Secretory Diarrhoeas

Octreotide, a synthetic peptide which shares amino acid homology with somatostatin (see p. 710), inhibits the release of peptides that mediate certain alimentary secretions, and may be used to relieve diarrhoea due to carcinoid tumours and vipomas.

The pathogenesis of inflammatory bowel disease is still poorly understood. Immune mechanisms are probably involved, and potential antigens include intestinal bacteria and intestinal epithelium. Abnormalities in inflammatory mediators have also been described; it has been suggested that an imbalance between proinflammatory and antiinflammatory cytokines may determine susceptibility, although the abnormalities observed could simply be secondary to the disease process.

The main drugs used in the treatment of ulcerative colitis and Crohn's disease are the aminosalicylates and corticosteroids. Their mode of action is obscure. Other immunosuppressives also have a role and recent studies into the mechanisms of inflammation are leading to the introduction of novel therapies to inhibit the inflammatory process.

In acute exacerbations of inflammatory bowel disease a gastrointestinal infection should always be excluded by stool microscopy and culture, and testing for Clostridium difficile toxin. Measures to correct anaemia, fluid and electrolyte abnormalities and to improve the general nutritional state are also important. Antidiarrhoeals should be used with extreme caution in active colitis and are contra-indicated if the disease is severe. They can lead to toxic dilatation of the colon, with perforation.

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