Drugs

Do NSAIDs increase the risk of Lower Gastrointestinal Bleeding?  Several case-control studies show a two- to threefold increase in LGIB with a variety of different NSAIDs. One large study in patients with rheumatoid arthritis comparing naproxen with rofecoxib demonstrated that the use of COX-2–selective inhibitors may decrease this rate by 54%. However more recent analysis …

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What are the indications for antibiotics in acute infectious diarrhea?  Antibiotic use for acute diarrhea depends largely on the infectious agent. In the developed world, most acute diarrhea is self-limited and viral, rendering antibiotics moot. In cases in which a particular pathogen is confirmed or highly suspected ( C. difficile, Giardia, EHEC, ETEC, EIEC, Shigella spp., Isospora, Microsporidia, Cyclospora, E. …

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Do antiparasitic agents (APAs) play a role in the treatment of acute diarrhea?  For immunocompetent patients in the developed world, empiric APAs play no role in the management of acute diarrhea. In patients in the developing world or those who are immunosuppressed, treatment should be guided based on the results of testing as there is …

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What is the role of antimotility agents (AMAs) in the treatment of acute infectious diarrhea?  Most episodes of acute diarrhea are self-limited, lasting less than 24 hours, and do not require AMAs. For longer lasting diarrheal illnesses, these agents may decrease total diarrhea duration, thus improving quality of life. In general, AMAs are safe for …

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What is the role of lubiprostone in IBS?  Lubiprostone is a chloride channel activator that increases secretions in the intestines, thereby increasing bowel transit. It acts locally on the epithelial cells that line the intestines and is rapidly metabolized, which leads to low systemic bioavailability. At a dose of 8 mcg twice daily, lubiprostone has …

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What is the role of linaclotide in IBS?  Linaclotide was recently approved by the FDA for adults with IBS-C and chronic idiopathic constipation. It is a minimally absorbed 14-amino-acid peptide that binds to and activates the guanylate cyclase C receptor. In two large, randomized trials, linaclotide resulted in improvement in abdominal pain, bowel function, and …

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What is the role of laxatives in IBS?  When constipation associated with IBS does not improve with fiber, low-dose laxatives can improve bowel function. Osmotic laxatives should be tried first as they tend to be gentler and cause fewer side effects such as cramps and diarrhea. Although effective at improving bowel function, osmotic laxatives such …

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