사상의학에서의 설사에 관한 고찰

송은영,채광민,이준희,이의주,고병희,Song, Eun-Young,Chai, Kwang-Min,Lee, Jun-Hee,Lee, Eui-Ju,Koh, Byung-Hee 사상체질의학회 2013 사상체질의학회지 Vol.25 No.4

Objectives This study was aimed to propose the guideline of the diarrhea in Sasang Constitutional Medicine. Methods 1) Literature search It was investigated that the prescriptions stated the diarrhea as a main and accessory symptoms to be treated in "Donguisasangshinpyun", "Donguisusebowon Sasang Chobongwon", "Donguisusebowon Gabobon", "Donguisusebowon Sinchukbon", "Dongmuyugo" 2) Clinial paper search (1) The foreign papers were searched by using the search word with 'Sasang AND Diarrhea' in pubmed (http://www.ncbi.nlm.nih.gov/pubmed/) and The Cochrane Library(http://www.thecochranelibrary.com) (2) The domestic papers were searched by using the search word with 'Soeumin AND Diarrhea', 'Soyangin AND Diarrhea', 'Taeeumin AND Diarrhea', 'Taeyangin AND Diarrhea', 'Sasang AND Diarrhea' in NDSL (http://www.ndsl.kr), KISS(http://kiss.kstudy.com), Oasis(http://oasis.kiom.re.kr), RISS(http://www.riss.kr) (3) The extracted factors were the evaluations on the mainly complained symptom, adopted four constitutional therapy and efficacy. Results & Conclusions The guidelines for treating the diarrhea in the Four Constitutional Medicine are as follows. 1) It is to categorize the constitution. 2) The diarrhea of taeeumin is prescribed with 'A Series of Taeeumjowi-tang, Galgeunhaegi-tang, Cheongsimyeonja-tang, Sahyang-san, etc'. by classifying into cold, fever, consumption and addiction. 3) The diarrhea of soyangin is regarded as an internal disease and it is prescribed with 'Baekhaobuja-tang, Baekhaobujaijung-tang, etc'. by classifying taeeum symptom and so-yin symptom. 4) The diarrhea of soeumin is Mangeum-disease and 'Jeoryeongchajeonja-tang, Hyeongbangsabaek-san, Hwalseokgosam-tang, Hyeongbanggihwang-tang, etc'. is prescribed depending on the complication.

설사로 내원한 환자의 진단 및 치료

이상혁 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.2

Diarrhea is common symptom in adults and children. This review article suggest practical, simple, and appropriate approach to the diagnosis and management of patients with acute and chronic diarrhea. Most patients with diarrhea do not seek medical attention, but patients who have had symptoms for more than a few days or who have coexisting fever, prostration, or rectal bleeding are likely to present for evaluation. Diarrhea in the immunocompromised host, traveler's diarrhea, and diarrhea in the hospitalized patient are also discussed. After an adequate history and physical examination, the clinician should be able to classify the acute diarrheal illness, access the severity, and determine whether investigations are needed. The management is mainly focused to preventing dehydration. Many kind of home remedies are used for mild, self-limited diarrhea and they frequently suffice it. But, in large volume, dehydrating diarrhea, oral rehydration solutions should be used, as they are formulated to stimulate sodium and water absorption and intravenous fluid also should be used in severe case. Antidiarrheal agents can be useful in reducing the number of bowel movements and diminishing the magnitude of fluid loss. Antibiotic therapy is not required in most patients with acute diarrheal disorders. Chronic diarrhea is not as common as acute diarrhea to practitioners and internists. The differential diagnosis is complex, and the variety of tests applicable to these patients can be bewildering. Secretory diarrhea has a broad differential diagnosis. Osmotic diarrhea has a more limited differential diagnosis. It sometimes need evaluation for chronic inflammatory causes and steatorrhea. The most important therapy for chronic diarrhea is to ensure that fluid and electrolyte deficits are repaired. Empiric therapy is frequently used in patients with in three situations: (1) as a temporizing or initial treatment before diagnostic testing; (2) after diagnostic testing has failed to confirm a diagnosis; and (3) when a diagnosis has been made, but no specific treatment is available or specific treatment fails to produce a cure. Guidelines for their use are presented.

Effect of Saccharomyces boulardii CNCM-I 3799 and Bacillus subtilis CU-1 on Acute Watery Diarrhea: A Randomized Double-Blind Placebo-Controlled Study in Indian Children

Ghosh, Apurba,Sundaram, Balasubramaniam,Bhattacharya, Piyali,Mohanty, Nimain,Dheivamani, Nirmala,Mane, Sushant,Acharyya, Bhaswati,Kamale, Vijay,Poddar, Sumon,Khobragade, Akash,Thomas, Winston,Prabhude The Korean Society of Pediatric Gastroenterology 2021 Pediatric gastroenterology, hepatology & nutrition Vol.24 No.5

Purpose: To assess the effect of combination probiotic Saccharomyces boulardii CNCM-I 3799 and Bacillus subtilis CU-1 in outpatient management of acute watery diarrhea in children. Methods: A randomized double-blind placebo-controlled study was conducted in 180 participants aged six months to five years with acute mild to moderate diarrhea. All were enrolled from six centers across India and centrally randomized to receive S. boulardii CNCM-I 3799 and B. subtilis CU-1 or a placebo along with oral rehydration salts and zinc supplementation. Each participant was followed up for three months to assess recurrence of diarrhea. Results: The mean duration of diarrhea in the probiotic and placebo groups were 54.16 hours and 59.48 hours, respectively. The difference in the duration of diarrhea in those administered with probiotic or placebo within 24 hours of diarrhea onset was 25.21 hours. Furthermore, the difference in duration of diarrhea was 13.84 hours (p<0.05) for participants who were administered with probiotics within 48 hours. There were no significant differences in the stool frequencies between the two arms. After three months, 15% in the probiotic group and 18.5% in the placebo group reported episodes of diarrhea. The mean duration of diarrhea was considerably lower in the probiotic group, 31.02 hours versus 48 hours in placebo (p=0.017). Conclusion: S. boulardii CNCM-I 3799 and B. subtilis CU-1 combination was effective in reducing the duration of diarrhea when administered within 48 hours of diarrhea onset. Similarly, it reduced recurrence of diarrhea and its intensity in the subsequent three months.

헬리코박터 파일로리 제균 치료와 연관된 설사

Hoon Gil Jo,Yong Sung Kim 대한상부위장관ㆍ헬리코박터학회 2021 Korean Journal of Helicobacter Upper Gastrointesti Vol.21 No.3

Eradication of Helicobacter pylori has contributed to the treatment of peptic ulcers and mucosa-associated lymphoid tissue lymphoma. Moreover, it has possibly decreased the prevalence of gastric cancer. However, eradication therapy is associated with various adverse effects, of which diarrhea is the most common. The incidence of diarrhea after eradication treatment varies from 8% to 48%. In particular, the incidence is higher in patients who receive first-line standard triple therapy compared with those who receive second-line therapy. Both antibiotics and proton pump inhibitors, components of eradication therapy, have short-term and long-term impacts on gut microbiota. The alterations of gut microbiota may not recover until 1 year after eradication therapy. Most cases of diarrhea that occur after eradication therapy are antibiotic-associated diarrhea caused by the destruction of the normal gut microbiota. In some cases, Clostridioides difficile-associated diarrhea occurs after eradication therapy. If bloody diarrhea occurs after eradication therapy and the Clostridioides difficile toxin is not detected, antibiotic-associated hemorrhagic colitis associated with Klebsiella oxytoca infection should be suspected. It is crucial to explain the possibility of diarrhea before initiating eradication therapy to increase compliance. Furthermore, probiotics may be administered to reduce diarrhea. If severe diarrhea or symptoms other than the usual antibiotic-associated diarrhea occur during or after eradication therapy, antibiotics should be discontinued. In addition, appropriate tests to determine the cause of diarrhea should be performed. This review summarizes the alteration of the gut microbiota, the causes of diarrhea after Helicobacter pylori eradication therapy, and its management.

중환자실 입원 환자의 설사 발생과 영향요인: 후향적 조사

이한나(Lee, Hanna),송라윤(Song, Rhayun) 기본간호학회 2019 기본간호학회지 Vol.26 No.4

Purpose: This study was done to examine incidence of diarrhea and explore factors influencing occurrence of diarrhea in patients admitted to intensive care units (ICU). Methods: For this retrospective research, data based on inclusion criteria were collected from the electronic medical records for 142 patients admitted to a university hospital ICU from September 2014 to August 2015. Statistical analysis was conducted using SPSS/WIN 22.0 program. Results: Incidence of diarrhea was 53.5% during the 12-month study period. Diarrhea occurred at 4.54 days and continued for 1.79 days on average. Average total frequency of diarrhea was 5.56 times. Increased ICU stay, enteral nutrition, and infection state were significant predictors of the occurrence of diarrhea. Infection increased risk of diarrhea 3.4 times and enteral nutrition increased risk of diarrhea to 2.2 times greater than patients not receivng enteral nutrition. Conclusion: Diarrhea in ICU patients is associated with multiple factors that should be considered to implement preventive strategies. Infection control should be emphasized, and close monitoring of diarrhea should be provided for those with enteral nutrition. Further studies are warranted to determine standardized clinical definition of diarrhea and diarrhea risk factors in ICU patients with different levels of severity and comorbidity.

전남동부지방의 설사자돈에 대한 역학조사

위성하 ( Sung Ha Wee ),박장일 ( Jang Il Park ),임종수 ( Jong Soo Lim ) 한국가축위생학회 1996 韓國家畜衛生學會誌 Vol.19 No.1

This study was perfomed to examine the distribution of causative agent of piglets diarrhea in eastern Chonnam province from February 1994 to March 1995. The causative agents of diarrhea were examined by bacterial culture test, parasitological test and serological test against PED, TGE and Rota. The 35 isolated E. coli were tested for antibiotic sensitivity. The results obtained were as follows. 1. The incidence of 81 piglets with diarrhea was most prevalent as 39.5% in the age of 2 to 4 weeks, compare to 34.6% in the age of 5 to 8 weeks and 16.0% under 1 weeks and 9.9% in the age of 9 to 11 weeks after birth. 2. The incidence of 81 piglets diarrhea showed bacterial diarrhea(75.3%), viral diarrhea(35.8%) and parasitological diarrhea(18.5%). When compared the isolation frequency of each etiological agent, enteropathogenic E. coli was most prevalent as 55.5% in bacterial diarrhea, rotavirus enteritis as 18.5% in viral diarrhea and trichuriasis as 13.6% in parasitological diarrhea. 3. The complicated infection of piglets was most prevalent as 41.7% in rotavirus enteritis with enteropathogenic E. coli in 24 complicated piglets diarrhea. 4. In antibiotic sensitivity test, isolates showed moderatly resistance to Tobramycin, Amikacin, Imipenem, Trimethoprim/Sulfamethoxazole, Gentamicin, Ampicillin but sensitivty to Ticarcillin/K. The 30 E. coli isolate showed multiple drug resistances in 3 different antibiotics.

REVIEW : Pharmacologic Agents for Chronic Diarrhea

( Kwang Jae Lee ) 대한장연구학회 2015 Intestinal Research Vol.13 No.4

Chronic diarrhea is usually associated with a number of non-infectious causes. When definitive treatment is unavailable, symptomatic drug therapy is indicated. Pharmacologic agents for chronic diarrhea include loperamide, 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists, diosmectite, cholestyramine, probiotics, antispasmodics, rifaximin, and anti-inflammatory agents. Loperamide, a synthetic opiate agonist, decreases peristaltic activity and inhibits secretion, resulting in the reduction of fluid and electrolyte loss and an increase in stool consistency. Cholestyramine is a bile acid sequestrant that is generally considered as the first-line treatment for bile acid diarrhea. 5-HT3 receptor antagonists have significant benefits in patients with irritable bowel syndrome (IBS) with diarrhea. Ramosetron improves stool consistency as well as global IBS symptoms. Probiotics may have a role in the prevention of antibiotic-associated diarrhea. However, data on the role of probiotics in the treatment of chronic diarrhea are lacking. Diosmectite, an absorbent, can be used for the treatment of chronic functional diarrhea, radiationinduced diarrhea, and chemotherapy-induced diarrhea. Antispasmodics including alverine citrate, mebeverine, otilonium bromide, and pinaverium bromide are used for relieving diarrheal symptoms and abdominal pain. Rifaximin can be effective for chronic diarrhea associated with IBS and small intestinal bacterial overgrowth. Budesonide is effective in both lymphocytic colitis and collagenous colitis. The efficacy of mesalazine in microscopic colitis is weak or remains uncertain. Considering their mechanisms of action, these agents should be prescribed properly. (Intest Res 2015;13:306-312)

How to Do in Persistent Diarrhea of Children?: Concepts and Treatments of Chronic Diarrhea

이건송,Dong Soo Kang,유지숙,장영표,Woo Sung Park 대한소아소화기영양학회 2012 Pediatric gastroenterology, hepatology & nutrition Vol.15 No.4

Chronic diarrhea is defined as passing watery stools that lasts for more than 2 weeks. Persistent diarrhea belongs to chronic diarrhea and is a chronic episode of diarrhea of infectious etiology. The etiology of chronic diarrhea is varied. It is important to consider the child’s age and clinical manifestations with alarm signals for an application of proper treatments to children with chronic diarrhea. Vicious cycle is present in chronic diarrhea and nutritional rehabilitation can break the vicious cycle of chronic diarrhea and is one of the main one thing among treatments. We should know the exact concept of chronic diarrhea and provide appropriate treatments according to etiologies of chronic diarrhea.

Clinical characteristics of coronavirus disease 2019 patients with diarrhea in Daegu

Min Kyu Kang,김경옥,Min Cheol Kim,Joon Hyun Cho,Sung Bum Kim,Jung Gil Park,Kook Hyun Kim,See Hyung Lee,장병익,Tae Nyeun Kim 대한내과학회 2020 The Korean Journal of Internal Medicine Vol.35 No.6

Background/Aims: Coronavirus disease 2019 (COVID-19) can reportedly cause gastrointestinal symptoms. Therefore, we investigated the clinical characteristics of COVID-19 patients with diarrhea. Methods: We included 118 COVID-19 patients admitted to a single hospital from February 20 to March 31, 2020. Medical records with clinical characteristics, laboratory data, treatment course, and clinical outcomes were compared based on the presence or absence of diarrhea. Prognostic factors for disease severity and mortality in COVID-19 were also assessed. Results: Among patients, 54 (45.8%) had diarrhea, whereas seven (5.9%) had only diarrhea. The median age of patients with diarrhea was 59 years (44 to 64), and 22 (40.7%) were male. Systemic steroid use, intensive care unit admission, septic shock, and acute respiratory distress syndrome were less frequent in the diarrhea group than in the non-diarrhea group. No significant differences were observed in total hospital stay and mortality between groups. On multivariate analysis, age (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.01 to 1.12; p = 0.044), diabetes (OR, 3.00; 95% CI, 1.25 to 20.47; p = 0.042), and dyspnea (OR, 41.19; 95% CI, 6.60 to 823.16; p < 0.001) were independent risk factors for septic shock. On Cox regression analysis, diabetes (hazard ratio [HR], 4.82; 95% CI, 0.89 to 26.03; p = 0.043) and chronic obstructive pulmonary disease (HR, 16.58; 95% CI, 3.10 to 88.70; p = 0.044) were risk factors for mortality. Conclusions: Diarrhea was present in 45.8% of patients and was a common symptom of COVID-19. Although patients with diarrhea showed less severe clinical features, diarrhea was not associated with disease severity or mortality.

Rectal Mechano-sensory Function in Patients with Carcinoid Diarrhea

( Tine Gregersen ),( Christina Brock ),( Anne Mette Haase ),( Søren Laurberg ),( Asbjørn M Drewes ),( Henning Grønbæk ),( Klaus Krogh ) 대한소화기기능성질환·운동학회 2016 Journal of Neurogastroenterology and Motility (JNM Vol.22 No.2

Background/Aims In patients with neuroendocrine tumors, excessive production of serotonin and other amines may cause the carcinoid syndrome, which is mainly characterized by diarrhea and flushing. Little is known about the pathophysiology of carcinoid diarrhea. In several other groups of patients, diarrhea may be associated with rectal hypersensitivity and increased rectal tone. Therefore, the aim of the present study was to compare rectal sensitivity and compliance in patients with carcinoid diarrhea and in healthy subjects. Methods Twelve patients (6 males, aged 54-78 years, median 65 years), with carcinoid diarrhea and 19 healthy subjects (7 males, aged 50-78 years, median 61 years) were included. Rectal mechanical and heat stimulation was used for assessment of rectal mechano-sensory properties. Results Overall, 5.3% higher temperatures were needed to elicit sensory responses in patients with carcinoid diarrhea than in healthy subjects (P = 0.015). Posthoc analyses revealed that the sensory threshold to heat was 48.1 ± 3.1oC in patients vs 44.7 ± 4.7oC in healthy subjects (P = 0.041). In contrast, patients and healthy subjects showed no overall differences in rectal sensory response to mechanical distension (P = 0.731) or rectal compliance (P = 0.990). Conclusions Patients with carcinoid diarrhea have higher sensory thresholds to heat stimulation in comparison to healthy subjects, but normal rectal sensation to mechanical distension and normal compliance. Therefore, treatment of carcinoid diarrhea should aim at prolonging gastrointestinal transit and decreasing secretion, rather than modifying rectal mechano-sensory function. (J Neurogastroenterol Motil 2016;22:264-271)