diarrhea

下痢 　

WordNet

1. frequent and watery bowel movements; can be a symptom of infection or food poisoning or colitis or a gastrointestinal tumor (同)diarrhoea, looseness of the bowels, looseness
2. of or relating to diarrhea (同)diarrhoeal, diarrhetic, diarrhoetic, diarrheic, diarrhoeic
3. a drug used to control or stop diarrhea (同)antidiarrheal_drug

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/06/27 15:10:32」(JST)

wiki ja

[Wiki ja表示]

下痢
分類及び外部参照情報
ICD-10	A09., K59.1
ICD-9	787.91
DiseasesDB	3742
eMedicine	ped/583
MeSH	D003967
プロジェクト:病気／Portal:医学と医療

下痢（げり、英: diarrhea）は、健康時の便と比較して、非常に緩いゲル（粥）状・若しくは液体状の便のことである。主に消化機能の異常により、人間を含む動物が患う症状である。軟便（なんべん）、泥状便（でいじょうべん）、水様便（すいようべん）ともいう。東洋医学では泄瀉（泄は大便が希薄で、出たり止まったりすること。瀉は水が注ぐように一直線に下る。）とも呼ばれる。

軟骨魚類・両生類・爬虫類・鳥類および一部の原始的な哺乳類は、下痢とよく似た軟らかい便を排泄するが、それらの排泄を指して「下痢」とは呼ばない。それらの生物は、消化器官の作りが原始的であったり、全排泄（出産や産卵をも含む）を総排泄腔で行うことから、便の柔らかい事が常態なのである。

発展途上国では主な死因の一つとなっている。

2004年の100,000人あたりの下痢の障害調整生命年（DALY）

  データなし

  < 500

  500-1000

  1000-1500

  1500-2000

  2000-2500

  2500-3000

  3000-3500

  3500-4000

  4000-4500

  4500-5000

  5000-6000

  > 6000

疫学

2004年には世界で約25億人が下痢に罹患し、150万人の5歳以下の子供が死んでいる。これらの患者の半分以上がアフリカ及び南アジアに在住している。20年前には500万人に1人が毎年死亡していたが現在では改善しつつある。これらの年代では、下痢の死因は全体の16%を占め、肺炎の17%の死因に次いで第2位の死因となっている。

原因

通常、便は大腸内にて水分やミネラルを吸収された上で排出されるが、何らかの原因で水分を多分に残したまま便意を催して排便される事がある。更に重症な場合は、逆に腸壁から腸管内に水分が排出される。これが下痢である。

大人は乳糖分解酵素の活性が失われ、乳糖を分解、吸収できないため大腸内での乳糖の濃度が高まると大腸内の浸透圧も高まり、大腸内で多量の水分を保留することとなり、これが下痢を引き起こす。糖アルコールである甘味料の多く（例えばマルチトール、ソルビトールなど）も分解、吸収できない場合が多いため、大量に摂取した場合に同様のメカニズムにより下痢が引き起こされる。エリスリトールは体内に吸収されるので下痢がおきにくい。大量のマグネシウムの摂取も人体に大量に吸収されないため同様のメカニズムにより下痢が引き起こされる。

日常において最も多く見られる原因としては、以下が挙げられる。

• 食べ過ぎによる消化不良
• 早食いによる消化不良
• 就寝前に食事をした場合による消化不良
• 腐敗したものを食べたことによる食中毒
• 冷たい物の飲み過ぎや食べすぎ
• 飲酒した日の翌朝
• 早朝からの冷えた飲料の摂取
• コーヒーや辛い食品といった刺激物の大量摂取
• 腹を冷やしたり、食後にベルトを締め付けすぎた時など
• 乳糖不耐症の者が牛乳のような乳糖を含む食品を多量に摂取した場合
• 人工甘味料を大量に摂取した場合
• 油を大量に摂取した場合
• マグネシウムを過剰に摂取（マグネシウムを豊富に含む豆乳を大量摂取、マグネシウムを多く含む薬剤を摂取）した場合
• 海外で日常食べ慣れないものを多量に摂取した
• 毒キノコや貝毒などの有害物質による食中毒
• O157、アメーバ赤痢、ノロウイルス、ロタウイルス、アデノウイルスなどの細菌やウイルスに経口感染して起こる食中毒
• 過度の精神的ストレス

分類

急性のものと慢性のものに大まかに分けられる。

発症から二週間以内のものを大体急性のものとして扱う。ウイルス性のものである可能性が高い。ほとんどの場合、自然に治癒する。

発症から四週間以上たったものを慢性の下痢として扱う。慢性の下痢には

• 大腸癌
• 潰瘍性大腸炎、クローン病などの炎症性腸疾患
• 甲状腺機能亢進症
• 糖尿病
• 慢性膵炎
• Whipple's disease

などの重要疾患が隠されていることがあるがたいていの場合比較的予後良好な以下のような疾患の場合が多い。

• 過敏性腸症候群などに代表される体質
• ヘリコバクター・ピロリの感染による消化不良
• 不安障害による心身症
• 神経性の消化不良
• 便意を我慢し過ぎる事による大腸の異常活動
• 医薬品の副作用...(PPIによるcollagenous colitisなど)

しかし、下痢は、赤痢やコレラと言った伝染病や、クリプトスポリジウムといった病原性原虫や寄生虫の寄生でも発生する上に、結果的に死に至る場合もあるため、たかが下痢と侮らず、少しでも続くようなら医師に相談した方が賢明である。特に海外旅行の後で症状が出た場合には尚更である。(輸入感染症)

症状

下痢は、消化能力の機能低下や、毒物の服用・何等かの感染症によって発生する症状である。

便が非常に柔らかくなる以外の主な症状としては、

• 腹痛
• 脱水症状
  • 虚血
  • 悪心・嘔吐
• 食欲減退
• 疲労や体力消耗

などが挙げられる。特に大腸での水分吸収が行われない為に生じる脱水症状は危険である。

小腸性下痢と大腸性下痢の比較

	小腸性下痢	大腸性下痢
便量	著しく増加	正常~増加
粘液	まれ	あり
メレナ	小腸出血時に発生	なし
血便	出血性腸炎を除きなし	時に存在
未消化物	あり	なし
渋り腹 （テネスムス）	なし	頻回
体重減少	しばしば	まれ
嘔吐	しばしば	まれ

また、骨盤内の腹膜炎は、頻回の便意をもよおすことがあり、これを「下痢」と感じることがあるため、気をつける必要がある。

他にも、上部の消化管出血(特に十二指腸からの出血)は吐血ではなく下痢便として排泄されることがあるため、注意が必要である。

病態

脱水症状は特に細胞外液脱水になり、塩分などのミネラル分などの消耗も起きるので電解質代謝異常を来す。便は通常アルカリ性なので体液の酸アルカリ平衡が酸性に向かいアシドーシスとなって、体液が酸性に傾きアシデミアになり易い。これは嘔吐の際に、酸性の胃液を吐くため平衡がアルカリ性に向かいアルカローシスになって、体液がアルカリに傾くアルケミアになり易い事と対比すると分かり易い。

また、脱水が高度になると循環血流量が減少するため、多臓器不全(腎不全など)やショック、意識障害を招くこともある。

治療

下痢の際には通常より多くの水分が失われるため、それを補填するために多目の水分補給が必要である。浸透圧の問題と、ナトリウムの吸収経路の問題(ナトリウムのトランスポーターはグルコースと共輸送のものがあるため)から、家庭では、温かい「ごく薄い」味噌汁やスポーツドリンクなどをこまめに少しずつ取ると良いといわれる。脱水症状は重篤になることもあるため、水分補給は気をつけて行う必要がある。食事をとらない場合は、一日2000mLを目安に少しずつ飲むとよい。尿量が「いつもくらい出る」というのもひとつの目安になる。東洋医学によると、冷やした飲み物は望ましくないとされている。西洋医学においても、冷たい飲み物は胃腸に刺激になるため、避けたほうがいいと考えられる。医療機関においては、嘔吐などにより経口摂取が不可能、または経口では不十分にしか摂取できないと判断されると、経静脈輸液を行う。

いつもの下痢が突然起きた場合には、下痢止め薬を服用するとよい。梅干なども効果があるとされている。食中毒などの感染症に伴う下痢は、病原体を速やかに排出する防衛作用であり、むやみな下痢止め処置はかえって病状の悪化を招くため、服用すべきでない。「いつもの下痢」でも異常に下痢が続く場合や症状が急変した場合はすぐに医師に相談すべきである。

予防も含め、東洋では下痢に対しては腹部を冷やさないようにすることが大切であるとされている。不快感を軽減することもできるため使い捨てカイロのような発熱体を腹部にあてがうことも役に立つ。ファッションの趣味として、腹部を露出することを好む者の場合、下痢になるリスクが高いため飲食物に注意を払うのが望ましい。なお、同じ腹痛でも、虫垂炎などの炎症が原因の場合、温めることは逆効果となるので注意を要する。

重篤な疾患でないと診断されていても、慢性に下痢をしてしまう人は、カフェインなど腸を必要以上に刺激してしまうものを避け、高浸透圧の人工甘味料も避けるべきである。さらに、常用薬の副作用によって下痢を引き起こしている可能性もあるので、医師、薬剤師などに相談するべきである。

東洋医学では下痢は、脾が虚している場合と、腎が虚している場合に分けられ、それぞれ、補う方法が異なるため、一律に下痢と診断して治療に当たるのは望ましくない。

発展途上国では多くの子供が感染症による下痢の脱水症状で死亡しており、点滴による水分補給も設備面で困難なために、水分を小腸で吸収させる経口補水塩を用いた治療が行われている。

関連項目

• 止瀉薬
• 糞
• 便秘
• 寄生虫
• 伝染病
• 感染症
• 食中毒
• 消化器官
  • 口
  • 胃
  • 十二指腸
  • 小腸
  • 大腸
  • 直腸
  • 肛門
• 酵素
• 脱水症状
• 旅行者下痢

脚注

外部リンク

• 厚生労働省検疫所・海外で顕著な寄生虫とその被害一覧
• 食品衛生の窓（東京都食品安全総合情報提供サイト）
• フルーツジュース（果汁）と下痢について-横浜市衛生研究所　感染症・疫学情報課

wiki en

[Wiki en表示]

For other uses, see Diarrhea (disambiguation).

Diarrhea

An electron micrograph of rotavirus, the cause of nearly 40% of hospitalizations from diarrhea in children under five.
ICD-10	A09, K59.1
ICD-9	787.91
DiseasesDB	3742
MedlinePlus	003126
eMedicine	ped/583
MeSH	D003967

Diarrhea or diarrhœa (from the Greek διάρροια from διά dia "through" and ῥέω rheo "flow") is the condition of having at least three loose or liquid bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin with loss of the normal stretchiness of the skin and changes in personality. This can progress to decreased urination, loss of skin color, a fast heart rate, and a decrease in responsiveness as it becomes more severe. Loose but non watery stools in babies who are breastfed; however, may be normal.

The most common cause is an infection of the intestines due to either a virus, bacteria, or parasite, a condition known as gastroenteritis. These infections are often acquired from food or water that has been contaminated by stool, or directly from another person who is infected. It may be divided into three types: short duration watery diarrhea, short duration bloody diarrhea, and if it lasts for more than two weeks persistent diarrhea. The short duration watery diarrhea may be due to an infection by cholera. If blood is present it is also known as dysentery. A number of non-infectious causes may also result in diarrhea including: hyperthyroidism, lactose intolerance, inflammatory bowel disease, a number of medications, and irritable bowel syndrome among other. In most cases stool cultures are not required to confirm the exact cause.

Prevention of infectious diarrhea is by improved sanitation, clean drinking water, and hand washing. Breastfeeding for at least six month is also recommended as is vaccination against rotavirus. Oral rehydration solution (ORS), which is clean water with modest amounts of salts and sugar, along with zinc tablets are the treatments of choice. This treatment have been estimated to have saved 50 million children in the past 25 years. When people have diarrhea it is recommended that they continue to eat healthy food and babies continue to be breastfeed. If commercial ORS are not available, homemade solutions may be used. In those with severe dehydration, intravenous fluids may be required. Most cases; however, can be managed well with fluids by mouth. Antibiotics, while rarely used, may be recommended in a few cases such as those who have bloody diarrhea and a high fever, those with severe diarrhea following travelling, and those who grow specific bacteria or parasites in their stool. Loperamide may help decrease the number of bowel movement but is not recommended in those with severe disease.

About 1.7 to 5 billion cases of diarrhea occur per year. It is most common in developing countries were young children get diarrhea on average three times a year. Worldwide, as of 2012, it is the second most common cause of deaths in children less than five (0.76 million or 11%). Frequent episodes of diarrhea are also a common cause of malnutrition and the most common cause in those less than five years of age. Other long term problems that can result include poor physical and intellectual development.

Definition

Types 5–7 on the Bristol Stool Chart indicate diarrhea

Diarrhea is defined by the World Health Organization as having three or more loose or liquid stools per day, or as having more stools than is normal for that person.

Acute diarrhea is defined as an abnormally frequent discharge of semisolid or fluid fecal matter from the bowel, lasting less than 14 days, by World Gastroenterology Organisation.

Secretory

Secretory diarrhea means that there is an increase in the active secretion, or there is an inhibition of absorption. There is little to no structural damage. The most common cause of this type of diarrhea is a cholera toxin that stimulates the secretion of anions, especially chloride ions. Therefore, to maintain a charge balance in the lumen, sodium is carried with it, along with water. In this type of diarrhea intestinal fluid secretion is isotonic with plasma even during fasting. It continues even when there is no oral food intake.

Osmotic

Osmotic diarrhea occurs when too much water is drawn into the bowels. If a person drinks solutions with excessive sugar or excessive salt, these can draw water from the body into the bowel and cause osmotic diarrhea. Osmotic diarrhea can also be the result of maldigestion (e.g., pancreatic disease or Coeliac disease), in which the nutrients are left in the lumen to pull in water. Or it can be caused by osmotic laxatives (which work to alleviate constipation by drawing water into the bowels). In healthy individuals, too much magnesium or vitamin C or undigested lactose can produce osmotic diarrhea and distention of the bowel. A person who has lactose intolerance can have difficulty absorbing lactose after an extraordinarily high intake of dairy products. In persons who have fructose malabsorption, excess fructose intake can also cause diarrhea. High-fructose foods that also have a high glucose content are more absorbable and less likely to cause diarrhea. Sugar alcohols such as sorbitol (often found in sugar-free foods) are difficult for the body to absorb and, in large amounts, may lead to osmotic diarrhea. In most of these cases, osmotic diarrhea stops when offending agent (e.g. milk, sorbitol) is stopped.

Exudative

Exudative diarrhea occurs with the presence of blood and pus in the stool. This occurs with inflammatory bowel diseases, such as Crohn's disease or ulcerative colitis, and other severe infections such as E. coli or other forms of food poisoning.

Inflammatory

Inflammatory diarrhea occurs when there is damage to the mucosal lining or brush border, which leads to a passive loss of protein-rich fluids and a decreased ability to absorb these lost fluids. Features of all three of the other types of diarrhea can be found in this type of diarrhea. It can be caused by bacterial infections, viral infections, parasitic infections, or autoimmune problems such as inflammatory bowel diseases. It can also be caused by tuberculosis, colon cancer, and enteritis.

Dysentery

If there is blood visible in the stools, it is also known as dysentery. The blood is trace of an invasion of bowel tissue. Dysentery is a symptom of, among others, Shigella, Entamoeba histolytica, and Salmonella.

Differential diagnosis

Diagram of the human gastrointestinal tract.

Diarrhea is most commonly due to viral gastroenteritis with rotavirus, which accounts for 40% of cases in children under five. (p. 17) In travelers however bacterial infections predominate. Various toxins such as mushroom poisoning and drugs can also cause acute diarrhea.

Chronic diarrhea can be the part of the presentations of a number of chronic medical conditions affecting the intestine. Common causes include ulcerative colitis, Crohn's disease, microscopic colitis, celiac disease, irritable bowel syndrome and bile acid malabsorption.

Infections

Main article: Infectious diarrhea

There are many causes of infectious diarrhea, which include viruses, bacteria and parasites. Norovirus is the most common cause of viral diarrhea in adults, but rotavirus is the most common cause in children under five years old. Adenovirus types 40 and 41, and astroviruses cause a significant number of infections.

Campylobacter spp. are a common cause of bacterial diarrhea, but infections by Salmonella spp., Shigella spp. and some strains of Escherichia coli are also a frequent cause.

In the elderly, particularly those who have been treated with antibiotics for unrelated infections, a toxin produced by Clostridium difficile often causes severe diarrhea.

Parasites do not often cause diarrhea except for the protozoan Giardia, which can cause chronic infections if these are not diagnosed and treated with drugs such as metronidazole, and Entamoeba histolytica.

Other infectious agents such as parasites and bacterial toxins also occur. In sanitary living conditions where there is ample food and a supply of clean water, an otherwise healthy person usually recovers from viral infections in a few days. However, for ill or malnourished individuals, diarrhea can lead to severe dehydration and can become life-threatening.

Malabsorption

Main article: Malabsorption

Malabsorption is the inability to absorb food fully, mostly from disorders in the small bowel, but also due to maldigestion from diseases of the pancreas.

Causes include:

• enzyme deficiencies or mucosal abnormality, as in food allergy and food intolerance, e.g. celiac disease (gluten intolerance), lactose intolerance (intolerance to milk sugar, common in non-Europeans), and fructose malabsorption.
• pernicious anemia, or impaired bowel function due to the inability to absorb vitamin B₁₂,
• loss of pancreatic secretions, which may be due to cystic fibrosis or pancreatitis,
• structural defects, like short bowel syndrome (surgically removed bowel) and radiation fibrosis, such as usually follows cancer treatment and other drugs, including agents used in chemotherapy; and
• certain drugs, like orlistat, which inhibits the absorption of fat.

Inflammatory bowel disease

Main article: Inflammatory bowel disease

The two overlapping types here are of unknown origin:

• Ulcerative colitis is marked by chronic bloody diarrhea and inflammation mostly affects the distal colon near the rectum.
• Crohn's disease typically affects fairly well demarcated segments of bowel in the colon and often affects the end of the small bowel.

Irritable bowel syndrome

Main article: Irritable bowel syndrome

Another possible cause of diarrhea is irritable bowel syndrome (IBS) which usually presents with abdominal discomfort relieved by defecation and unusual stool (diarrhea or constipation) for at least 3 days a week over the previous 3 months. Symptoms of diarrhea-predominant IBS can be managed through a combination of dietary changes, soluble fiber supplements, and/or medications such as loperamide or codeine. About 30% of patients with diarrhea-predominant IBS have bile acid malabsorption diagnosed with an abnormal SeHCAT test.

Other causes

• Diarrhea can be caused by chronic ethanol ingestion.
• Ischemic bowel disease. This usually affects older people and can be due to blocked arteries.
• Microscopic colitis, a type of inflammatory bowel disease where changes are only seen on histological examination of colonic biopsies.
• Bile salt malabsorption (primary bile acid diarrhea) where excessive bile acids in the colon produce a secretory diarrhea.
• Hormone-secreting tumors: some hormones (e.g., serotonin) can cause diarrhea if excreted in excess (usually from a tumor).
• Chronic mild diarrhea in infants and toddlers may occur with no obvious cause and with no other ill effects; this condition is called toddler's diarrhea.

Pathophysiology

Evolution

According to two researchers, Nesse and Williams, diarrhea may function as an evolved expulsion defense mechanism. As a result, if it is stopped, there might be a delay in recovery. They cite in support of this argument research published in 1973 which found that treating Shigella with the anti-diarrhea drug (Co-phenotrope, Lomotil) caused people to stay feverish twice as long as those not so treated. The researchers indeed themselves observed that: "Lomotil may be contraindicated in shigellosis. Diarrhea may represent a defense mechanism".

Diagnostic approach

The following types of diarrhea may indicate further investigation is needed:

• In infants
• Moderate or severe diarrhea in young children
• Associated with blood
• Continues for more than two days
• Associated non-cramping abdominal pain, fever, weight loss, etc.
• In travelers
• In food handlers, because of the potential to infect others;
• In institutions such as hospitals, child care centers, or geriatric and convalescent homes.

A severity score is used to aid diagnosis in children.

Prevention

A rotavirus vaccine decrease the rates of diarrhea in a population. New vaccines against rotavirus, Shigella, ETEC, and cholera are under development, as well as other causes of infectious diarrhea.

Probiotics decrease the risk of diarrhea in those taking antibiotics. In institutions and in communities, interventions that promote hand washing lead to significant reductions in the incidence of diarrhea.

Management

In many cases of diarrhea, replacing lost fluid and salts is the only treatment needed. This is usually by mouth – oral rehydration therapy – or, in severe cases, intravenously. Diet restrictions such as the BRAT diet are no longer recommended. Research does not support the limiting of milk to children as doing so has no effect on duration of diarrhea. To the contrary, WHO recommends that children with diarrhea continue to eat as sufficient nutrients are usually still absorbed to support continued growth and weight gain and that continuing to eat speeds also recovery of normal intestinal functioning. CDC recommends that children and adults with cholera also continue to eat.

Medications such as loperamide (Imodium) and bismuth subsalicylate may be beneficial; however they may be contraindicated in certain situations.

Fluids

See also: Management of dehydration

A person consuming oral rehydration solution.

Oral rehydration solution (ORS) can be used to prevent dehydration. Standard home solutions such as salted rice water, salted yogurt drinks, vegetable and chicken soups with salt can be given. Home solutions such as water in which cereal has been cooked, unsalted soup, green coconut water, weak tea (unsweetened), and unsweetened fresh fruit juices can have from half a teaspoon to full teaspoon of salt (from one-and-a-half to three grams) added per liter. Clean plain water can also be one of several fluids given. There are commercial solutions such as Pedialyte, and relief agencies such as UNICEF widely distribute packets of salts and sugar. A WHO publication for physicians recommends a homemade ORS consisting of one liter water with one teaspoon salt (3 grams) and two tablespoons sugar (18 grams) added (approximately the "taste of tears"). Rehydration Project recommends adding the same amount of sugar but only one-half a teaspoon of salt, stating that this more dilute approach is less risky with very little loss of effectiveness. Both agree that drinks with too much sugar or salt can make dehydration worse.

Appropriate amounts of supplemental zinc and potassium should be added if available. But the availability of these should not delay rehydration. As WHO points out, the most important thing is to begin preventing dehydration as early as possible. In another example of prompt ORS hopefully preventing dehydration, CDC recommends for the treatment of cholera continuing to give Oral Rehydration Solution during travel to medical treatment.

Vomiting often occurs during the first hour or two of treatment with ORS, especially if a child drinks the solution too quickly, but this seldom prevents successful rehydration since most of the fluid is still absorbed. WHO recommends that if a child vomits, to wait five or ten minutes and then start to give the solution again more slowly.

Drinks especially high in simple sugars, such as soft drinks and fruit juices, are not recommended in children under 5 years of age as they may increase dehydration. A too rich solution in the gut draws water from the rest of the body, just as if the person were to drink sea water. Plain water may be used if more specific and effective ORT preparations are unavailable or are not palatable. Additionally, a mix of both plain water and drinks perhaps too rich in sugar and salt can alternatively be given to the same person, with the goal of providing a medium amount of sodium overall. A nasogastric tube can be used in young children to administer fluids if warranted.

Eating

WHO recommends a child with diarrhea continue to be fed. Continued feeding speeds the recovery of normal intestinal function. In contrast, children whose food is restricted have diarrhea of longer duration and recover intestinal function more slowly. A child should also continue to be breastfed. The WHO states "Food should never be withheld and the child's usual foods should not be diluted. Breastfeeding should always be continued." And in the specific example of cholera, CDC also makes the same recommendation. In young children who are not breast-fed and live in the developed world, a lactose free diet may be useful to speed recovery.

Medications

While antibiotics are beneficial in certain types of acute diarrhea, they are usually not used except in specific situations. There are concerns that antibiotics may increase the risk of hemolytic uremic syndrome in people infected with Escherichia coli O157:H7. In resource poor countries, treatment with antibiotics may be beneficial. However, some bacteria are developing antibiotic resistance, particularly Shigella. Antibiotics can also cause diarrhea, and antibiotic-associated diarrhea is the most common adverse effect of treatment with general antibiotics.

While bismuth compounds (Pepto-Bismol) decreased the number of bowel movements in those with travelers' diarrhea, they do not decrease the length of illness. Anti motility agents like loperamide are also effective at reducing the number of stools but not the duration of disease. These agents should only be used if bloody diarrhea is not present.

Bile acid sequestrants such as cholestyramine can be effective in chronic diarrhea due to bile acid malabsorption. Therapeutic trials of these drugs are indicated in chronic diarrhea if bile acid malabsorption cannot be diagnosed with a specific test, such as SeHCAT retention.

Alternative therapies

Zinc supplementation benefits children with diarrhea in developing countries, but only in infants over six months old. This supports the World Health Organisation guidelines for zinc, but not in the very young.

Probiotics reduce the duration of symptoms by one day and reduced the chances of symptoms lasting longer than four days by 60%. The probiotic lactobacillus can help prevent antibiotic associated diarrhea in adults but possibly not children. For those who with lactose intolerance, taking digestive enzymes containing lactase when consuming dairy products often improves symptoms.

Epidemiology

See also: Diarrhea in developing regions

Disability-adjusted life year for diarrhea per 100,000 inhabitants in 2004.

  no data

  < 500

  500–1000

  1000–1500

  1500–2000

  2000–2500

  2500–3000

  3000–3500

  3500–4000

  4000–4500

  4500–5000

  5000–6000

  > 6000

World wide in 2004 approximately 2.5 billion cases of diarrhea occurred which results in 1.5 million deaths among children under the age of five. Greater than half of these were in Africa and South Asia. This is down from a death rate of 4.5 million in 1980 for gastroenteritis. Diarrhea remains the second leading cause of infant mortality (16%) after pneumonia (17%) in this age group.

References

External links

• Diarrhea at DMOZ

UpToDate Contents

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• 1. 先進国の成人における急性下痢に対するアプローチ approach to the adult with acute diarrhea in developed countries
• 2. 小児における下痢の評価 evaluation of diarrhea in children
• 3. 先進国の成人における慢性下痢に対するアプローチ approach to the adult with chronic diarrhea in developed countries
• 4. 小児における慢性下痢の原因の概要 overview of the causes of chronic diarrhea in children
• 5. 先進国の小児における慢性下痢症の診断へのアプローチ approach to the diagnosis of chronic diarrhea in children in developed countries

English Journal

• Numerical taxonomy of the genus Pestivirus: New software for genotyping based on the palindromic nucleotide substitutions method.

• Giangaspero M, Apicella C, Harasawa R.SourceDepartment of Veterinary Microbiology, School of Veterinary Medicine, Faculty of Agriculture, Iwate University, 18-8, Ueda 3 Chome, Morioka, 020-8550, Iwate, Japan. Electronic address: giangasp@gmail.com.
• Journal of virological methods.J Virol Methods.2013 Sep;192(1-2):59-67. doi: 10.1016/j.jviromet.2013.04.023. Epub 2013 May 14.
• The genus Pestivirus from the family Flaviviridae is represented by four established species; Bovine viral diarrhea virus 1 (BVDV-1); Bovine viral diarrhea virus 2 (BVDV-2); Border disease virus (BDV); and Classical swine fever virus (CSFV); as well a tentative species from a Giraffe. The palindromi
• PMID 23684846

• Sorafenib versus capecitabine in the management of advanced hepatocellular carcinoma.

• Abdel-Rahman O, Abdel-Wahab M, Shaker M, Abdel-Wahab S, Elbassiony M, Ellithy M.SourceClinical Oncology Department, Faculty of Medicine, Ain Shams University, Lofty Elsayed Street, Abbaseya, Cairo, Egypt, omar.abdelrhman@med.asu.edu.eg.
• Medical oncology (Northwood, London, England).Med Oncol.2013 Sep;30(3):655. Epub 2013 Jul 4.
• The only approved systemic therapy for patients with advanced hepatocellular carcinoma (HCC) till now is sorafenib. A preliminary study suggested that capecitabine, an oral fluoropyrimidine, may be effective in advanced HCC. We have tested this hypothesis in this phase 2 study. In this single-center
• PMID 23824645

• Associations between UGT1A1*6/*28 polymorphisms and irinotecan-induced severe toxicity in Chinese gastric or esophageal cancer patients.

• Gao J, Zhou J, Li Y, Peng Z, Li Y, Wang X, Shen L.SourceKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, No. 52, Fucheng Road, Haidian District, Beijing, 100142, China.
• Medical oncology (Northwood, London, England).Med Oncol.2013 Sep;30(3):630. doi: 10.1007/s12032-013-0630-8. Epub 2013 Jun 20.
• The aim of this study was to investigate the associations between UDP-glucuronosyltransferase (UGT) 1A1 polymorphisms and irinotecan-induced toxicities in Chinese advanced gastric or esophageal cancer patients. The genotypes of UGT1A1*6 and UGT1A1*28 were analyzed by PCR amplification and Sanger seq
• PMID 23783485

Japanese Journal

• 下痢・便秘 (特集 外科医が知っておくべきがん薬物療法の副作用とその対策) -- (症状別対策マニュアル)

• 國崎 主税,牧野 洋知,木村 準 [他]
• 臨床外科 = Journal of clinical surgery 70(5), 565-569, 2015-05
• NAID 40020445816

• In a Methotrexate-Induced Model of Intestinal Mucositis, Olmesartan Reduced Inflammation and Induced Enteropathy Characterized by Severe Diarrhea, Weight Loss, and Reduced Sucrose Activity

• de Araujo Aurigena Antunes,Borba Pedro Brito,de Souza Fernando Henrique Destefani [他]
• Biological & pharmaceutical bulletin 38(5), 746-752, 2015-05
• NAID 40020440820

• 囊腫型消化管重複症における粘膜抜去術についての検討

• 瀬尾 尚吾,高見澤 滋,好沢 克 [他]
• 日本小児外科学会雑誌 51(2), 201-204, 2015-04
• NAID 40020442837

Related Pictures

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★リンクテーブル★

リンク元	「下痢」「diarrheal」「diarrheal disease」「diarrhoeal」「rrhea」
拡張検索	「bovine viral diarrhea virus 2」

「下痢」

　　[★]

英

diarrhea

関

下痢症(症候としての下痢)

概念

• 24時間の糞便重量150-200g以上 or 24時間の糞便中の水分量が150-200ml以上のもの

病態

• 滲出性下痢
• 腸管運動亢進性下痢
• 分泌性下痢
• 浸透圧性下痢
• 消化吸収障害性下痢

漢方医学

[show details]

• 黄連剤：黄連湯、半夏瀉心湯
• 人参湯類：人参湯
• その他：五苓散、真武湯

「diarrheal」

　　[★]

• adj.

• 下痢性の、下痢の

関

diarrhea、diarrheal disease、diarrhoea、diarrhoeal

　

「diarrheal disease」

　　[★]

• 下痢、下痢症、下痢性疾患

関

diarrhea、diarrheal、diarrhoea、diarrhoeal

「diarrhoeal」

　　[★]

• adj.

• 下痢性の、下痢の

関

diarrhea、diarrheal、diarrheal disease、diarrhoea

「rrhea」

　　[★]

• comb form

• 排出、放出、流出

• ex.

• diarrhea
• steatorrhea

「bovine viral diarrhea virus 2」

　　[★]

• ウシウイルス性下痢症ウイルス2

関

BVDV-2、BVDV2