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

 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

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

TREATMENT OF IBD

CELIAC DISEASE

COLLAGENOUS COLITIS

CLOSTRIDIUM DIFFICILE

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

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

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:

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:

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?