title: Review: Management of postprandial diarrhea syndrome.
abstract: Unexpected, urgent, sometimes painful bowel movements after eating are common complaints among adults. Without a clear etiology, if pain is present and resolves with the movements, this is usually labeled "irritable bowel syndrome-diarrhea" based solely on symptoms. If this symptom-based approach is applied exclusively, it may lead physicians not to consider treatable conditions: celiac disease, or maldigestion due to bile acid malabsorption, pancreatic exocrine insufficiency, or an a-glucosidase (sucrase, glucoamylase, maltase, or isomaltase) deficiency. These conditions can be misdiagnosed as irritable bowel syndrome-diarrhea (or functional diarrhea, if pain is not present). Limited testing is currently available to confirm these conditions (antibody screens for celiac disease; fecal fat as a surrogate marker for pancreatic function). Therefore, empirical treatment with alpha amylase, pancreatic enzymes, or a bile acid-binding agent may simultaneously treat these patients and serve as a surrogate diagnostic test. This review will summarize the current evidence for bile acid malabsorption, and deficiencies of pancreatic enzymes or a-glucosidases as potential causes for postprandial diarrhea, and provide an algorithm for treatment options.
authors.affiliation: Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Money
authors.forename: Michael
authors.initials: M
authors.lastname: Camilleri
mesh_terms: D000328:Adult; D001647:Bile Acids and Salts / Q000378:metabolism; D003937:Diagnosis, Differential; D003967:Diarrhea / Q000209:etiology* / Q000628:therapy; D004063:Digestion; D004334:Drug Administration Schedule; D010188:Exocrine Pancreatic Insufficiency / Q000175:diagnosis* / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D005512:Food Hypersensitivity / Q000175:diagnosis; D005632:Fructose / Q000378:metabolism; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005959:Glucosidases / Q000037:antagonists & inhibitors* / Q000172:deficiency* / Q000378:metabolism; D006801:Humans; D007422:Intestines / Q000382:microbiology; D043183:Irritable Bowel Syndrome / Q000175:diagnosis / Q000188:drug therapy; D008286:Malabsorption Syndromes / Q000175:diagnosis; D008487:Medical History Taking; D020799:Pancrelipase / Q000008:administration & dosage / Q000627:therapeutic use*; D019518:Postprandial Period; D013577:Syndrome; D016896:Treatment Outcome; D000516:alpha-Amylases / Q000627:therapeutic use
chemical_list: D001647:Bile Acids and Salts; D005765:Gastrointestinal Agents; D005632:Fructose; D020799:Pancrelipase; D005959:Glucosidases; D000516:alpha-Amylases