Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Absorbents. Absorbents are compounds that absorb water. Absorbents that are taken orally
bind water in the small intestine and colon and make diarrheal stools less
watery. They also may bind toxic chemicals produced by bacteria that cause the
small intestine to secrete fluid; however, the importance of toxin binding in
reducing diarrhea is unclear.
The two main absorbents are attapulgite
and polycarbophil, and
they are both available without prescriptions.
Equalactin is
the antidiarrheal product containing attapulgite; however the laxative, Konsyl,
also contains attapulgite. Attapulgite and polycarbophil remain in the
intestine and, therefore, have no side effects outside of the gastrointestinal tract.
They may occasionally cause constipation and bloating. One concern is
that absorbents also can bind medications and interfere with their absorption into the body. For
this reason, it often is recommended that medications and absorbents be taken several hours
apart so that they are physically separated within the intestine.
Anti-motility medications.
Anti-motility medications are drugs that relax the muscles of the small intestine and/or the
colon. Relaxation results in slower flow of intestinal contents. Slower flow
allows more time for water to be absorbed from the intestine and colon and
reduces the water content of stool. Cramps, due to spasm of the intestinal
muscles, also are relieved by the muscular relaxation.
The two main anti-motility medications are loperamide (Imodium), which is
available without a prescription, and
diphenoxylate (Lomotil), which requires
a prescription. Both medications are related to opiates (for example, codeine ) but neither
has the pain-relieving effects of opiates.
Loperamide (Imodium), though related to
opiates, does not cause addiction.
Diphenoxylate is a man-made medication that at high doses
can be addictive because of its opiate-like, euphoric (mood-elevating) effects.
In order to prevent abuse of diphenoxylate and addiction, a second medication,
atropine, is added to loperamide in Lomotil. If too much Lomotil is ingested,
unpleasant side effects from too much atropine will occur.
Loperamide and diphenoxylate are safe and well-tolerated. There are some
precautions, however, that should be observed.
Anti-motility medications should not be used without a doctor's
guidance to treat diarrhea caused by moderate or severe ulcerative colitis,
C.
difficile colitis, and intestinal infections by bacteria that invade the
intestine (for example, Shigella). Their use can lead to more serious inflammation
and prolong the infections.
Diphenoxylate can cause drowsiness or dizziness, and
caution should be used if driving or performing tasks that require alertness
and coordination are required.
Anti-motility medications should not be used in children
younger than two years of age.
Most unimportant, acute diarrhea should improve within 72
hours. If symptoms do not improve or if they worsen, a doctor should be
consulted before continuing treatment with anti-motility medications.
Bismuth compounds. Many
bismuth-containing preparations are available around the world.
Bismuth
subsalicylate (Pepto-Bismol) is available in the United States. It contains two
potentially active ingredients, bismuth and salicylate (aspirin). It is not
clear how effective bismuth compounds are, except in traveler's diarrhea and the
treatment of H. pylori
infection of the stomach
where they have been shown to be effective. It also is not clear how bismuth
subsalicylate might work. It is thought to have some antibiotic-like properties
that affect bacteria that cause diarrhea. The salicylate is anti-inflammatory
and could reduce secretion of water by reducing inflammation. Bismuth also might
directly reduce the secretion of water by the intestine.
Pepto-Bismol is well-tolerated. Minor side effects include darkening of the
stool and tongue. There are several precautions that should be observed when
using Pepto-Bismol.
Since it contains aspirin, patients who are allergic
to aspirin should not take Pepto-Bismol.
Pepto-Bismol should not be used with other
aspirin-containing medications since too much aspirin may be ingested and lead to
aspirin toxicity, the most common manifestation of which is ringing in the
ears.
The aspirin in Pepto-Bismol can accentuate the effects of
anticoagulants, particularly warfarin (Coumadin),
and lead to excessive bleeding. It also may cause abnormal bleeding in people
who have a tendency to bleed because of genetic disorders or underlying
diseases, for example, cirrhosis, that may cause abnormal bleeding.
The aspirin in Pepto-Bismol can aggravate stomach and
duodenal ulcer disease.
Pepto-Bismol and aspirin-containing products should not be
given to children and
teenagers with chickenpox, influenza, and
other viral infections because they may cause
Reye's syndrome. Reye's syndrome is
a serious illness affecting primarily the liver and brain that can lead to
liver failure and coma, with a mortality rate of at least 20%.
Pepto-Bismol should not be given to infants and children
younger than two years of age.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Gastroenteritis (viral gastroenteritis, stomach flu) is an infection caused by a variety of viruses that results in vomiting and/or diarrhea. Even though it is often called the "stomach flu," it is not caused by the influenza viruses. Viruses that can cause gastroenteritis (stomach flu) include: rotaviruses, adenoviruses, caliciviruses, astroviruses, Norwalk virus, and a group of Noroviruses. Gastroenteritis is not caused by bacteria. The main symptoms of gastroenteritis include vomiting and watery diarrhea, however, headache, fever, and abdominal cramps (stomach ache) may also be present.
Staphylococcus or Staph is a group of bacteria that can cause a multitude of diseases. Staph infections can cause illness directly by infection or indirectly by the toxins they produce. Symptoms and signs of a Staph infection include redness, swelling, pain, and drainage of pus. Minor skin infections are treated with an antibiotic ointment, while more serious infections are treated with intravenous antibiotics.
Hemorrhoid is an enlarged vein in the walls of the anus and sometimes around the
rectum, usually caused by untreated constipation, but occasionally associated
with chronic diarrhea. If untreated, hemorrhoids can
worsen, protruding from the anus. Also known as piles.
Gas or "intestinal gas" means different things to different people. Everyone has gas and eliminates it by belching or farting (passing it through the rectum).
Diverticulitis is a condition in which diverticuli in the colon rupture. The rupture results in infection in the tissues that surround the colon. Diverticulitis symptoms include: abdominal pain, abdominal cramps, diarrhea, constipation, and bloating. Treatment methods include prescription medications, and in some cases, diverticulitis surgery.
Dehydration is the excessive loss of body water. There are a number of causes of dehydration including heat exposure, prolonged vigorous exercise, and some diseases of the gastrointestinal tract. The best way to treat dehydration is to prevent it from occurring.
Crohn's disease is a chronic inflammatory disease,
primarily involving the small and large intestine, but which can
affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are
common symptoms.
Colon cancer is a malignancy that arises from the inner lining of the colon. Most, if not all, of these cancers develop from colonic polyps. Removal of these precancerous polyps can prevent colon cancer.
Anal itching is the irritation of the skin at the exit of the rectum, known as the anus, accompanied by the desire to scratch. Causes include everything from irritating foods we eat, to certain disease and infections. Treatment options include local anesthetics, vasoconstrictors, protectants, astringents, antiseptics, keratolytics, analgesics, and corticosteroids. If condition persists, a doctor examination may be needed to identify an underlying cause.
An upper respiratory infection is a contagious infection of the structures of the upper respiratory tract, which includes the sinuses, nasal passages, pharynx, and larynx. Common causes of an upper respiratory infection include bacteria and viruses such as rhinoviruses, group A streptococci, influenza, respiratory syncytial, whooping cough, diphtheria, and Epstein-Barre. Examples of symptoms of upper respiratory infection include sneezing, sore throat, cough, fever, and nasal congestion. Treatment of upper respiratory infection are generally with OTC medication and home remedies.
Hyperthyroidism is an excess of thyroid hormone resulting from an overactive thyroid gland. Symptoms can include increased heart rate, weight
loss, depression, and cognitive slowing. Treatment is by medication, the use of
radioactive iodine, thyroid surgery, or reducing the dose of thyroid hormone.
Clostridium difficile (C. difficile) is a bacterium, and is one of the most common causes of infection of the colon. C. difficile spores are found frequently in hospitals, nursing homes, extended care facilities, and nurseries for newborn infants. They can be found on bedpans, furniture, toilet seats, linens, telephones, stethoscopes, fingernails, rings, floors, infants' rooms, and diaper pails. They even can be carried by pets. Antibiotic-associated (C. difficile) colitis is an infection of the colon caused by C. difficile that occurs primarily among individuals who have been using antibiotics. Treatment for C. difficile colitis hydration, replenishment of electrolyte deficiencies, discontinuing the antibiotic that caused the colitis, and using antibiotics to eradicate the C. difficile bacterium.
Ulcerative colitis is a chronic inflammation of the colon. Symptoms include abdominal pain, diarrhea, and rectal bleeding. Ulcerative colitis is closely related to Crohn's disease, and together they are referred to as inflammatory bowel disease. Treatment depends upon the type of ulcerative colitis diagnosed.
In lactose intolerance, the digestive system cannot digest lactose (the main sugar in milk). Symptoms of lactose intolerance include diarrhea, flatulence, abdominal pain, abdominal bloating, abdominal distention, and nausea. There are several tests to diagnose lactose intolerance. Treatment is generally made with dietary changes, supplements, and adaptation to small amounts of milk.
IBS (irritable bowel syndrome) is a common gastrointestinal disorder involving abnormal gut contractions (motility) characterized by abdominal pain,
bloating, mucous in stools, and irregular bowel habits with alternating diarrhea
and constipation, symptoms that tend to be chronic and to wax and wane over the
years. Treatment options include medication and lifestyle changes such as diet, exercise, and stress management to control symptoms. Also called spastic colitis, mucus colitis, nervous colon syndrome.
Norovirus infection causes stomach flu, or gastroenteritis. It's a very contagious illness with symptoms that include nausea and vomiting, diarrhea, stomach cramps, fever, headache, chills, and muscle aches. Norovirus infection cannot be treated with antibiotics, so treatment focuses on maintaining proper hydration.
Stool color is generally brown. When stool color changes, often, an individual becomes concerned. The presence of the bilirubin in bile is generally responsible for stool color. Bilirubin concentration can vary bile color from light yellow to almost black in color. Changes in bilirubin can cause stool to turn green, gray, or clay-like in color. Intestinal bleeding may turn stool black, tarry, red, maroon, or smelly stool. Medication and food may also affect stool color.
Celiac disease is a result of an immune reaction to gluten, a protein found in wheat or related grains and present in many foods that we eat. Celiac disease causes impaired absorption and digestion of nutrients through the small intestine. Signs and symptoms of celiac disease include malabsorbption (diarrhea, foul smelling gas, bloating, and increased amounts of fat in the stool) and malnutrition (weight loss, edema, anemia, bruising easily, neuropathy, and infertility). Treatment for celiac disease is a gluten free diet, and at times if necessary, medications
E. coli is the most common cause of bladder infections. Bladder infection symptoms and signs include frequent urination, burning urination, and foul smelling urine. Mild bladder infections may go away by increasing one's intake of fluid. More severe infections may be treated with a few days of antibiotics.
Small intestinal bacterial overgrowth (SIBO) refers to a condition in which abnormally large numbers of bacteria (at least 100,000 bacteria per ml of fluid) are present in the small intestine and the types of bacteria in the small intestine resemble more the bacteria of the colon than the small intestine. There are many conditions associated with small intestinal bacterial overgrowth, to include: diabetes, scleroderma, Crohn's disease, and others. There is a striking similarity between the symptoms of irritable bowel syndrome and SIBO. It has been theorized that SIBO may be responsible for the symptoms of at least some patients with irritable bowel syndrome. Symptoms of SIBO include: excess gas, abdominal bloating, diarrhea, and abdominal pain.
Typhoid fever is an illness caused by the Salmonella typhi bacteria. The illness is contracted by ingesting the bacteria in contaminated water or food. Symptoms include headaches, fever, diarrhea, lethargy, aches and pains, and poor appetite. Treatment focuses on killing the Salmonella bacteria with antibiotics.
The most common food allergies are to eggs, nuts, milk, peanuts, fish, shellfish, strawberries and tomatoes. Symptoms and signs include nausea, vomiting, diarrhea, abdominal pain, itching, hives, eczema, asthma, lightheadedness, and anaphylaxis. Allergy skin tests, RAST, and ELISA tests may be used to diagnose a food allergy. Though dietary avoidance may be sufficient treatment for mild allergies, the use of an Epipen may be necessary for severe food allergies.
Potassium is an essential electrolyte necessary for cell function. Low potassium (hypokalemia) may be caused by diarrhea, vomiting, ileostomy, colon polyps, laxative use, diuretics, elevated corticosteroid levels, renal artery stenosis, and renal tubular acidosis, or other medications. Symptoms of low potassium include weakness, aches, and cramps of the muscles. Treatment is dependant upon the cause of the low potassium (hypokalemia).
Food poisoning is common, but can also be life threatening. The most common form of food poisoning is caused by bacteria and include symptoms such as fever, abdominal pain, diarrhea, nausea and vomiting.
Inflammation of the inner lining of the colon is referred to as colitis. Symptoms of the inflammation of the colon lining include diarrhea, pain, and blood in the stool. There are several causes of colitis including infection, ischemia of the colon, inflammatory bowel disease (Crohn's disease, Ulcerative colitis, or microscopic colitis). Treatment depends on the cause of the colitis.
Malaria is an infectious disease transmitted by the bite of an infected Anopheles mosquito. Symptoms of malaria include chills, pain, fever, and sweating. Though mild cases of malaria can be treated with oral medication, severe cases require intravenous drug treatment and fluids.
Hyponatremia is a condition where the level of sodium in the blood is low. Causes of hyponatremia can occur from excess fluid in the body, or a loss of sodium in body fluid. Some of the symptoms of hyponatremia include headache, muscle cramps or spasm, seizures, weakness and confusion. Treatment of hyponatremia depends on the cause.
Pinworm infection is an intestinal infection caused by a pinworm, seatworm, or threadworm. Female pinworms leave the intestine through the anus and deposit eggs on the skin around the anus while a person is asleep. Pinworm infection is the most common worm infection in the US. Symptoms include anal itching or vaginal itching. Pinworm infection is generally spread by inadequate handwashing from infected persons. Treatment is effective after a diagnosis is made with a pinworm test.
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