Steatorrhea medical therapy: Difference between revisions

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__NOTOC__
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{{Steatorrhea}}
{{Steatorrhea}}
{{CMG}}; {{AE}}{{Vbe}}
{{CMG}} ; {{AE}} {{Vbe}} {{ADG}}
 
 
 
==Overview==
==Overview==
Management of [[steatorrhea]] include treatment of underlying etiology, control of [[diarrhea]] and correction of [[nutritional deficiencies]].


==Medical Therapy==
==Medical Therapy==
Medical management of steatorrhea include treatment of underlying etiology.
Management of [[steatorrhea]] include treatment of underlying etiology, control of [[diarrhea]] and correction of [[nutritional deficiencies]].<ref name="pmid2509353">{{cite journal |vauthors=Marotta RB, Floch MH |title=Dietary therapy of steatorrhea |journal=Gastroenterol. Clin. North Am. |volume=18 |issue=3 |pages=485–512 |year=1989 |pmid=2509353 |doi= |url=}}</ref><ref name="pmid5917827">{{cite journal |vauthors= |title=Varieties of steatorrhea |journal=Br Med J |volume=2 |issue=5524 |pages=1214–5 |year=1966 |pmid=5917827 |pmc=1944784 |doi= |url=}}</ref><ref name="pmid8878143">{{cite journal |vauthors=Koch J, Garcia-Shelton YL, Neal EA, Chan MF, Weaver KE, Cello JP |title=Steatorrhea: a common manifestation in patients with HIV/AIDS |journal=Nutrition |volume=12 |issue=7-8 |pages=507–10 |year=1996 |pmid=8878143 |doi= |url=}}</ref>
* '''Celiac disease'''
=== Correction of Nutritional Deficiencies ===
** Refractory disease
* Oral supplementation with vitamins and minerals is usually well tolerated in patients who are are undergoing specified treatment for underlying etiology.
* Rapid recovery following the identification of a nutritional deficiency can be achieved by supplementation with 5 to 10 times the Recommended Dietary Allowance.
** Preferred regimen (1) : [[Vitamin A]] 40,000 to 50,000 units q12h
*** Note : Maintenance: 8000 to 20,000 units/day (dosage ≥15,000 units can be [[teratogenic]])
** Preferred regimen (2) : [[Vitamin D3]] ([[cholecalciferol]]) 30,000 to 50,000 units q24h
** Preferred regimen (3) : [[Vitamin K]] 2.5 to 12.5 mg q24h
** Preferred regimen (4) : [[Folic acid]] 5 mg q24h during repletion
** Preferred regimen (5) : [[Vitamin B12]] ([[cyanocobalamin]]) 1 mg [[Subcutaneous|subcutaneously]]
** Preferred regimen (6) : [[Ferrous sulfate]] 325 mg (65 mg elemental [[iron]]) q8h
** Preferred regimen (7) : [[Magnesium gluconate]] 1 to 4 g (54 to 216 mg elemental [[magnesium]]) q6h
** Preferred regimen (8) : [[Calcium carbonate]] 500 mg (elemental [[calcium]]) q12h
 
=== Antidiarrheal agents ===
*Preferred regimen (1) : [[Loperamide]] 2 to 4 mg as needed, not to exceed 12 mg/day
*Preferred regimen (1) : [[Diphenoxylate and Atropine|Diphenoxylate with atropine]] ([[Lomotil]]) 1 to 2 tabs after loose stool, not to exceed 8 per day
*Preferred regimen (1) : [[Opium Deodorized|Deodorized opium tincture]] 10 percent (10 mg per mL) 0.3 to 0.6 mL q8h
=== Bile acid binding resins ===
:* Preferred regimen (1) : [[Cholestyramine]] 4 g three times daily
:* Preferred regimen (1) : [[Colestipol]] granules 5 to 10 g three times daily
:** Note: Administer ≥1 hour before or >4 hours after other drugs to prevent decreased absorption of other drugs.
===Pancreatic enzymes===
* Preferred regimen (1) : Pancrelipase delayed-release capsules (Creon minimicrospheres)
* Preferred regimen (1) : [[Pancrelipase]] tablets and powder (Viokase) 1 g
* (equivalent to 20,000 units [[lipase]] component) with meals
** Note:  Approximately 30,000 units (90,000 USP) ([[lipase]] component) with each meal.


*** A minority of patients suffer from refractory disease, which means they do not improve on a [[gluten-free diet]]. This may be because the disease has been present for so long that the intestines are no longer able to heal on diet alone or the patient is not adhering to the diet, or the patient is consuming foods that contain [[gluten]]. Pharmacotherapy is used if dietary modification is not effective.<ref name="pmid20332526">{{cite journal |vauthors=Rubio-Tapia A, Murray JA |title=Classification and management of refractory coeliac disease |journal=Gut |volume=59 |issue=4 |pages=547–57 |year=2010 |pmid=20332526 |pmc=2861306 |doi=10.1136/gut.2009.195131 |url=}}</ref>
=== Management of Underlying Etiologies ===
* For a detailed explanation of management of Crohn's disease click [[Crohn's disease medical therapy|here]]
* For a detailed explanation of management of celiac disease click [[Celiac disease medical therapy|here]]
* For a detailed explanation of management of gallstones disease click [[Gallstone disease medical therapy|here]]  
* For a detailed explanation of management of cystic fibrosis disease click [[Cystic fibrosis medical therapy|here]]
* For a detailed explanation of the management of small bowel bacterial overgrowth syndrome click [[Small intestinal bacterial overgrowth syndrome|here]]


****1. '''Steroids'''
::***Preferred regimen(1): [[Prednisone]] 0.5–1 mg/kg q24h
::***Preferred regimen(2): [[Budesonide]] 9 mg q24h
::***Preferred regimen(3): [[Prednisone]] 0.5–1 mg/kg q24h and [[azathioprine]] 2 mg/kg q24h combination
****2. '''Immunosuppressive drugs''' (Used in steroid dependent or steroid refractory disease)
*****2.1 '''Antiproliferative agents'''
******Preferred regimen(1): [[Azathioprine]] 2 mg/kg q24h
*****2.2 '''Calcineurin Inhibitors:'''
******Preferred regimen(1): [[Cyclosporine]] 5 mg/kg q24h PO
*****2.3 '''Monoclonal antibodies'''
******Preferred regimen(1): [[Infliximab]] 5 mg/kg q24h
******Preferred regimen(2): [[Alemtuzumab]] 30 mg twice a week per 12 weeks
===Dermatitis herpetiformis===
*1. '''Life style modification'''<ref name="pmid12477369">{{cite journal |vauthors=Collin P, Reunala T |title=Recognition and management of the cutaneous manifestations of celiac disease: a guide for dermatologists |journal=Am J Clin Dermatol |volume=4 |issue=1 |pages=13–20 |year=2003 |pmid=12477369 |doi= |url=}}</ref>
**1.1 '''Gluten-free diet (GFD)'''
*2. '''Pharmocatherapy'''<ref name="pmid18360613">{{cite journal |vauthors=Mutasim DF |title=Therapy of autoimmune bullous diseases |journal=Ther Clin Risk Manag |volume=3 |issue=1 |pages=29–40 |year=2007 |pmid=18360613 |pmc=1936286 |doi= |url=}}</ref><ref name="pmid20729961">{{cite journal |vauthors=Han A |title=A practical approach to treating autoimmune bullous disorders with systemic medications |journal=J Clin Aesthet Dermatol |volume=2 |issue=5 |pages=19–28 |year=2009 |pmid=20729961 |pmc=2924135 |doi= |url=}}</ref>
**2.1 '''Sulfones'''
***Preferred treatment(1): [[Dapsone]] 50 mg q24h increased every week until clearance or tolerance
**2.2 '''Suhphonamides'''
***Alternative treatment (1):  [[Sulfasalazine]] 500 mg q8h (maximum, 2g q8h)
**2.3 '''Combination treatment'''<ref name="pmid28133723">{{cite journal |vauthors=Bevans SL, Sami N |title=Dapsone and sulfasalazine combination therapy in dermatitis herpetiformis |journal=Int. J. Dermatol. |volume=56 |issue=5 |pages=e90–e92 |year=2017 |pmid=28133723 |doi=10.1111/ijd.13542 |url=}}</ref>
***Alternative treatment (1): [[Dapsone]] plus [[sulfasalazine]]
**2.4 '''Other treatment''' (intolerance or allergies to dapsone and  [[sulfasalazine]])
***Alternative treatment (1): [[Colchicine]]<ref name="pmid7458365">{{cite journal |vauthors=Silvers DN, Juhlin EA, Berczeller PH, McSorley J |title=Treatment of dermatitis herpetiformis with colchicine |journal=Arch Dermatol |volume=116 |issue=12 |pages=1373–84 |year=1980 |pmid=7458365 |doi= |url=}}</ref>
***Alternative treatment (2): [[Cholestyramine]]
***Alternative treatment (3): [[Tetracycline]]<ref name="pmid10844495">{{cite journal |vauthors=Shah SA, Ormerod AD |title=Dermatitis herpetiformis effectively treated with heparin, tetracycline and nicotinamide |journal=Clin. Exp. Dermatol. |volume=25 |issue=3 |pages=204–5 |year=2000 |pmid=10844495 |doi= |url=}}</ref>
***Alternative treatment (4): [[Nicotinamide|Niacinamide]]<ref name="pmid10844495" />
***Alternative treatment (5): [[Heparin]]<ref name="pmid10844495" />
***Alternative treatment (6): [[Cyclosporine|Cyclosporin]]
**2.5 '''Monoclonal antibodies'''<ref name="pmid28030659">{{cite journal |vauthors=Albers LN, Zone JJ, Stoff BK, Feldman RJ |title=Rituximab Treatment for Recalcitrant Dermatitis Herpetiformis |journal=JAMA Dermatol |volume=153 |issue=3 |pages=315–318 |year=2017 |pmid=28030659 |doi=10.1001/jamadermatol.2016.4676 |url=}}</ref>
***Preferred treatment(1): [[Rituximab]]
**:'''Note:''' Used is severe cases not improved by other medications.
==References==
==References==
{{reflist|2}}
{{reflist|2}}

Latest revision as of 23:56, 11 February 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2] Aditya Ganti M.B.B.S. [3]

Overview

Management of steatorrhea include treatment of underlying etiology, control of diarrhea and correction of nutritional deficiencies.

Medical Therapy

Management of steatorrhea include treatment of underlying etiology, control of diarrhea and correction of nutritional deficiencies.[1][2][3]

Correction of Nutritional Deficiencies

  • Oral supplementation with vitamins and minerals is usually well tolerated in patients who are are undergoing specified treatment for underlying etiology.
  • Rapid recovery following the identification of a nutritional deficiency can be achieved by supplementation with 5 to 10 times the Recommended Dietary Allowance.

Antidiarrheal agents

Bile acid binding resins

  • Preferred regimen (1) : Cholestyramine 4 g three times daily
  • Preferred regimen (1) : Colestipol granules 5 to 10 g three times daily
    • Note: Administer ≥1 hour before or >4 hours after other drugs to prevent decreased absorption of other drugs.

Pancreatic enzymes

  • Preferred regimen (1) : Pancrelipase delayed-release capsules (Creon minimicrospheres)
  • Preferred regimen (1) : Pancrelipase tablets and powder (Viokase) 1 g
  • (equivalent to 20,000 units lipase component) with meals
    • Note:  Approximately 30,000 units (90,000 USP) (lipase component) with each meal.

Management of Underlying Etiologies

  • For a detailed explanation of management of Crohn's disease click here
  • For a detailed explanation of management of celiac disease click here
  • For a detailed explanation of management of gallstones disease click here
  • For a detailed explanation of management of cystic fibrosis disease click here
  • For a detailed explanation of the management of small bowel bacterial overgrowth syndrome click here

References

  1. Marotta RB, Floch MH (1989). "Dietary therapy of steatorrhea". Gastroenterol. Clin. North Am. 18 (3): 485–512. PMID 2509353.
  2. "Varieties of steatorrhea". Br Med J. 2 (5524): 1214–5. 1966. PMC 1944784. PMID 5917827.
  3. Koch J, Garcia-Shelton YL, Neal EA, Chan MF, Weaver KE, Cello JP (1996). "Steatorrhea: a common manifestation in patients with HIV/AIDS". Nutrition. 12 (7–8): 507–10. PMID 8878143.

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