIET, GFD,FODMAP DIET  ENZYMES - BEANO  CHARCOAL  PROBIOTICS  ANTIBIOTICS

13 GAS EATER UNDERWEAR BUY AT

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18 EVALUATION FOR IBD  CBC, IRON STUDIES, CR, LFT’S, TSH, CRP, STOOL CULTURES  COLONOSCOPY  MRE/CTE  CAPSULE ENDOSCOPY

19 TREATMENT OF IBD

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21 CELIAC DISEASE

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25 COLLAGENOUS COLITIS

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27 CLOSTRIDIUM DIFFICILE

28 FMT  NOT NEW!!!!!!!!!!!  FIRST DESCRIPTION FROM CHINA IN THE 4 TH 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

29 FMT  DISTAL GI TRACT CONTAINS A DIVERSE ARRAY OF MICROORGANISMS, OF WHICH BACTERIA IS THE MOST DOMINANT WITH AT LEAST 1 X TH 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

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31 Diversity in Patients before and after Infusion of Donor Feces, as Compared with Diversity in Healthy Donors. van Els Van Nood et al. NEJM. 2013; 368:

32 without Relapse for Recurrent Clostridium difficile Infection. van Nood E et al. N Engl J Med 2013;368: Els Van Nood et al. NEJM. 2013; 368:

33 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

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36 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?

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